Fracture patterns and outcomes in children and adolescents aged 5–19 years with type 1 diabetes: Analysis of data from the US nationwide inpatient sample, 2005–2020

IF 3.6 2区医学 Q2 ENDOCRINOLOGY & METABOLISM

Bone Pub Date : 2025-08-27 DOI:10.1016/j.bone.2025.117617

Kai Yuan Cheng, Chen Yu Yang, Shih Chia Liu

{"title":"Fracture patterns and outcomes in children and adolescents aged 5–19 years with type 1 diabetes: Analysis of data from the US nationwide inpatient sample, 2005–2020","authors":"Kai Yuan Cheng, Chen Yu Yang, Shih Chia Liu","doi":"10.1016/j.bone.2025.117617","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Despite the high prevalence of type 1 diabetes mellitus (T1DM) and fractures in pediatric populations, little is known about fracture patterns and T1DM-specific outcomes. This study aimed to investigate differences in fracture patterns and T1DM-specific outcomes between children and adolescents with/without T1DM.</div></div><div><h3>Methods</h3><div>This retrospective observational study assessed differences in fracture patterns and outcomes among hospitalized children and adolescents (ages 5–19) with and without T1DM using the United State (US) Nationwide Inpatient Sample (NIS). Children and adolescents treated for limb fractures via closed/open reduction or debridement were analyzed. Propensity score matching (PSM) balanced baseline characteristics, yielding 295 T1DM patients and 2950 non-T1DM controls. Outcomes were examined using in-hospital outcomes from the NIS database.</div></div><div><h3>Results</h3><div>Among 135,981 children and adolescents (mean age: 13; 68.1 % male), tibia/fibula fractures were most common (28.6 %), and 52.3 % underwent open reduction and internal fixation (ORIF). No significant differences in fracture site were found between T1DM and non-T1DM groups. However, children and adolescents with T1DM had higher odds of venous thromboembolism (VTE) (adjusted odds ratio [aOR]: 2.20; 95 % CI: 1.07–4.52) and acute kidney injury (AKI) (aOR: 4.59; 95 % CI: 2.02–10.44). Age-stratified analysis revealed elevated VTE risk (aOR: 5.25) and prolonged ventilation (aOR: 2.02) in T1DM children and adolescents aged 10–14, and higher AKI risk (aOR: 3.42) in those aged 15–19. Among T1DM patients, VTE risk was highest with upper limb fractures (aOR: 7.73), while AKI risk increased with lower limb fractures (aOR: 9.83).</div></div><div><h3>Conclusions</h3><div>Children and adolescents with T1DM do not differ in fracture patterns but are at higher risk for complications, particularly VTE and AKI. These findings highlight the need for vigilant perioperative care and further studies with detailed clinical data and long-term follow-up to guide management strategies.</div></div>","PeriodicalId":9301,"journal":{"name":"Bone","volume":"200 ","pages":"Article 117617"},"PeriodicalIF":3.6000,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Bone","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S8756328225002297","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ENDOCRINOLOGY & METABOLISM","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Despite the high prevalence of type 1 diabetes mellitus (T1DM) and fractures in pediatric populations, little is known about fracture patterns and T1DM-specific outcomes. This study aimed to investigate differences in fracture patterns and T1DM-specific outcomes between children and adolescents with/without T1DM.

Methods

This retrospective observational study assessed differences in fracture patterns and outcomes among hospitalized children and adolescents (ages 5–19) with and without T1DM using the United State (US) Nationwide Inpatient Sample (NIS). Children and adolescents treated for limb fractures via closed/open reduction or debridement were analyzed. Propensity score matching (PSM) balanced baseline characteristics, yielding 295 T1DM patients and 2950 non-T1DM controls. Outcomes were examined using in-hospital outcomes from the NIS database.

Results

Among 135,981 children and adolescents (mean age: 13; 68.1 % male), tibia/fibula fractures were most common (28.6 %), and 52.3 % underwent open reduction and internal fixation (ORIF). No significant differences in fracture site were found between T1DM and non-T1DM groups. However, children and adolescents with T1DM had higher odds of venous thromboembolism (VTE) (adjusted odds ratio [aOR]: 2.20; 95 % CI: 1.07–4.52) and acute kidney injury (AKI) (aOR: 4.59; 95 % CI: 2.02–10.44). Age-stratified analysis revealed elevated VTE risk (aOR: 5.25) and prolonged ventilation (aOR: 2.02) in T1DM children and adolescents aged 10–14, and higher AKI risk (aOR: 3.42) in those aged 15–19. Among T1DM patients, VTE risk was highest with upper limb fractures (aOR: 7.73), while AKI risk increased with lower limb fractures (aOR: 9.83).

Conclusions

Children and adolescents with T1DM do not differ in fracture patterns but are at higher risk for complications, particularly VTE and AKI. These findings highlight the need for vigilant perioperative care and further studies with detailed clinical data and long-term follow-up to guide management strategies.

查看原文本刊更多论文

5-19岁1型糖尿病儿童和青少年的骨折模式和结局：2005-2020年美国全国住院患者样本数据分析

背景：尽管1型糖尿病（T1DM）和骨折在儿童人群中的患病率很高，但对骨折模式和T1DM特异性结局知之甚少。本研究旨在探讨患有/不患有T1DM的儿童和青少年之间骨折类型和T1DM特异性结局的差异。方法本回顾性观察性研究使用美国（US）全国住院患者样本（NIS）评估患有和非T1DM的住院儿童和青少年（5-19岁）骨折模式和结局的差异。分析了通过闭合/开放复位或清创治疗肢体骨折的儿童和青少年。倾向评分匹配（PSM）平衡了基线特征，得到295名T1DM患者和2950名非T1DM对照组。使用NIS数据库中的住院结果检查结果。结果135,981名儿童和青少年（平均年龄13岁，男性占68.1%）中，胫腓骨骨折最为常见（28.6%），52.3%接受了切开复位内固定（ORIF）。T1DM组与非T1DM组骨折部位差异无统计学意义。然而，患有T1DM的儿童和青少年发生静脉血栓栓塞（VTE）的几率更高（调整优势比[aOR]: 2.20; 95% CI: 1.07-4.52）和急性肾损伤（AKI）（aOR: 4.59; 95% CI: 2.02-10.44）。年龄分层分析显示，10-14岁T1DM儿童和青少年VTE风险升高（aOR: 5.25）和延长通气时间（aOR: 2.02）， 15-19岁儿童和青少年AKI风险升高（aOR: 3.42）。在T1DM患者中，上肢骨折的VTE风险最高（aOR: 7.73），而下肢骨折的AKI风险增加（aOR: 9.83）。结论：儿童和青少年T1DM在骨折类型上没有差异，但发生并发症的风险更高，尤其是静脉血栓栓塞和AKI。这些发现强调了围手术期警惕护理的必要性，并需要进一步研究详细的临床数据和长期随访，以指导管理策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Bone 医学-内分泌学与代谢

CiteScore

8.90

自引率

4.90%

发文量

264

审稿时长

30 days

期刊介绍： BONE is an interdisciplinary forum for the rapid publication of original articles and reviews on basic, translational, and clinical aspects of bone and mineral metabolism. The Journal also encourages submissions related to interactions of bone with other organ systems, including cartilage, endocrine, muscle, fat, neural, vascular, gastrointestinal, hematopoietic, and immune systems. Particular attention is placed on the application of experimental studies to clinical practice.