New Assessment Tool Predicts Pediatric Fracture Risk

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The FSI proved to be at least as effective in predicting fracture risk in children.
The FSI proved to be at least as effective in predicting fracture risk in children.

A new biomechanical bone assessment evaluates fracture risk in children at least as effectively as femoral and total body bone mineral density (BMD), according to findings presented at the American Society of Bone and Mineral Research (ASBMR) 2017 Annual Meeting, held September 8-11, 2017 in Denver, Colorado.

Researchers in the Generation R Study, a prospective, multiethnic, pregnancy and birth cohort in Rotterdam, The Netherlands, evaluated the influence of a geometry-derived femoral stress index (FSI) on fracture risk by examining the skeletal determinates in healthy, school-age children (n=3633). Dual energy X-ray absorptiometry (DXA) scans were performed to measure total body and hip BMD, and hip structural analysis (HSA) with derivation of FSI was performed on 1851 participants.

Fractures occurred in 521 (14.3%) of the 3633 participants, with no significant difference noted between sexes. At mean age 6, lower total body BMD was linked to a 26% higher risk of fracture (P =.001), and a 43% higher risk at mean age 9 (P =4.26x10-7).

In HSA, fractures occurred in 251 participants with similar likelihoods per standard deviation (SD) decrease in total body less head BMD (P =.01), femoral neck BMD (P =.005), and narrow neck BMD (P =.005). The strongest association of fracture risk was observed on the FSI, with each SD increment resulting in a 28% increased odds of fracture (P =.0001).

The FSI proved to be at least as effective in predicting fracture risk in children as femoral and total body BMD. “This stress index models bending and axial forces acting on the femoral neck due to loading, considering bone length levers and corrected for lean mass fraction,” the researchers concluded.

Reference

Grgic O, Medina-Gomez C, Trajanoska K, et al. Femoral stress index is prominently associated with risk of fracture in children of school age. Presented at: American Society for Bone and Mineral Research 2017 Annual Meeting; September 8-11, 2017; Denver, CO. Abstract 1116.

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