ESPE Abstracts

Introduction: Up to now, no systematic literature review has studied whether overweight or obesity compared to normal weight in childhood and adolescence is associated with an increased fracture risk (fractures overall and by site).

Methods: The systematic literature search was conducted in PubMed/Medline, Embase, Cochrane Library, BIOSIS databases using defined keywords and MeSH terms. 1,677 publications were identified (n=320 duplicates). 1,295 publications were excluded after screening the title/abstract and full text. 62 publications were included in the analysis.

Results: 7/10 studies showed an increased fracture risk in children and adolescents with obesity compared to children and adolescents with normal weight (range reported OR/RR: 1.1-4.4). In 8/12 studies, obesity was associated with a significantly increased risk of fractures compared to children and adolescents with normal weight (range reported OR/RR: 1.1-13.2). Children and adolescents with extreme obesity had a 1.4 to 1.5-fold increased risk of fractures compared to children and adolescents with normal weight (2/2 studies). In 5/16 studies, the percentage of children and adolescents with overweight and/or obesity was higher than the percentage of children and adolescents with normal weight in the group of children and adolescents who suffered a fracture. In n=7 studies, a trend for higher BMIz/fat mass was observed in children and adolescents with fractures compared to children without fractures. The remaining publications reported only the percentage of children and adolescents with obesity in the presence of a fracture, without the comparison with a control group. Another result of this systematic literature review was that we identified factors discussed in the literature as increasing the risk of fractures in children and adolescents with overweight and/or obesity. These factors include: lower physical activity, poorer balance, lower serum vitamin D concentrations, higher leptin and lower adiponectin concentrations in children and adolescents with overweight and/or obesity compared to children and adolescents with normal weight.

Conclusion: Compared to normal weight, overweight or obesity in childhood and adolescence is associated with a 2-fold increased fracture risk (fractures overall and by site). Treating physicians should be aware of this increased risk of fractures in children and adolescents with overweight or obesity and encourage an increase in physical activity in them and regularly determine parameters of bone metabolism such as serum vitamin D concentration.