Clinical Orthopaedics and Related Research®

, Volume 471, Issue 4, pp 1199–1207 | Cite as

Childhood Obesity Is Associated With Increased Risk of Most Lower Extremity Fractures

  • Jeff Kessler
  • Corinna Koebnick
  • Ning Smith
  • Annette Adams
Symposium: Childhood Obesity and Musculoskeletal Problems



A number of studies have found an increased risk of lower extremity injuries in obese patients. Most studies, however, are unable to provide stable population-based estimates based on the degree of obesity and few assess the risk pertaining to more detailed fracture location in the lower extremities.


We therefore investigated the relationship between obesity and lower extremity fractures in different age and fracture locations in a stable population.


This is a population-based, cross-sectional study from the electronic medical records of 913,178 patients aged 2 to 19 years. The body mass index (BMI) for each patient in the cohort was used to stratify patients into five weight classes (underweight, normal weight, overweight, moderate obesity, and extreme obesity) based on BMI for age. Records were assessed for the occurrence of lower extremity fractures for each cohort member. The associations among the five weight classes and specific lower extremity fractures were estimated using multiple logistic regression models and expressed with odds ratios (ORs) and 95% confidence intervals (CIs) using multivariate analysis to adjust for patient demographic variables.


Overweight, moderately obese, and extremely obese patients all had an increased OR of fractures of the foot (OR, 1.14, 1.23, and 1.42, respectively, with 95% CI, 1.04–1.24, 1.12–1.35, and 1.26–1.61, respectively) along with the ankle, knee, and leg (OR, 1.27, 1.28, and 1.51, respectively, with 95% CI, 1.16–1.39, 1.15–1.42, and 1.33–1.72, respectively). The association was strongest in the 6- to 11-year-old age group. We found no association between increasing BMI and increased risk of fractures of the femur and hip.


Increasing BMI is associated with increased odds of foot, ankle, leg, and knee fractures in children.

Level of Evidence

Level III, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.


Obese Patient Fracture Risk Obese Child Increase Fracture Risk Weight Class 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



We thank Hooman Nikizad for preparation of references and Gez Bowman for help with table preparation.


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Copyright information

© The Association of Bone and Joint Surgeons® 2012

Authors and Affiliations

  • Jeff Kessler
    • 1
    • 2
  • Corinna Koebnick
    • 1
    • 2
  • Ning Smith
    • 1
    • 2
  • Annette Adams
    • 1
    • 2
  1. 1.Kaiser Los Angeles Medical CenterLos AngelesUSA
  2. 2.Department of Research and EvaluationKaiser Permanente Southern CaliforniaPasadenaUSA

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