Children with atopic dermatitis are at higher risk of suffering a fracture, suggests a recent study from South Korea published in the journal Allergy.¹ The risk increased proportionately with the severity of the disease.

To examine the association between atopic dermatitis and incidence of fractures, data of 1,778,588 children born between 2009 and 2015 was scrutinized. Information was sourced from the first National Health Screening Program for Infants and Children and evaluated for location of fracture and time of fracture. The follow-up period was an average of 7.52 years.

A total of 342,601 children (19.3%) examined were diagnosed with atopic dermatitis. Children with atopic dermatitis were 14% more likely to develop fractures (33.37 vs 28.88 per 1000 person-years, respectively). The risk of fracture increased as the severity of AD increased; children with moderate to severe AD were at the highest fracture risk (35.54 per 1000 person-years) compared to children with mild AD (33.08 per 1000 person-years) and children in the control group (28.88 per 1000 person-years).

Children with mild AD were at 12% higher risk of fracture with aHR of 1.12, while the fracture risk increased by 23% among patients with moderate-to-severe AD (aHR 1.23).

Age at diagnosis was found to affect the risk of fracture. In children younger than 2 years, the aHR for fracture risk was 1.19, for children aged 2-4 years, the aHR was 1.08, while in children aged ≥5 years, the aHR was 1.03. The risk was maximum in the first year after the diagnosis of AD with aHR of 1.53, although the risk continued for up to 5 years (aHR 1.35). The effect was similar for the different fracture sites assessed: head (aHR 1.13), spine (aHR 1.33), upper limb (aHR 1.06), lower limb (aHR 1.13) and other sites (aHR 1.21). The enhanced risk of fractures is multifactorial, state the authors and may include dietary habits, intake of calcium and vitamin D, physical activity, sleep quality and effect of systemic corticosteroids.

This study shows that children with AD were at a higher risk of fracture. The risk was highest among children diagnosed at an early age. Most fractures occurred within the first year of diagnosis.

Reference

1. Lee SW, et al. Fracture incidence in children after developing atopic dermatitis: A Korean nationwide birth cohort study. Allergy. 2022 Nov 9. doi: 10.1111/all.15577.