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Epidemiology of fractures in children with cerebral palsy : a Swedish population-based registry study

Linton, Gustaf ; Hägglund, Gunnar LU ; Czuba, Tomasz LU and Alriksson-Schmidt, Ann I LU (2022) In BMC Musculoskeletal Disorders 23. p.1-10
Abstract

BACKGROUND: Children with cerebral palsy (CP) form a heterogeneous group and may have risk or protective factors for fractures compared with typically developing children. The fracture sites may also differ from those of children who do not have CP. We analyzed the fracture epidemiology in a total population of children with CP.

METHODS: This was a retrospective registry study based on data from the Swedish Cerebral Palsy Follow-Up Program (CPUP) and the Swedish National Patient Register. All children in the CPUP born in 2000-2015 were included. The Gross Motor Function Classification System (GMFCS) level, reported fractures, fracture site, and epilepsy diagnosis were recorded up to 2018. Hazards and hazard ratios were calculated... (More)

BACKGROUND: Children with cerebral palsy (CP) form a heterogeneous group and may have risk or protective factors for fractures compared with typically developing children. The fracture sites may also differ from those of children who do not have CP. We analyzed the fracture epidemiology in a total population of children with CP.

METHODS: This was a retrospective registry study based on data from the Swedish Cerebral Palsy Follow-Up Program (CPUP) and the Swedish National Patient Register. All children in the CPUP born in 2000-2015 were included. The Gross Motor Function Classification System (GMFCS) level, reported fractures, fracture site, and epilepsy diagnosis were recorded up to 2018. Hazards and hazard ratios were calculated for first-time fractures.

RESULTS: Of the 3,902 participants, 368 (9.4%) had at least one reported fracture. The cumulative risk of sustaining a fracture before age 16 years was 38.3% (95% confidence interval 33.9-42.4). The hazard for fracture was 7 times higher in children with epilepsy. The overall fracture incidence was not statistically significantly related to sex or GMFCS level. Fractures in the upper extremities were most prevalent in children with a lower GMFCS level, and femoral fractures were most prevalent in children at GMFCS level V. Most fractures occurred in early childhood and after 8 years of age.

CONCLUSIONS: Children with CP were at similar risk of sustaining fractures as typically developing children, but the risk was higher in children with comorbid epilepsy. Fractures occurred in children at GMFCS levels I-III at sites similar to those for typically developing children; fractures in the upper extremities were the most frequent. Children at GMFCS levels IV or V and those with epilepsy were more likely to have a fracture in the lower extremities, and the femur was the most frequent site.

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author
; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Adolescent, Adult, Cerebral Palsy/diagnosis, Child, Child, Preschool, Epilepsy/complications, Fractures, Bone/epidemiology, Humans, Registries, Retrospective Studies, Sweden/epidemiology, Young Adult
in
BMC Musculoskeletal Disorders
volume
23
article number
862
pages
1 - 10
publisher
BioMed Central (BMC)
external identifiers
  • pmid:36104768
  • scopus:85137917851
ISSN
1471-2474
DOI
10.1186/s12891-022-05813-9
language
English
LU publication?
yes
additional info
© 2022. The Author(s).
id
819e8451-9f27-477a-8670-eec8ae131c6a
date added to LUP
2022-09-21 20:36:50
date last changed
2024-06-26 12:30:59
@article{819e8451-9f27-477a-8670-eec8ae131c6a,
  abstract     = {{<p>BACKGROUND: Children with cerebral palsy (CP) form a heterogeneous group and may have risk or protective factors for fractures compared with typically developing children. The fracture sites may also differ from those of children who do not have CP. We analyzed the fracture epidemiology in a total population of children with CP.</p><p>METHODS: This was a retrospective registry study based on data from the Swedish Cerebral Palsy Follow-Up Program (CPUP) and the Swedish National Patient Register. All children in the CPUP born in 2000-2015 were included. The Gross Motor Function Classification System (GMFCS) level, reported fractures, fracture site, and epilepsy diagnosis were recorded up to 2018. Hazards and hazard ratios were calculated for first-time fractures.</p><p>RESULTS: Of the 3,902 participants, 368 (9.4%) had at least one reported fracture. The cumulative risk of sustaining a fracture before age 16 years was 38.3% (95% confidence interval 33.9-42.4). The hazard for fracture was 7 times higher in children with epilepsy. The overall fracture incidence was not statistically significantly related to sex or GMFCS level. Fractures in the upper extremities were most prevalent in children with a lower GMFCS level, and femoral fractures were most prevalent in children at GMFCS level V. Most fractures occurred in early childhood and after 8 years of age.</p><p>CONCLUSIONS: Children with CP were at similar risk of sustaining fractures as typically developing children, but the risk was higher in children with comorbid epilepsy. Fractures occurred in children at GMFCS levels I-III at sites similar to those for typically developing children; fractures in the upper extremities were the most frequent. Children at GMFCS levels IV or V and those with epilepsy were more likely to have a fracture in the lower extremities, and the femur was the most frequent site.</p>}},
  author       = {{Linton, Gustaf and Hägglund, Gunnar and Czuba, Tomasz and Alriksson-Schmidt, Ann I}},
  issn         = {{1471-2474}},
  keywords     = {{Adolescent; Adult; Cerebral Palsy/diagnosis; Child; Child, Preschool; Epilepsy/complications; Fractures, Bone/epidemiology; Humans; Registries; Retrospective Studies; Sweden/epidemiology; Young Adult}},
  language     = {{eng}},
  month        = {{09}},
  pages        = {{1--10}},
  publisher    = {{BioMed Central (BMC)}},
  series       = {{BMC Musculoskeletal Disorders}},
  title        = {{Epidemiology of fractures in children with cerebral palsy : a Swedish population-based registry study}},
  url          = {{http://dx.doi.org/10.1186/s12891-022-05813-9}},
  doi          = {{10.1186/s12891-022-05813-9}},
  volume       = {{23}},
  year         = {{2022}},
}