From: The role of PPARγ in childhood obesity-induced fractures
Study | Study design | Population | Age (years) | Gender | Geographical location | Obesity assessment | Bone/fracture assessment | Results |
---|---|---|---|---|---|---|---|---|
Goulding et al. [28] | Case-control | 206 (3 with distal forearm fracture) | 3–15 | Female | Dunedin, New Zealand | BMI Total fat mass | DXA: radius DXA: lumbar DXA: whole body Past medical records | Girls with forearm fractures have lower BMD and higher adiposity than non-fracture controls |
Goulding et al. [29] | Cohort study | 200 (100 forearm fracture) | 10 ± 2.9 | Female | Dunedin, New Zealand | BMI | DXA: radius DXA: lumbar DXA: whole body Past medical records | Girls with higher BMI and lower bone density were at greater risk for fracture |
Goulding et al. [30] | Case-control | 200 (100 forearm fracture) | 3–19 | Male | Dunedin, New Zealand | BMI Total fat mass | DXA: radius DXA: hip DXA: lumbar DXA: whole body Past medical records | Boys with forearm fracture were more overweight and had lower radial BMD |
Skaggs et al. [31] | Case-control | 100 (50 with forearm fracture | 4–15 | Female | Los Angeles, California, USA | BMI | CT: radius Past fracture history | Girls with forearm fractures had a smaller radius and higher weight compared to non-fracture controls |
Davidson et al. [32] | Case-control | 50 (25 obese) | 4–17 | Male | Dunedin, New Zealand | BMI | DXA: radius DXA: whole body | Obese children were at greater risk of forearm fracture |
Goulding et al. [33] | Cross-sectional | 90 children with forearm fracture | 5–19 | Male and female | Dunedin, New Zealand | BMI | DXA: lumbar DXA: hip DXA: forearm DXA: whole body Past fracture history | Children with repeated forearm fractures had lower radial BMD and higher BMI |
Taylor et al. [34] | Retrospective cross-sectional | 355 (227 overweight) | 12.2 ± 2.8 | Male and female | Washington, DC, USA | BMI | DXA: lower extremities Past fracture history | Overweight children had a greater prevalence of fracture |
Janicka et al. [35] | Cross-sectional | 300 healthy cases | 13–21 | Male and female | Los Angles, California, USA | BMI | CT: femur CT: lumbar DXA: lumbar | Total body fat mass was not associated with BMD or cortical bone structure in males. Females had a negative association between DXA leg BMD and fat mass |
Pollack et al. [36] | Cross-sectional | 115 | 18.2 ± 0.4 | Male and female | Athens, Georgia, USA | BMI | DXA: whole body pQCT: radius pQCT: tibia | Body fat percentage was inversely correlated with cortical bone size and strength indices |
Wetzsteon et al. [37] | Longitudinal | 445 (143 obese) | 9–11 | Male and female | British Columbia, Canada | BMI | DXA: whole body pQCT: tibia | In overweight children, bone strength adapted to greater lean mass but did not respond to excess fat mass |
Dimitri et al. [38] | Cross-sectional | 103 children (52 obese) | 11.7 ± 2.8 | Male and female | Sheffield, UK | BMI Total fat mass | DXA: lumbar DXA: radius DXA: whole body Past fracture history | Obese children with prior fracture had reduced BMD |
Gilsanz et al. [39] | Cross-sectional | 100 healthy adolescents and young adults | 15–25 | Female | Los Angeles, California, USA | BMI Waist circumference | CT: waist CT: femur | High levels of visceral fat were associated with decreased femoral cortical and cross-sectional area. Subcutaneous fat had beneficial effects in these measurements. |
Farr et al. [40] | Cross-sectional | 198 healthy children | 8–15 | Male and female | Minnesota, USA | Total body fat mass | DXA: whole body HRpQCT: radius HRpQCT: tibia | Total body fat mass affected the distal tibial failure and no effect on radius. |
Sayers et al. [41] | Longitudinal cohort | 3914 | Avg.: 13.8 | Male and female | Southwest England | Total body fat and lean mass | DXA: total hip DXA: femoral neck | In females there was a positive relationship between adiposity and femoral neck buckling |
Russell et al. [42] | Cross-sectional | 30 (15 obese, 15 normal weight) | 12–18 | Female | Boston, Massachusetts, USA | BMI | MRI: lumbar DXA: lumbar DXA: hip DXA: whole body | Visceral adipose levels inversely correlated with vertebral bone density in females |
Wey et al. [43] | Cross-sectional and longitudinal | 370 | 8–18 | Male and female | South Dakota, USA | DXA: whole body pQCT: radius | Higher fat mass was associated with reduced bone size. Longitudinal gain of fat negatively impacted cortical area. | |
Kessler et al. [19] | Cross-sectional | 913,718 | 2–19 | Male and female | California, USA | BMI | Past fracture history | Higher BMI was associated with increased risk of lower extremity fractures |
Fornari et al. [44] | Retrospective cross-sectional | 922 fracture cases | 5.0 ± 2.5 | Male and female | California, USA | BMI | Past fracture history | Children with obesity were at a greater risk of and severity for lateral condyle factures. |
Laddu et al. [45] | Longitudinal | 260 healthy children | 8–13 | Female | Arizona, USA | BMI | DXA: whole body pQCT: femur pQCT: tibia | At baseline, visceral fat mass was a positive predictor of bone strength. Longitudinally, central fat mass may hinder cortical bone strength. |
Sabhaney et al. [20] | Cross-sectional | 2213 (1078 had fracture, 316 obese) | 9.5 ± 4.2 | Male and female | British Columbia and Ontario, Canada | BMI | Past fracture history | Obese children had a minor decreased odds of fracture relative to normal weight children |
Kwan et al. [17] | Retrospective cross-sectional | 1340 patients with extremity factures | 2–17 | Male and female | Toronto, Ontario, Canada | Weight-for-age > 95th percentage | Past fracture history | Obese children were not at an increased risk of sustaining more severe extremity fractures or subsequent complications then non-obese children. |
Gilbert et al. [46] | Retrospective chart review | 331 femur and tibia factures | 2–14 | Male and female | Alabama and Tennessee, USA | BMI | Past fracture history | Obese patients were twice as likely to have fractures involving the physis. |
Moon et al. [21] | Cross-sectional | 401 acute upper limb fracture | 3–18 | Male and female | Southhampton, UK | BMI SFT: triceps SFT: subscapular | Upper limb fractures in the previous 60 days | Overweight and obese prevalence was higher in children with forearm and upper arm fractures. More pronounced in boys upper limb fractures |
Manning et al. [47] | Retrospective case-control | 929 forearm fractures | 0–17 years | Male and female | Washington, DC, USA | Weight-for-age/sex > 95th percentage | Past radial bone fractures | Children with weight greater than the 95th percentile of age/sex had higher odds of ground-level fractures. |
Khadilkar et al. [48] | Cross-sectional | 245 | 6–17 | Male and female | Pune, India | BMI | DXA: whole body | Total BMC, BMC, and bone area are lower in increasing BMI |