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Fractures in spina bifida from childhood to young adulthood

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Abstract

Summary

This study assessed the prevalence and types of fractures in spina bifida and examined risk factors for fracture. Fracture prevalence was highest in childhood and reduced in adolescence and young adulthood. The importance of maintaining mobility is highlighted by the increased risk of fracture in those who are non-ambulatory.

Introduction

The aims of this study are to study the prevalence and types of fractures according to age group in spina bifida and examine risk factors associated with fracture.

Methods

This is a retrospective cohort study of 146 individuals with spina bifida aged 2 years or older who attended the paediatric or adult spina bifida multidisciplinary clinic at a single tertiary hospital.

Results

Median age at which first fracture occurred was 7 years (interquartile range 4–13 years). Fracture rates in children (ages 2–10), adolescents (ages 11–18) and adults (age > 18) were 10.9/1000 (95 % confidence interval 5.9–18.3), 5.4/1000 (95 % CI 1.5–13.8) and 2.9/1000 (95 % CI 0.6–8.1) patient years respectively. Childhood fractures predominantly involved the distal femur and femoral shaft; these fractures were rarely seen in adulthood. Non-ambulatory status was associated with a 9.8 times higher risk of fracture compared with ambulatory patients (odds ratio 9.8, p = 0.016, 95 % CI 1.5–63.0). Relative risk of re-fracture was 3.1 (95 % CI 1.4–6.8). Urological intervention with intestinal segments was associated with renal calculi (p = 0.037) but neither was associated with fracture.

Conclusions

The risk of fracture is lower in adults compared with children with spina bifida. The predominant childhood fracture affects the distal femur, and immobility is the most significant risk factor for fracture. Clinical factors contributing to fracture risk need to be elucidated to enable selection of patients who require investigation and treatment of osteoporosis.

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Acknowledgments

We thank Sue Panckridge for preparation of the figure.

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Authors and Affiliations

  1. Department of Endocrinology, Monash Health, 246 Clayton Rd, Clayton, Victoria, 3168, Australia

    A. Trinh, P. Wong, P. R. Ebeling, P. J. Fuller & F. Milat

  2. Hudson Institute of Medical Research, Clayton, Melbourne, Australia

    A. Trinh, P. Wong, P. J. Fuller & F. Milat

  3. Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Australia

    A. Trinh, J. Brown, P. R. Ebeling, P. J. Fuller & F. Milat

  4. Department of Paediatrics, Monash Health, Melbourne, Australia

    J. Brown

  5. Developmental Paediatrics, Monash Children’s, Monash Health, Melbourne, Australia

    S. Hennel

  6. Victorian Paediatric Rehabilitation Service, Monash Children’s, Monash Health, Melbourne, Australia

    S. Hennel

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  1. A. Trinh
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Corresponding author

Correspondence to A. Trinh.

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Grants

AT is supported by a Royal Australasian College of Physicians/Osteoporosis Australia Research Grant. PW and FM is supported by an Osteoporosis Australia/Australia and New Zealand Bone and Mineral Society Clinical Grant. PJF is supported by a National Health and Medical Research Council of Australia, Senior Principal Research Fellowship (#1,002,559). Hudson Institute is supported by the Victorian Government’s Operational Infrastructure Support program.

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Trinh, A., Wong, P., Brown, J. et al. Fractures in spina bifida from childhood to young adulthood. Osteoporos Int 28, 399–406 (2017). https://doi.org/10.1007/s00198-016-3742-0

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  • DOI: https://doi.org/10.1007/s00198-016-3742-0

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