Childhood fractures are common, result in substantial costs and morbidity and appear to be increasing in incidence. Recent studies suggest that elevated fracture risk in otherwise healthy children is a function of lower bone mineralization. Because the majority of bone mineralization occurs before adulthood, poor bone health in childhood also negatively impacts adult bone health and may increase the risk of adult fractures associated with osteoporosis. Early identification of children with poor bone health may allow early intervention with important long term benefits. African American children, in particular, may be at higher risk of poor bone health due to both environmental and genetic factors. The overall objective of this case-control study is therefore to compare bone health in urban African American children with and without traumatic fractures to evaluate the hypothesis that African American children with forearm fractures are more likely to have deficient bone health than fracture-free controls.
Specific Aim 1 : Determine the association between forearm fracture in African American children and environmental predictors of bone health. Hypothesis 1: Cases will have significantly higher body mass index, significantly lower dietary intake of calcium/vitamin D and significantly less sun exposure than controls.
Specific Aim 2 : Determine the prevalence of vitamin D deficiency and decreased bone density (BMD) among cases and controls. Hypothesis 2: Cases will have a significantly higher prevalence of vitamin D deficiency and a significantly lower BMD than controls.
Specific Aim 3 : Investigate the association between forearm fracture in African American children and the F allele vitamin D receptor gene polymorphism. Hypothesis 3: Cases will have significantly more prevalent F allele SNP than controls. This proposal is unique in its investigation of the relationship between bone health and childhood fractures through a systematic evaluation of bone health in a vulnerable population. Further elucidating the association between bone health deficits and fractures in at-risk children would enable targeted intervention, which may decrease fracture rates, both in later childhood and in adulthood. Furthermore, the results of this research could promote effective prevention through screening and the expansion of injury prevention strategies to recognize underlying medical conditions contributing to risk.

National Institute of Health (NIH)
National Center for Research Resources (NCRR)
Mentored Patient-Oriented Research Career Development Award (K23)
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Special Emphasis Panel (ZRR1-CR-4 (01))
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Wilde, David B
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Children's Research Institute
United States
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Ryan, Leticia Manning; Teach, Stephen J; Ezeibe, Uchenna et al. (2015) Is high weight status associated with pediatric forearm fractures requiring anatomic reduction? J Investig Med 63:649-52
Manning Ryan, Leticia; Teach, Stephen J; Searcy, Kimberle et al. (2015) The Association Between Weight Status and Pediatric Forearm Fractures Resulting From Ground-Level Falls. Pediatr Emerg Care 31:835-8
Ryan, Leticia Manning; Guagliardo, Mark; Teach, Stephen J et al. (2013) The association between fracture rates and neighborhood characteristics in Washington, DC, children. J Investig Med 61:558-63
Ryan, Leticia Manning; Chamberlain, James M; Singer, Steven A et al. (2012) Genetic influences on vitamin D status and forearm fracture risk in African American children. J Investig Med 60:902-6
Ryan, Leticia Manning; Teach, Stephen J; Singer, Steven A et al. (2012) Bone mineral density and vitamin D status among African American children with forearm fractures. Pediatrics 130:e553-60
Singer, Steven A; Chamberlain, James M; Tosi, Laura et al. (2011) Association between upper extremity fractures and weight status in children. Pediatr Emerg Care 27:717-22
Ryan, Leticia Manning; Brandoli, Cinzia; Freishtat, Robert J et al. (2010) Prevalence of vitamin D insufficiency in African American children with forearm fractures: a preliminary study. J Pediatr Orthop 30:106-9
Ryan, Leticia Manning; Teach, Stephen J; Searcy, Kimberle et al. (2010) Epidemiology of pediatric forearm fractures in Washington, DC. J Trauma 69:S200-5
Ryan, Leticia M (2010) Forearm fractures in children and bone health. Curr Opin Endocrinol Diabetes Obes 17:530-4