Skip to main content

Advertisement

SpringerLink
Log in

Does Obesity Affect Fracture Healing in Children?

  • Symposium: Childhood Obesity and Musculoskeletal Problems
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Obesity is a risk factor for various orthopaedic diseases, including fractures. Obesity’s influence on circulating hormones and cytokines and bone mineralization ultimately influences the body’s osteogenic response and bone mineralization, potentially increasing the risk of fracture and impacting fracture healing.

Questions/purposes

Does obesity delay fracture recovery in overweight or obese children as measured by the time to release to normal activity? Is this average time for return to activity influenced by the mechanism of the injury? Does obesity’s effect on mineralization and loading in overweight or obese children lead to a greater proportion of upper extremity fracture versus lower extremity fracture?

Methods

We prospectively followed 273 patients with nonpathologic long bone fractures treated from January 2010 to October 2011. Patients were stratified into obese/overweight, normal weight, and underweight groups. All patients were followed until release to regular activities (mean, 41 days; range, 13–100 days).

Results

Release to regular activities occurred sooner in obese/overweight than in normal weight patients: 39 and 42 days, respectively. A greater proportion of obese/overweight patients had low to moderate energy mechanisms of injury than did normal weight patients, but we found no difference between the groups in terms of return to activity when stratified by mechanism. There was also no difference in the proportion of upper extremity injuries between the two groups.

Conclusions

Obese/overweight children did not have a delay in release to activities compared with children of normal weight.

Level of Evidence

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

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Baldock PA, Sainsbury A, Allison S, Lin EJ, Couzens M, Boey D, Enriquez R, During M, Herzog H, Gardiner EM. Hypothalamic control of bone formation: distinct actions of leptin and y2 receptor pathways. J Bone Miner Res. 2005;20:1851–1857.

    Article  PubMed  CAS  Google Scholar 

  2. Bartell SM, Rayalam S, Ambati S, Gaddam DR, Hartzell DL, Hamrick M, She JX, Della-Fera MA, Baile CA. Central (ICV) leptin injection increases bone formation, bone mineral density, muscle mass, serum IGF-1, and the expression of osteogenic genes in leptin-deficient ob/ob mice. J Bone Miner Res. 2011;26:1710–1720.

    Article  PubMed  CAS  Google Scholar 

  3. Bennett BD, Solar GP, Yuan JQ, Mathias J, Thomas GR, Matthews W. A role for leptin and its cognate receptor in hematopoiesis. Curr Biol. 1996;6:1170–1180.

    Article  PubMed  CAS  Google Scholar 

  4. Cao JJ. Effects of obesity on bone metabolism. J Orthop Surg Res. 2011;6:30.

    Article  PubMed  Google Scholar 

  5. Centers for Disease Control and Prevention. Obesity rates among all children in the United States. Available at: http://www.cdc.gov/obesity/childhood/data.html. Accessed March 6, 2012.

  6. Centers for Disease Control and Prevention. Obesity among low-income preschool children. Available at: http://www.cdc.gov/obesity/downloads/PedNSSFactSheet.pdf. Accessed March 6, 2012.

  7. Centers for Disease Control and Prevention. Basics about childhood obesity. Available at: http://www.cdc.gov/obesity/childhood/basics.html. Accessed March 12, 2012.

  8. Cornish J, Callon KE, Bava U, Lin C, Naot D, Hill BL, Grey AB, Broom N, Myers DE, Nicholson GC, Reid IR. Leptin directly regulates bone cell function in vitro and reduces bone fragility in vivo. J Endocrinol. 2002;175:405–415.

    Article  PubMed  CAS  Google Scholar 

  9. Davids JR, Huskamp M, Bagley AM. A dynamic biomechanical analysis of the etiology of adolescent tibia vara. J Pediatr Orthop. 1996;16:461–468.

    Article  PubMed  CAS  Google Scholar 

  10. Davidson PL, Goulding A, Chalmers DJ. Biomechanical analysis of arm fracture in obese boys. J Paediatr Child Health. 2003;39:657–664.

    Article  PubMed  CAS  Google Scholar 

  11. De Laet C, Kanis JA, Oden A, Johanson H, Johnell O, Delmas P, Eisman JA, Kroger H, Fujiwara S, Garnero P, McCloskey EV, Mellstrom D, Melton LJ 3rd, Meunier PJ, Pols HA, Reeve J, Silman A, Tenenhouse A. Body mass index as a predictor of fracture risk: a meta-analysis. Osteoporos Int. 2005;16:1330–1338.

    Article  PubMed  Google Scholar 

  12. De Schepper J, Van den Broeck M, Jonckheer MH. Study of lumbar spine bone mineral density in obese children. Acta Paediatr. 1995;84:313–315.

    Article  PubMed  Google Scholar 

  13. Dimitri P, Bishop N, Walsh JS, Eastell R. Obesity is a risk factor for fracture in children but is protective against fracture in adults: a paradox. Bone. 2012;50:457–466.

    Article  PubMed  CAS  Google Scholar 

  14. Ducy P, Amling M, Takeda S, Priemel M, Schilling AF, Beil FT, Shen J, Vinson C, Rueger JM, Karsenty G. Leptin inhibits bone formation through a hypothalamic relay: a central control of bone mass. Cell. 2000;100:197–207.

    Article  PubMed  CAS  Google Scholar 

  15. Ealey KN, Fonseca D, Archer MC, Ward WE. Bone abnormalities in adolescent leptin-deficient mice. Regul Pept. 2006;136:9–13.

    Article  PubMed  CAS  Google Scholar 

  16. Fischer S, Milinarsky A, Giadrosich V, Dib G, Arriagada M, Arinoviche R. X-ray absorptiometry of bone in obese and eutrophic children from Valparaiso, Chile. J Rheumatol. 2000;27:1294–1296.

    CAS  Google Scholar 

  17. Friedl G, Windhager R, Schmidt H, Aigner R. The osteogenic response of undifferentiated human mesenchymal stem cells (hMSCs) to mechanical strain is inversely related to body mass index of the donor. Acta Orthop. 2009;80:491–498.

    Article  PubMed  Google Scholar 

  18. Gettys FK, Jackson JB, Frick SL. Obesity in pediatric orthopaedics. Orthop Clin North Am. 2011;42:95–105.

    Article  PubMed  Google Scholar 

  19. Gordeladze JO, Drevon CA, Syversen U, Reseland JE. Leptin stimulates human osteoblastic cell proliferation, de novo collagen synthesis, and mineralization: impact on differentiation markers, apoptosis, and osteoclastic signaling. J Cell Biochem. 2002;85:825–836.

    Article  PubMed  CAS  Google Scholar 

  20. Goulding A, Jones IE, Taylor RW, Piggot JM, Taylor D. Dynamic and static tests of balance and postural sway in boys: effects of previous wrist bone fractures and high adiposity. Gait Posture. 2003;17:136–141.

    Article  PubMed  CAS  Google Scholar 

  21. Goulding A, Taylor RW, Jones IE, Manning PJ, Williams SM. Spinal overload: a concern for obese children and adolescents? Osteoporos Int. 2002;13:835–840.

    Article  PubMed  CAS  Google Scholar 

  22. Goulding A, Taylor RW, Jones IE, McAuley KA, Manning PJ, Williams SM. Overweight and obese children have low bone mass and area for their weight. Int J Obes Relat Metab Disord. 2000;24:627–632.

    Article  PubMed  CAS  Google Scholar 

  23. Hamrick MW, Della-Fera MA, Choi YH, Pennington C, Hartzell D, Baile CA. Leptin treatment induces loss of bone marrow adipocytes and increases bone formation in leptin-deficient ob/ob mice. J Bone Miner Res. 2005;20:994–1001.

    Article  PubMed  CAS  Google Scholar 

  24. Hasanoglu A, Bideci A, Cinaz P, Tumer L, Unal S. Bone mineral density in childhood obesity. J Pediatr Endocrinol Metab. 2000;13:307–311.

    Article  PubMed  CAS  Google Scholar 

  25. Holloway WR, Collier FM, Aitken CJ, Myers DE, Hodge JM, Malakellis M, Gough TJ, Collier GR, Nicholson GC. Leptin inhibits osteoclast generation. J Bone Miner Res. 2002;17:200–209.

    Article  PubMed  CAS  Google Scholar 

  26. Hosokawa T. [Altered bone metabolism in db/db mice] [in Japanese]. Nihon Ronen Igakkai Zasshi. 1992;29:540–548.

    Article  PubMed  CAS  Google Scholar 

  27. Kelsey JL, Acheson RM, Keggi KJ. The body build of patients with slipped capital femoral epiphysis. Am J Dis Child. 1972;124:276–281.

    PubMed  CAS  Google Scholar 

  28. Leonard MB, Shults J, Wilson BA, Tershakovec AM, Zemel BS. Obesity during childhood and adolescence augments bone mass and bone dimensions. Am J Clin Nutr. 2004;80:514–523.

    PubMed  CAS  Google Scholar 

  29. Lorentzon R, Alehagen U, Boquist L. Osteopenia in mice with genetic diabetes. Diabetes Res Clin Pract. 1986;2:157–163.

    Article  PubMed  CAS  Google Scholar 

  30. Maffei M, Fei H, Lee GH, Dani C, Leroy P, Zhang Y, Proenca R, Negrel R, Ailhaud G, Friedman JM. Increased expression in adipocytes of ob RNA in mice with lesions of the hypothalamus and with mutations at the db locus. Proc Natl Acad Sci USA. 1995;92:6957–6960.

    Article  PubMed  CAS  Google Scholar 

  31. Maffei M, Halaas J, Ravussin E, Pratley RE, Lee GH, Zhang Y, Fei H, Kim S, Lallone R, Ranganathan S, Kern PA, Friedman JM. Leptin levels in human and rodent: measurement of plasma leptin and ob RNA in obese and weight-reduced subjects. Nat Med. 1995;1:1155–1161.

    Article  PubMed  CAS  Google Scholar 

  32. Manzoni P, Brambilla P, Pietrobelli A, Beccaria L, Bianchessi A, Mora S, Chiumello G. Influence of body composition on bone mineral content in children and adolescents. Am J Clin Nutr. 1996;64:603–607.

    PubMed  CAS  Google Scholar 

  33. Matsunuma A, Kawane T, Maeda T, Hamada S, Horiuchi N. Leptin corrects increased gene expression of renal 25-hydroxyvitamin D3-1 alpha-hydroxylase and -24-hydroxylase in leptin-deficient, ob/ob mice. Endocrinology. 2004;145:1367–1375.

    Article  PubMed  CAS  Google Scholar 

  34. Pollack KM, Xie D, Arbogast KB, Durbin DR. Body mass index and injury risk among US children 9-15 years old in motor vehicle crashes. Inj Prev. 2008;14:366–371.

    Article  PubMed  CAS  Google Scholar 

  35. Rana AR, Michalsky MP, Teich S, Groner JI, Caniano DA, Schuster DP. Childhood obesity: a risk factor for injuries observed at a level-1 trauma center. J Pediatr Surg. 2009;44:1601–1605.

    Article  PubMed  Google Scholar 

  36. Schott AM, Cormier C, Hans D, Favier F, Hausherr E, Dargent-Molina P, Delmas PD, Ribot C, Sebert JL, Breart G, Meunier PJ. How hip and whole-body bone mineral density predict hip fracture in elderly women: the EPIDOS Prospective Study. Osteoporos Int. 1998;8:247–254.

    Article  PubMed  CAS  Google Scholar 

  37. Skaggs DL, Loro ML, Pitukcheewanont P, Tolo V, Gilsanz V. Increased body weight and decreased radial cross-sectional dimensions in girls with forearm fractures. J Bone Miner Res. 2001;16:1337–1342.

    Article  PubMed  CAS  Google Scholar 

  38. Taylor ED, Theim KR, Mirch MC, Ghorbani S, Tanofsky-Kraff M, Adler-Wailes DC, Brady S, Reynolds JC, Calis KA, Yanovski JA. Orthopedic complications of overweight in children and adolescents. Pediatrics. 2006;117:2167–2174.

    Article  PubMed  Google Scholar 

  39. Thomas T, Gori F, Khosla S, Jensen MD, Burguera B, Riggs BL. Leptin acts on human marrow stromal cells to enhance differentiation to osteoblasts and to inhibit differentiation to adipocytes. Endocrinology. 1999;140:1630–1638.

    Article  PubMed  CAS  Google Scholar 

  40. Williams GA, Callon KE, Watson M, Costa JL, Ding Y, Dickinson M, Wang Y, Naot D, Reid IR, Cornish J. Skeletal phenotype of the leptin receptor-deficient db/db mouse. J Bone Miner Res. 2011;26:1698–1709.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

We thank Elaine Henze and Cheryl Quimba for their editorial expertise in preparing the manuscript.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA

    Rushyuan J. Lee MD, Nigel N. Hsu MD & Colleen M. Lenz CRNP

  2. Shriners Hospital for Children®-Honolulu, 1310 Punahou Street, Honolulu, HI, 96826-1099, USA

    Arabella I. Leet MD

Authors
  1. Rushyuan J. Lee MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nigel N. Hsu MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Colleen M. Lenz CRNP
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Arabella I. Leet MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Arabella I. Leet MD.

Additional information

Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution has approved or waived approval for the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

About this article

Cite this article

Lee, R.J., Hsu, N.N., Lenz, C.M. et al. Does Obesity Affect Fracture Healing in Children?. Clin Orthop Relat Res 471, 1208–1213 (2013). https://doi.org/10.1007/s11999-012-2626-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11999-012-2626-7

Keywords

Search

Navigation