Incidence, prevalence, and characteristics of fractures in children, adolescents, and adults with spina bifida

Objective: To determine the age-specific incidence, prevalence, and characteristics of fractures in persons with spina bifida. Design: Year-long historical cross-sectional study. Subjects: Two hundred twenty-one consecutive patients aged 2-58 years evaluated in 2003 at a regional referral center. Twenty percent (n =44) were children age 2-10 years; 30% (n = 68) were adolescents age 11 18 years; and 50% (n = 109) were adults age 19- 58 years. Fifty-five percent (n = 121) were female; 64% (n = 141) had shunted hydrocephalus. Fifty-eight percent (n = 129) were community ambulators. Defect levels included 14% (n = 31) thoracic; 37% (n = 81) mid-lumbar; 35% (n = 79) low-lumbar; and 14% (n = 30) sacral. Methods: Chart review of 221 consecutive children, adolescents, and adults enrolled in a spina bifida program in Syracuse, New York, was used to determine incidence and prevalence rates. Chi-square was used for subgroup analyses, and linear regression was used to examine independent association of motor level, functional independence (Functional Independence Measures score), body mass index (BMI), shunted hydrocephalus, epilepsy, and/or other congenital anomalies with fractures, controlling for insurance status, race/ethnicity, age, and sex. Results: Annual incidence of fractures among children, adolescents, and adults was 23/1000; 2911000; and 18/1000, respectively. Overall prevalence was 20011000. One in 4 patients with fractures reported multiple fractures. Median age at first fracture was I I years. Most fractures involved the femur or tibia. Comparisons between adult- and childhood-onset fractures were not significant for difference in sex, BMI, defect level, functional independence, shunted hydrocephalus, epilepsy, or other congenital anomalies. In regression models only defect level RR = 1.646 (P= 0.019; 95% CI 1.085-2.498) and age RR = 1.033 (P= 0.036; 95% CI 1.002-1.065) were independently associated with fractures. Conclusions: Fractures in persons with spina bifida are most common during early adolescence. Environmental modifications may be more effective than pharmacological treatment in reducing the prevalence of fractures in this population.