title: Differences in childhood adiposity influence upper limb fracture site.
abstract: BACKGROUND
  Although it has been suggested that overweight and obese children have an increased risk of fracture, recent studies in post-menopausal women have shown that the relationship between obesity and fracture risk varies by fracture site. We therefore assessed whether adiposity and overweight/obesity prevalence differed by upper limb fracture site in children.
  
  
  METHODS
  Height, weight, BMI, triceps and subscapular skinfold thickness (SFT) were measured in children aged 3-18 years with an acute upper limb fracture. Data was compared across three fracture sites (hand, forearm and upper arm/shoulder [UA]), and to published reference data.
  
  
  RESULTS
  401 children (67.1% male, median age 11.71 years, range 3.54-17.27 years) participated. 34.2%, 50.6% and 15.2% had fractures of the hand, forearm and UA, respectively. Children with forearm fractures had higher weight, BMI, subscapular SFT and fat percentage z-scores than those with UA fractures (p<0.05 for all). SFT and fat percentage z-scores were also higher in children with forearm fractures compared to hand fractures, but children with hand and UA fractures did not differ. Overweight and obesity prevalence was higher in children with forearm fractures (37.6%) than those with UA fractures (19.0%, p=0.009). This prevalence was also higher than the published United Kingdom population prevalence (27.9%, p=0.003), whereas that of children with either UA (p=0.13) or hand fractures (29.1%, p=0.76) did not differ. These differences in anthropometry and overweight/obesity prevalence by fracture site were evident in boys, but not present in girls.
  
  
  CONCLUSIONS
  Measurements of adiposity and the prevalence of overweight/obesity differ by fracture site in children, and in particular boys, with upper limb fractures.
authors.affiliation: Paediatric Endocrinology, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK; MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK. Electronic address: rm@mrc.soton.ac.uk.
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Moon
authors.affiliation: Paediatric Endocrinology, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK.
authors.forename: Adelynn
authors.initials: A
authors.lastname: Lim
authors.affiliation: Paediatric Endocrinology, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK.
authors.forename: Megan
authors.initials: M
authors.lastname: Farmer
authors.affiliation: Paediatric Endocrinology, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK.
authors.forename: Avinash
authors.initials: A
authors.lastname: Segaran
authors.affiliation: Paediatric Orthopaedics, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK.
authors.forename: Nicholas M P
authors.initials: NM
authors.lastname: Clarke
authors.affiliation: MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK.
authors.forename: Elaine M
authors.initials: EM
authors.lastname: Dennison
authors.affiliation: MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK.
authors.forename: Nicholas C
authors.initials: NC
authors.lastname: Harvey
authors.affiliation: MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK; NIHR Musculoskeletal Research Unit, University of Oxford, Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7HE, UK.
authors.forename: Cyrus
authors.initials: C
authors.lastname: Cooper
authors.affiliation: Paediatric Endocrinology, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK.
authors.forename: Justin H
authors.initials: JH
authors.lastname: Davies
mesh_terms: D050154:Adiposity / Q000502:physiology*; D000293:Adolescent; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology*; D006801:Humans; D008297:Male; D009765:Obesity / Q000150:complications / Q000453:epidemiology*; D050177:Overweight / Q000150:complications / Q000453:epidemiology*; D015995:Prevalence; D012737:Sex Factors; D006113:United Kingdom; D034941:Upper Extremity / Q000293:injuries
keywords: Adiposity; Children; Fracture; Obesity