ESPE Abstracts

Objectives: The results from several European studies done during the last 25 years show that fractures are common in childhood with the highest incidence in pubertal years. Fractures are more prevalent among males, and the distal arm is the most common location. The role of the body weight as a risk factor for fractures in childhood is still unclear and under debate.

Methods: А survey about fracture history and the presence of concomitant skeletal or chronic illnesses have been conducted at 14 high schools in the city of Varna, Bulgaria, among students 16-19 years of age. The survey was completed correctly by 2513 students (1291 girls, 1106 boys, 116 without sex assignment) - 415 filled in electronically (Google forms) and 2098 on paper. All forms were filled in by a parent or by a parent and the student together.

Results: A total of 612 students (24% of all, 57% males) had fractured during childhood - 257 females (20% of females) and 337 males (30% of males), with a total incidence of 13.1/1000/years. Reported 195 males (58%) with 1 fracture, 86 (26%) - 2 fractures and 56 (16%) - 3 or more fractures. More than half of the fractures among males (57%) happened between 12–16 years of age. Among females, 179 (69%) had 1 fracture, 51 (20%) - 2 fractures and 27 (11%) - 3 or more fractures; 50% of all fractures among females between 10-14 years of age. The most common fracture site is the upper limb (72% in boys, 65% in girls), lower limb (20% boys, 27% girls), 8% in both sexes with other locations (clavicula, ribs, skull, etc). Girls with overweight/obesity are 9% in those without fractures, 10% in those with 1 fracture, 15% in those with 2 or more fractures and 21% in those with 4 or more fractures. Boys without fractures are overweight/obese in 16% and those with 3 or more fractures in 22%. Those with fractures (8% boys,17% girls) had other musculoskeletal complaints/problems – most often knees (33%, 30%), scoliosis (21%, 16%), lower back pain (14%, 18%). The same complaints with similar distribution are reported by 7% of the boys and 13% of the girls without fractures.

Conclusions: We present the first Bulgarian study on the epidemiology of childhood fractures. The results are comparable to those published earlier from other countries. More data is needed to reveal the role of adipose tissue on bone metabolism and bone strength.