title: Incidence, prevalence, and characteristics of fractures in children, adolescents, and adults with spina bifida.
abstract: OBJECTIVE
  To determine the age-specific incidence, prevalence, and characteristics of fractures in persons with spina bifida.
  
  
  METHODS
  Year-long historical cross-sectional study.
  
  
  METHODS
  Two hundred twenty-one consecutive patients aged 2-58 years evaluated in 2003 at a regional referral center. Twenty percent (n=44) were children age 2-10 years; 30% (n=68) were adolescents age 11-18 years; and 50% (n=109) were adults age 19-58 years. Fifty-five percent (n=121) were female; 64% (n=141) had shunted hydrocephalus. Fifty-eight percent (n=129) were community ambulators. Defect levels included 14% (n=31) thoracic; 37% (n=81) mid-lumbar; 35% (n=79) low-lumbar; and 14% (n = 30) sacral.
  
  
  METHODS
  Chart review of 221 consecutive children, adolescents, and adults enrolled in a spina bifida program in Syracuse, New York, was used to determine incidence and prevalence rates. Chi-square was used for subgroup analyses, and linear regression was used to examine independent association of motor level, functional independence (Functional Independence Measures score), body mass index (BMI), shunted hydrocephalus, epilepsy, and/or other congenital anomalies with fractures, controlling for insurance status, race/ethnicity, age, and sex.
  
  
  RESULTS
  Annual incidence of fractures among children, adolescents, and adults was 23/1000; 29/1000; and 18/1000, respectively. Overall prevalence was 200/1000. One in 4 patients with fractures reported multiple fractures. Median age at first fracture was 11 years. Most fractures involved the femur or tibia. Comparisons between adult- and childhood-onset fractures were not significant for difference in sex, BMI, defect level, functional independence, shunted hydrocephalus, epilepsy, or other congenital anomalies. In regression models only defect level RR = 1.646 (P = 0.019; 95% CI 1.085-2.498) and age RR = 1.033 (P= 0.036; 95% CI 1.002-1.065) were independently associated with fractures.
  
  
  CONCLUSIONS
  Fractures in persons with spina bifida are most common during early adolescence. Environmental modifications may be more effective than pharmacological treatment in reducing the prevalence of fractures in this population.
authors.affiliation: SUNY Upstate Medical Center, Syracuse, New York, USA. dosan@upstate.edu
authors.forename: Nienke P
authors.initials: NP
authors.lastname: Dosa
authors.forename: Michael
authors.initials: M
authors.lastname: Eckrich
authors.forename: Danielle A
authors.initials: DA
authors.lastname: Katz
authors.forename: Margaret
authors.initials: M
authors.lastname: Turk
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Liptak
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000375:Aging; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D050723:Fractures, Bone / Q000209:etiology*; D006801:Humans; D015994:Incidence; D007867:Leg Bones / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D016135:Spinal Dysraphism / Q000150:complications* / Q000453:epidemiology*; D018709:Statistics, Nonparametric