Archives of Osteoporosis

, 13:63 | Cite as

Appendicular fracture epidemiology of children and adolescents: a 10-year case review in Western Australia (2005 to 2015)

  • Mark Jenkins
  • Sophia Nimphius
  • Nicolas H. HartEmail author
  • Paola Chivers
  • Timo Rantalainen
  • Kristina Rueter
  • Meredith L. Borland
  • Fleur McIntyre
  • Katherine Stannage
  • Aris Siafarikas
Original Article



Fracture incidence data of Australian children and adolescents have not been reported in the literature. A 10-year case review of fracture presentations in Western Australia is provided. Between 2005 and 2015, fracture incidence increased relative to population growth. This is concerning, and interventions are required to reverse this trend.


Fracture incidence in 0–16-year-olds is high and varies between countries. Boys have a 1.5:1 ratio of fracture incidence compared to girls. There are no specific data for Australia. Western Australia is a state with unique geography and population distribution having only a single tertiary paediatric hospital (Princess Margaret Hospital, PMH, in Perth) managing the majority of children and adolescents with fractures in the Emergency Department (ED). The aims of this study were to characterise fracture presentations to PMH-ED and compare the incidence to population data.


A database audit of fracture presentations between 2005 and 2015 for fracture rates with a sub-analysis for gender, fracture site and age and a comparison to Perth Metropolitan and Western Australian population data was performed.


Analysis included 31,340 presentations. Fracture incidence, adjusted for the annual population size, increased from 0.63% in 2005 to 0.85% in 2015 (p < 0.001). The month of May reported the highest fracture rate (p < 0.001) corresponding with the start of the winter sports season. Males had a 1.5 times higher fracture incidence than females (p < 0.001), with upper limb fractures three times more common than lower limb fractures (p < 0.001). Fracture incidence increased with age until the early teenage years (15 years for males; 12 years for females) when a decline occurred.


Increased fracture incidence in Western Australia between 2005 and 2015 identifies a concerning trend for bone health in children and adolescents. Further research is needed to identify potential lifestyle factors that impact fracture incidence translating into evidence-based strategies to reverse these trends and improve bone health.


Bone Population Paediatric Incidence Audit 



The authors thank Mr. Dmitry Skarin for handling the queries to the EDIS database.

Author contribution

MJ drafted the initial manuscript. MJ, SN, NHH, PC, TR, FM and AS conceptualised the research design and interpreted the results. MJ and PC analysed, and SN and NHH reviewed statistical methods. KR, MLB, KS and AS contributed to data acquisition and interpretation. All authors critically evaluated and approved the final draft.

Funding statement

Mr. Mark Jenkins is supported by an Australian Government Research Training Program Scholarship. Dr. Nicolas H. Hart is supported by the Cancer Council of Western Australia Postdoctoral Research Fellowship.

Compliance with ethical standards

Ethics approval was obtained from the Princess Margaret Hospital Human Research Ethics Committee (GEKO ID: 12649) for analysis and subsequent publication of the de-identified data.

Conflicts of interest


Supplementary material

11657_2018_478_MOESM1_ESM.docx (55 kb)
ESM 1 (DOCX 43 kb)


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2018

Authors and Affiliations

  • Mark Jenkins
    • 1
    • 2
  • Sophia Nimphius
    • 1
    • 2
  • Nicolas H. Hart
    • 2
    • 3
    • 4
    Email author
  • Paola Chivers
    • 2
    • 3
    • 4
  • Timo Rantalainen
    • 2
    • 3
    • 4
    • 5
  • Kristina Rueter
    • 6
    • 7
    • 8
  • Meredith L. Borland
    • 6
    • 7
  • Fleur McIntyre
    • 2
    • 9
  • Katherine Stannage
    • 10
    • 11
  • Aris Siafarikas
    • 2
    • 3
    • 4
    • 7
    • 11
    • 12
  1. 1.Centre for Exercise and Sports Science ResearchEdith Cowan UniversityPerthAustralia
  2. 2.Western Australian Bone Research CollaborationPerthAustralia
  3. 3.Institute for Health ResearchThe University of Notre Dame AustraliaPerthAustralia
  4. 4.Exercise Medicine Research InstituteEdith Cowan UniversityPerthAustralia
  5. 5.Gerontology Research CentreUniversity of JyväskyläJyväskyläFinland
  6. 6.Emergency DepartmentPrincess Margaret HospitalPerthAustralia
  7. 7.Medical School, Division of PaediatricsUniversity of Western AustraliaPerthAustralia
  8. 8.Department of ImmunologyPrincess Margaret HospitalPerthAustralia
  9. 9.School of Health SciencesUniversity of Notre Dame AustraliaPerthAustralia
  10. 10.Department of Orthopaedic SurgeryPrincess Margaret HospitalPerthAustralia
  11. 11.Department of Endocrinology and DiabetesPrincess Margaret HospitalPerthAustralia
  12. 12.Telethon Kids Institute for Child Health ResearchPerthAustralia

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