Fracture rates in urban South African children of different ethnic origins: the Birth to Twenty cohort.
Fracture rates were compared in children of different ethnic backgrounds from Johannesburg, South Africa. More white children fracture than black and mixed ancestry children. Reasons for this may be due to greater sports participation by whites and genetic protective factors in blacks. This has to be further investigated.


BACKGROUND
Fracture rates in childhood are as high as those in the elderly. Recent research has been undertaken to understand the reasons for this, but there is little information available on ethnic differences in childhood fracture rates.


METHODS
Using the birth to twenty longitudinal cohort of children, we retrospectively obtained information on fractures and their sites from birth to 14.9 years of age on 2031 participants. The ethnic breakdown of the children was black (B) 78%, white (W) 9%, mixed ancestry (MA) 10.5% and Indian (I) 1.5%.


RESULTS
Four hundred and forty-one (22%) children had sustained a fracture one or more times during their lifetime (males 27.5% and females 16.3%; p < 0.001). The percentage of children fracturing differed between the ethnic groups (W 41.5%, B 19%, MA 21%, I 30%; p < 0.001). Of the 441 children reporting fractures, 89(20%) sustained multiple fractures. The most common site of fracture was the upper limb (57%).


CONCLUSIONS
More white children fracture than black and mixed ancestry children. This is the first study to show ethnic differences in fracture rates among children. The reasons for these differences have to be further elucidated. Greater sports participation by whites and genetic protective factors in blacks may be contributing factors.
Thandrayen
K
K
MRC Mineral Metabolism Research Unit, Department of Paediatrics, Chris Hani Baragwanath Hospital, PO Bertsham, Johannesburg, 2013, South Africa. kebashni.thandrayen@wits.ac.za
Norris
S A
SA
Pettifor
J M
JM
D000293:Adolescent; D000328:Adult; D044383:Black People; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005006:Ethnicity; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology* / Q000208:ethnology; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009104:Multiple Trauma / Q000453:epidemiology; D013019:South Africa / Q000453:epidemiology; D014505:Urban Population; D044465:White People; D055815:Young Adult