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Risk factors for upper limb fractures in children

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Ma, D 2004 , 'Risk factors for upper limb fractures in children', PhD thesis, University of Tasmania.

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Abstract

Fractures in younger life are very common especially those involving the upper limb. However, the causes of these fractures are poorly understood. The aim of this population based case-control study was to evaluate the association of both bone dependent and independent factors with upper limb fracture risk in children 9-16 years of age. Areal (aBMD) and apparent (BMAD) bone mineral density were measured by dual energy Xray absorptiometry (DXA). Skeletal age (SA) and metacarpal index (MI) was determined by hand radiograph. Types and patterns of physical activity, risk taking and diet were assessed by interview-administered questionnaires. Coordination was measured using the 8-point movement ABC. A total of 321 fracture cases and 321 randomly selected ageand gender- matched controls were recruited. Fracture sites were as follow: hand: n=91, wrist and forearm: n=190, upper arm: n=40. Conditional logistic regression analysis showed wrist and forearm fracture risk was significantly associated with lumbar spine BMAD (OR: 1.52/SD reduction, 95% CI 1.18-1.96), MI (OR: 1.43/SD reduction, 95% CI 1.14-2.20), light physical activity (OR: 0.81/unit, 95% CI 0.65-1.00), cola consumption (OR: 1.43/category, 95% CI 1.08-1.88) but conclusions may be limited by sample size considerations. Obesity or overweight was not associated with any fracture type. For total fractures, there was a gender discordant effect of sports participation with an increased fracture risk in boys and decreased fracture risk in girls which reached statistical significance for total, contact, non-contact and high-risk sports participation as well as four individual sports (soccer, cricket, surfing and swimming). In conclusion, both bone dependent and independent factors are important determinants of upper limb fracture risk in children. There is heterogeneity of cause for both gender and different fracture sites that will necessitate different approaches to prevention.

Item Type: Thesis - PhD
Authors/Creators:Ma, D
Keywords: Fractures in children
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Copyright 2004 the author - The University is continuing to endeavour to trace the copyright owner(s) and in the meantime this item has been reproduced here in good faith. We would be pleased to hear from the copyright owner(s).

Additional Information:

Chapter 4 appears to be, in part, the equivalent of the pre-peer reviewed version of the following article: Ma, D., Jones, G., 2002. Clinical risk factors but not bone density are associated with prevalent fractures in prepubertal children, Journal of paediatrics and child health, 38(5), 497-500, which has been published in final form at https://doi.org/10.1046/j.1440-1754.2002.00037.x This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions

Chapter 7 appears to be, in part, the equivalent of the pre-peer reviewed version of the following article: Ma, D., Jones, G., 2003. Television, computer, and video viewing; physical activity; and upper limb fracture risk in children: a population‐based case control study, Journal of bone and mineral research, 18(11), 1970-1977, which has been published in final form at https://doi.org/10.1359/jbmr.2003.18.11.1970 This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions

Chapter 8 appears to be, in part, the equivalent of a pre-print version of an article published as: Ma, D., Morley, R., Jones, G., 2004. Risk-taking, coordination and upper limb fractures in children: a population based case-control study, Osteoporosis international, 8, 633-638

Chapter 9 appears to be, in part, the equivalent of a pre-print version of an article published as: Ma, D., Jones, G., 2004. Soft drink and milk consumption, physical activity, bone mass, and upper limb fractures in children: a population-based case-control study, Calcified tissue international, 75(4), 286-291

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