Childhood Obesity and Its Association with Long Bone Fractures: A Systematic Review
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By
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Ahmed Aly
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Tarek Aly
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March 10, 2026
Clinical Scorecard: Childhood Obesity and Its Association with Long Bone Fractures: A Systematic Review
At a Glance
| Category | Detail |
|---|---|
| Condition | Childhood obesity and its impact on long bone fractures |
| Key Mechanisms | Insulin resistance altering bone formation, mechanical loading increasing cortical bone, chronic inflammation impairing bone quality via RANKL/RANK/OPG pathway |
| Target Population | Children and adolescents aged 0–19 years with overweight or obesity (BMI ≥85th percentile) |
| Care Setting | Pediatric orthopedic and trauma care settings |
Key Highlights
- Obesity rates in children aged 6 to 19 have tripled since the 1970s.
- Obesity induces physiological changes in the growing skeleton, affecting fracture risk and healing.
- Chronic low-grade inflammation in obesity disrupts bone remodeling, increasing fracture complexity.
Guideline-Based Recommendations
Diagnosis
- Use BMI percentiles to classify pediatric weight status: underweight (<5th), healthy (5th to <85th), overweight (85th to <95th), obese (≥95th).
- Assess fracture incidence and patterns specifically in obese pediatric patients.
Management
- Consider obesity-related physiological and mechanical factors when planning fracture treatment.
- Anticipate potential complications and altered healing patterns in obese children.
Monitoring & Follow-up
- Monitor for post-traumatic complications and resource utilization differences in obese versus non-obese children.
- Evaluate inflammatory markers and bone quality indicators as part of follow-up.
Risks
- Increased risk of fracture-related complications and complex injury patterns in obese children.
- Potential for altered surgical outcomes due to obesity-associated physiological changes.
Patient & Prescribing Data
Children and adolescents aged 0–19 years classified as overweight or obese by BMI percentiles.
Obesity influences fracture risk and management complexity; treatment plans should integrate considerations of altered bone physiology and mechanical loading.
Clinical Best Practices
- Apply standardized BMI percentile classifications for accurate obesity diagnosis in pediatric patients.
- Recognize the dual impact of mechanical loading and chronic inflammation on bone health in obese children.
- Incorporate multidisciplinary approaches addressing metabolic and orthopedic aspects in managing fractures among obese pediatric patients.
References
- Centers for Disease Control - Pediatric Body Weight Categories
- PRISMA 2020 Statement
- Newcastle–Ottawa Scale for Quality Assessment
Based on findings from:
Obesity and long bone fractures in children. Systematic review
Ahmed Aly, Tarek Aly. Archives Of Orthopaedic And Trauma Surgery, 2026.
https://link.springer.com/article/10.1007/s00402-026-06221-7
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