Foot fracture risk rises with childhood BMI

By Lynda Williams, Senior medwireNews Reporter

Body mass index (BMI) is significantly associated with the risk for lower extremity fracture in children, US researchers report.

Their review of medical records for 913,178 children aged 2 to 19 years enrolled in the Kaiser Permanente Southern California (KPSC) Children's Health Study shows that the likelihood of foot fracture increased significantly with obesity. In all, 19.2% of children were obese, defined as having a BMI at the 95th percentile or above.

Compared with children with a normal BMI , overweight (BMI-for-age ≥ 85th percentile or BMI ≥25 kg/m²), moderately obese (BMI-for-age ≥ 95th percentile or BMI ≥30 kg/m²), and extremely obese (BMI-for-age ≥ 1.2×95th percentile or BMI ≥35 kg/m²) children were 1.14, 1.23, and 1.42 times more likely to sustain a fracture of the foot.

The risk for fractures of the ankle, knee, and leg were also increased, at odds ratios (ORs) of 1.27, 1.28, and 1.51, respectively.

By contrast, underweight children (BMI-for-age ≤ 5th percentile) were significantly less likely to experience lower extremity fractures than children with a normal weight.

Adjustment by age showed that the link between obesity and lower extremity fracture was strongest for children aged 6 to 11 years, with an OR of 2.23 for extremely obese versus healthy weight children. In comparison, the OR was just 1.11 for children aged 12 to 19 years.

There was no significant correlation between obesity and the risk for fractures of the femur or hip.

These results follow evidence that rising BMI is significantly associated with an increased risk for lower extremity sprains, strains, dislocations, and pain in children and adolescents, say Jeff Kessler (Kaiser Los Angeles Medical Center, California, USA) and co-workers.

They say their research therefore "emphasizes the need for uniform familial education on the deleterious musculoskeletal effects of obesity from early on to try to minimize the societal, financial, and medical burden imposed by this problem."

Kessler et al add in Clinical Orthopedics and Related Research that their study "highlights the need for a better understanding of bone density in children of all ages and sizes to understand how weight affects bone density in early, middle, and late childhood."

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