Abstract
Background and purpose — Associations between obesity and slipped capital femoral epiphysis (SCFE) during adolescence are described; however, few studies report on the lifetime risk of obesity in patients with SCFE. In addition, with the obesity epidemic in children and adolescents, an increasing incidence of SCFE might be expected. An association of SCFE with hypothyroidism seems ambiguous, and the association between SCFE and depression and all-cause mortality has not yet been evaluated. This study investigates the associations of SCFE with obesity, hypothyroidism, depression, and mortality, and putative changes in the yearly incidence of SCFE.Patients and methods — 2,564 patients diagnosed with SCFE at age 5–16 diagnosed between 1964 and 2011 were identified in the Swedish Patient Register. These were matched for age, sex, and residency with unexposed control individuals. Cox regression models were fitted to estimate the risk of obesity, hypothyroidism, depression, and death, in exposed compared with unexposed individuals.Results — The risk of obesity (HR 9, 95% CI 7–11) and hypothyroidism (HR 3, CI 2–4) was higher in SCFE patients compared with controls. There was no increase in the risk of developing depression (HR 1, CI 1–1.3) in SCFE patients. In contrast, all-cause mortality was higher in SCFE patients than in controls (HR 2, CI 1–2). The incidence of SCFE did not increase over the past decades.Interpretation — Patients with SCFE have a higher lifetime risk of obesity and hypothyroidism and a higher risk of all-cause mortality compared with individuals without SCFE. These findings highlight the lifetime comorbidity burden of patients who develop SCFE in childhood, and increased surveillance of patients with a history of SCFE may be warranted. The incidence of SCFE did not increase over the last decades despite increasing obesity rates.
Highlights
Associations between obesity and slipped capital femoral epiphysis (SCFE) during adolescence are described; few studies report on the lifetime risk of obesity in patients with SCFE
Lifetime risk of comorbidities and death in SCFE patients compared with unexposed individuals The risk of developing obesity was higher in patients with SCFE than in controls (HR 9, confidence intervals (CIs) 7–11), as was the risk of developing hypothyroidism (HR 3, CI 2–4)
Oping obesity was higher in male (HR 11, CI 8–16) than in female SCFE patients (HR 7, CI 5–10), and a similar pattern was seen for the risk of hypothyroidism, which was higher in male (HR 5, CI 3–8) than in female SCFE patients (HR 2, CI 2–4; Table 1)
Summary
Associations between obesity and slipped capital femoral epiphysis (SCFE) during adolescence are described; few studies report on the lifetime risk of obesity in patients with SCFE. Interpretation — Patients with SCFE have a higher lifetime risk of obesity and hypothyroidism and a higher risk of all-cause mortality compared with individuals without SCFE. These findings highlight the lifetime comorbidity burden of patients who develop SCFE in childhood, and increased surveillance of patients with a history of SCFE may be warranted. The etiology of the disease is still unknown but several studies have concluded that overweight and obesity are catalyzing factors, either by overloading the growth plate (Fishkin et al 2006) or as an endocrine condition diminishing the stability of the growth plate The latter would explain the age-dependent relationship between obesity and SCFE onset, where obese children are found to suffer from SCFE at a younger age compared with children of age- and length-adequate weight (Perry et al 2018). The risk of developing obesity in SCFE patients, in childhood but during later life, is still unknown
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