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Fracture risk highest for children, adolescents with osteogenesis imperfecta
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Danish patients with osteogenesis imperfecta have an increased fracture rate throughout their lives vs. those without the disease, with the highest fracture rate observed during their first two decades of life, according to findings from a population-based, cohort study.
“We saw the highest rates of forearm, femur and lower leg and ankle fractures in the youngest age group,” Lars Folkestad, MD, of the department of endocrinology at Odense University Hospital in Kloevervaenget, Denmark, and colleagues wrote. “This indicates that children with [osteogenesis imperfecta] are likely to be more susceptible to long-bone fractures when they start to walk and become more active. We would speculate that the [discordance] in bone strength and growth could explain some of the increased fracture rates seen in patients with [osteogenesis imperfecta] during the first two decades of life.”
Folkestad and colleagues analyzed data from 644 adults with osteogenesis imperfecta identified through the Danish National Patient Register (55.6% women). Each patient was matched with matched by sex and age to five adults randomly selected from the Civil Registry System (n = 3,361; 55.2% women). Researchers extracted bone fracture data from the NPR between 1995 and 2012, including date of fracture and fracture site. To limit possible bias stemming from the higher frequency of complications and reoperations following a fracture in the osteogenesis imperfecta group, researchers introduced a 180-day wash-out period for each fracture recorded.
Over a mean 17.9 years’ observation, 416 patients with osteogenesis imperfecta experienced 1,566 fractures; median number of fractures was 1 per patient, amounting to 0.15 fractures per person-year. In the reference population, 709 participants experienced a total of 1,018 fractures. Compared with the reference population, the fracture rate ratio for patients aged 0 to 19 years was 10.7; 17.2 for patients aged 20 to 54 years, and 4.1 for patients aged at least 55 years. Boys and young men under age 19 years exhibited the highest fracture rate at 257 fractures per 1,000 person-years. Among adults aged at least 55 years, women with osteogenesis imperfecta had higher fracture rates vs. the reference group (fracture RR = 8; 95% CI, 5.6-11.3), as did men with osteogenesis imperfecta (fracture RR = 4.9; 95% CI, 3.2-7.7). The most frequent fracture sites in the osteogenesis imperfecta cohort were at the forearm, femur, lower leg and ankle.
“Though the relative risk declines with age, fractures as a whole appear to follow the same pattern in terms as of absolute rates as that of the general population, with a peak fracture rate during the toddler and adolescent years, fewer fractures during adulthood and increased fracture rates in older women,” the researchers wrote. –by Regina Schaffer
Disclosure: Folkestad reports receiving speaking fees from Astra Zeneca and Genzyme. Please see the full study for the other authors’ relevant financial disclosures.
08/29/2016
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