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Table 1 Summary of pediatric studies evaluating adiposity and bone mineral density and fractures

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