Osteoporosis International

, Volume 29, Issue 2, pp 441–450 | Cite as

The association between childhood fractures and adolescence bone outcomes: a population-based study, the Tromsø Study, Fit Futures

  • T. ChristoffersenEmail author
  • N. Emaus
  • E. Dennison
  • A.-S. Furberg
  • L. Gracia-Marco
  • G. Grimnes
  • O. A. Nilsen
  • D. Vlachopoulos
  • A. Winther
  • L. A. Ahmed
Original Article



Childhood fracture may predict persistent skeletal fragility, but it may also reflect high physical activity which is beneficial to bone development. We observe a difference in the relationship between previous fracture and bone outcome across physical activity level and sex. Further elaboration on this variation is needed.


Childhood fracture may be an early marker of skeletal fragility, or increased levels of physical activity (PA), which are beneficial for bone mineral accrual. This study investigated the association between a previous history of childhood fracture and adolescent bone mineral outcomes by various PA levels.


We recruited 469 girls and 492 boys aged 15–18 years to this study. We assessed PA levels by questionnaire and measured areal bone mineral density (aBMD) and bone mineral content (BMC) using dual-energy X-ray absorptiometry (DXA) at arm, femoral neck (FN), total hip (TH), and total body (TB) and calculated bone mineral apparent density (BMAD, g/cm3). Fractures from birth to time of DXA measurements were retrospectively recorded. We analyzed differences among participants with and without fractures using independent sample t test. Multiple linear regression was used to examine the association between fractures and aBMD and BMC measurements according to adolescent PA.


Girls with and without a previous history of fracture had similar BMC, aBMD, and BMAD at all sites. In multiple regression analyses stratified by physical activity intensity (PAi), there was a significant negative association between fracture and aBMD-TH and BMC-FN yet only in girls reporting low PAi. There was a significant negative association between forearm fractures, BMAD-FN, and BMAD-arm among vigorously active boys.


Our findings indicate a negative association between childhood fractures and aBMD/BMC in adolescent girls reporting low PAi. In boys, such an association appears only in vigorously active participants with a history of forearm fractures.


Bone mineral density Child DXA Fracture Physical activity 



peak bone mass


areal bone mineral density


bone mineral content


bone mineral apparent density


the Tromsø Study, Fit Futures


dual-energy X-ray absorptiometry


coefficient of variation


femoral neck


total hip


total body


physical activity


physical activity intensity


Health Behavior in School-aged Children


standard deviation



We are grateful to the study participants, the staff at the Clinical Research Unit at University Hospital of North Norway (UNN HF), and the Fit Futures administration for conducting the study. We thank Robert Kechter at Finnmark Hospital Trust and Carsten Rolland at School of Sport Sciences UiT The Arctic University of Norway for office and administration contribution. We also thank the Norwegian Osteoporosis Association for supporting pediatric software and the Northern Norway Regional Health Authorities for funding this work.

Funding information

North Norwegian Health Authorities (SFP1160-14) funded this study. The funders had no role in the study design, data collection, analysis, or interpretation, or in the decision to submit this manuscript for publication.

Compliance with ethical standards

The study was approved by the Norwegian Data Protection Authority (reference number 2009/1282) and by the Regional Committee of Medical and Health Research Ethics (reference number 2011/1702/REKnord).

Conflicts of interest


Supplementary material

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ESM 1 (DOCX 13 kb)
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ESM 3 (DOCX 16 kb)


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2017

Authors and Affiliations

  1. 1.Department of Health and Care SciencesUiT The Arctic University of NorwayTromsøNorway
  2. 2.Finnmark Hospital TrustAltaNorway
  3. 3.MRC Lifecourse Epidemiology UnitSouthamptonUK
  4. 4.Victoria UniversityWellingtonNew Zealand
  5. 5.Department of Community MedicineUiT The Arctic University of NorwayTromsøNorway
  6. 6.Department of Microbiology and Infection ControlUniversity Hospital of North NorwayTromsøNorway
  7. 7.PROFITH “PROmoting FITness and Health through physical activity” Research Group, Department of Physical Education and Sports, Faculty of Sport SciencesUniversity of GranadaGranadaSpain
  8. 8.Growth, Exercise, Nutrition and Development Research GroupUniversity of ZaragozaZaragozaSpain
  9. 9.Division of Internal MedicineUniversity Hospital of North NorwayTromsøNorway
  10. 10.Tromsø Endocrine Research Group, Department of Clinical MedicineUiT The Arctic University of NorwayTromsøNorway
  11. 11.Children’s Health and Exercise Research Centre, Sport and Health Sciences University of ExeterExeterUK
  12. 12.Division of Neurosciences, Orthopedics and Rehabilitation ServicesUniversity Hospital of North NorwayTromsøNorway
  13. 13.Institute of Public Health, College of Medicine and Health SciencesUnited Arab Emirates UniversityAl AinUAE

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