Abstract
Very few epidemiologic studies on bone fracture have been conducted in schools for handicapped children (Yogo schools). The aim of this study was to clarify the frequency and risk factors of bone fracture in physically disabled children in Japan. We used a cross-sectional design to examine 525 physically disabled children in 38 Yogo schools in the Hokuriku-Koshinetsu District of Japan. The questionnaire surveyed information on participant sex, age, level of physical disability, and bone fracture history. Information on fractures was obtained, including number of fractures over participant lifetime, age when fractures occurred, location, and cause. One-year-period prevalence and lifetime prevalence were defined as the proportion of subjects with incident fractures in the previous year and with a history of fracture, respectively. Participant ages ranged from 6 to 15years, and 66.3% had cerebral palsy (CP). The 1-year-period prevalence was 3.6% and lifetime fracture prevalence was 9.7%. The 1-year-period prevalence in the age groups of 6-9, 10-12, and 13-15years was 2/184 (1.1%), 5/171 (2.9%), and 12/164 (7.3%), respectively (P for trend=0.0031). There were no differences in period prevalence between sexes, and this was not associated with presence of CP. Multiple logistic regression analysis showed that age and presence of one joint contracture in the lower limbs or hip were independently associated with occurrence of bone fracture over participant lifetime. Physically disabled children are at high risk of bone fracture, and further risk factors should be determined.
Highlights
In 2006, an estimated 251,000 children, or 2% of the total population of that age in Japan, were reported to be attending classes meant for disabled children or special schools for such children, and this number is increasing [1]
There were no differences in period prevalence between sexes, and this was not associated with presence of cerebral palsy (CP)
Multiple logistic regression analysis showed that age and presence of one joint contracture in the lower limbs or hip were independently associated with occurrence of bone fracture over participant lifetime
Summary
In 2006, an estimated 251,000 children, or 2% of the total population of that age in Japan, were reported to be attending classes meant for disabled children or special schools for such children, and this number is increasing [1]. Health and Welfare Statistics in Japan [1] reported that approximately 25% of disabled children have a physical disability, and health problems related to these disabilities appear to be an important issue in child health in schools. One prevalent health problem in physically disabled children is bone fracture. Children with physical disabilities such as cerebral palsy (CP) have been known to have osteopenia [2] and low bone mineral density [3, 4]. This may be due in part to low or no mobility and to hypovitaminosis D caused by immobility [5]. When a child suffers from a fracture, he or she rests quietly in bed, which causes secondary disabilities such as joint contracture and disuse muscle atrophy [6], which
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