ORIGINAL ARTICLE
Appendicular fracture epidemiology of children and adolescents:
a 10-year case review in Western Australia (2005 to 2015)
Mark Jenkins
1,2
&
Sophia Nimphius
1,2
&
Nicolas H. Hart
2,3,4
&
Paola Chivers
2,3,4
&
Timo Rantalainen
2,3,4,5
&
Kristina Rueter
6,7,8
&
Meredith L. Borland
6,7
&
Fleur McIntyre
2,9
&
Katherine Stannage
10,11
&
Aris Siafarikas
2,3,4,7,11,12
Received: 3 January 2018 /Accepted: 15 May 2018
#
International Osteoporosis Foundation and National Osteoporosis Foundation 2018
Abstract
Summary Fracture incidence data of Australian children and adolescents have not been reported in the literature. A 10-year case
review of fracture presentations in Western Australia is provided. Between 2005 and 2015, fracture incidence increased relative to
population growth. This is concerning, and interventions are required to reverse this trend.
Purpose Fracture incidence in 0–16-year-olds is high and varies between countries. Boys have a 1.5:1 ratio of fracture incidence
compared to girls. There are no specific data for Australia. Western Australia is a state with unique geography and population
distribution having only a single tertiary paediatric hospital (Princess Margaret Hospital, PMH, in Perth) managing the majority
of children and adolescents with fractures in the Emergency Department (ED). The aims of this study were to characterise fracture
presentations to PMH-ED and compare the incidence to population data.
Methods A database audit of fracture presentations between 2005 and 2015 for fracture rates with a sub-analysis for gender,
fracture site and age and a comparison to Perth Metropolitan and Western Australian population data was performed.
Results Analysis included 31,340 presentations. Fracture incidence, adjusted for the annual population size, increased from
0.63% in 2005 to 0.85% in 2015 (p < 0.001). The month of May reported the highest fracture rate (p < 0.001) corresponding
with the start of the winter sports season. Males had a 1.5 times higher fracture incidence than females (p < 0.001), with upper
limb fractures three times more common than lower limb fractures (p < 0.001). Fracture incidence increased with age until the
early teenage years (15 years for males; 12 years for females) when a decline occurred.
Conclusions Increased fracture incidence in Western Australia between 2005 and 2015 identifies a concerning trend for bone
health in children and adolescents. Further research is needed to identify potential lifestyle factors that impact fracture incidence
translating into evidence-based strategies to reverse these trends and improve bone health.
Electronic supplementary material The online version of this article
(https://doi.org/10.1007/s11657-018-0478-9) contains supplementary
material, which is available to authorized users.
* Nicolas H. Hart
n.hart@ecu.edu.au
1
Centre for Exercise and Sports Science Research, Edith Cowan
University, Perth, WA, Australia
2
Western Australian Bone Research Collaboration, Perth, WA,
Australia
3
Institute for Health Research, The University of Notre Dame
Australia, Perth, WA, Australia
4
Exercise Medicine Research Institute, Edith Cowan University,
Building 21, Room 222, 270 Joondalup Drive, Joondalup,
Perth, WA 6027, Australia
5
Gerontology Research Centre, University of Jyväskylä,
Jyväskylä, Finland
6
Emergency Department, Princess Margaret Hospital, Perth, WA,
Australia
7
Medical School, Division of Paediatrics, University of Western
Australia, Perth, WA, Australia
8
Department of Immunology, Princess Margaret Hospital, Perth, WA,
Australia
9
School of Health Sciences, University of Notre Dame Australia,
Perth, WA, Australia
10
Department of Orthopaedic Surgery, Princess Margaret Hospital,
Perth, WA, Australia
11
Department of Endocrinology and Diabetes, Princess Margaret
Hospital, Perth, WA, Australia
12
Telethon Kids Institute for Child Health Research, Perth, WA,
Australia
Archives of Osteoporosis (2018) 13:63
https://doi.org/10.1007/s11657-018-0478-9
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