Impact of organized sports on risk of bone fracture among adolescents: ABCD – growth study

Author(s)

Kyle Robinson Lynch

• Document type: Master's Dissertation
• Press: Presidente Prudente. 2018-07-11.
• Institution: Universidade Estadual Paulista (Unesp). Faculdade de Ciências e Tecnologia. Presidente Prudente
• Defense date: 2018-06-21
• Advisor: Rômulo Araújo Fernandes

Abstract

Objective: To analyze the risk of traumatic fractures according to the engagement in sports with different levels of physical impact, as well as to identify the potential impact of sports participation on health care costs among adolescents. Methods: Longitudinal study with 24 months of follow-up. The sample was composed of 285 adolescents of both sexes (202 boys and 83 girls) who were contacted by the researchers in schools (n= 104) and sports clubs (n= 181) located in the metropolitan region of Presidente Prudente, Sao Paulo, Brazil. All adolescents were invited, considering the inclusion criteria: 1) 10-19 years-old, 2) parents' consent form signed, 3) if contacted in any sports club, at least one year of training experience; if contacted in any school unit, at least one year without regular practice of sport or exercise. The groups were classified as: Control (n= 104), Swimming (n= 34), and Impact Sports (n= 147). The occurrence of fractures and health care costs were assessed monthly during the 12 months before baseline, as well as 12 months after baseline. Sex, age, body composition, sports participation, peak height velocity (PHV) and C-reactive protein (CRP) were assessed during the 12 months of follow-up. Statistical analyses were composed of Mann-Whitney test, chisquare test, Cox Regression, Kruskal-Wallis test, Analysis of Covariance and measures of effect size. Statistical significance was set at p<0.05 and all analyzes were performed using BioEstat software (version 5.2 [BioEstat, Teffe, Brazil]). Results: The incidence of new fractures was 2.1% (n= 6). The occurrence of traumatic fractures during the 24-month period (12-month follow-up plus previous 12 months) was 6.0% ([95%CI: 3.2% to 8.7%]; n= 17). The overall costs accounted during the 12-month follow-up were U$ 2,991.96. When comparing the adolescents according to the incidence of new fractures, there were no differences regarding age, BMD, BF, sports, PHV, and CRP. Overall health care costs were also not different according to subjects with any fracture during the 24-month period. Sports participation did not show any significant association or risk with the occurrence of traumatic fractures. When breaking the groups down by sport, track and field [US$ 4.13 (27.67)], gymnastics [US$ 10.77 (23.90)], judo [US$ 4.24 (6.96)], and swimming [US$ 24.67 (46.50)] presented higher costs when compared to the control group. Karate, kung-Fu, tennis, basketball and baseball did not show significant differences when compared to the control group. Concerning health care costs, swimmers presented higher costs with medicine (p-value= 0.001), appointments (p-value= 0.001), and tests (p-value= 0.005) when compared to control and impact sports groups. Even after adjustment by confounders, swimmers (Mean: US$ log10 1.172 [95%CI: 0.925 to 1.420]) had higher health care costs than control (Mean: US$ log10 0.280 [95%CI: 0.101 to 0.459]) and impact sports (Mean: US$ log10 0.404 [95%CI: 0.290 to 0.519]) (p-value = 0.001). Sports participation explained 13.2% of all variance in health care costs, while sex (2.6% of the variance) and fractures (3.5% of the variance) were also covariates related to health care costs in this model. Conclusion: The findings from this study indicate that sports participation (including impact sports) did not increase the risk of fracture among adolescents, while traumatic fracture was the main determinant of health care costs among these adolescents. Moreover, some sports seem to be related to higher health care costs among adolescents, independently of the significant economic burden of fractures and sex. (AU)

• FAPESP's process: 16/20377-0 - Impact of organized sports on risk of bone fracture among adolescents: ABCD - growth study
• Grantee: Kyle Robinson Lynch
• Support Opportunities: Scholarships in Brazil - Master