This study aimed to determine if having an overweight or obese range BMI at time of beginning school is associated with increased fracture incidence in childhood. A dynamic cohort was created from ...children presenting for routine pre-school primary care screening, collected in the Information System for Research in Primary Care (SIDIAP) platform in Catalonia, Spain. Data were collected from 296 primary care centres representing 74% of the regional paediatric population. 466,997 children (48.6% female) with a validated weight and height measurement within routine healthcare screening at age 4 years (±6 months) between 2006 and 2013 were included, and followed up to the age of 15, migration out of region, death, or until 31/12/2016. BMI was calculated at age 4 years and classified using WHO growth tables, and fractures were identified using previously validated ICD10 codes in electronic primary care records, divided by anatomical location. Actuarial lifetables were used to calculate cumulative incidence. Cox regression was used to investigate the association of BMI category and fracture risk with adjustment for socioeconomic status, age, sex, and nationality. Median follow up was 4.90 years (IQR 2.50 to 7.61). Cumulative incidence of any fracture during childhood was 9.20% (95% CI 3.79% to 14.61%) for underweight, 10.06% (9.82% to 10.29%) for normal weight, 11.28% (10.22% to 12.35%) for overweight children, and 13.05% (10.69% to 15.41%) for children with obesity. Compared to children of normal range weight, having an overweight and obese range BMI was associated with an excess risk of lower limb fracture (adjusted HR 1.42 1.26 to 1.59; 1.74 1.46 to 2.06 respectively) and upper limb fracture (adjusted HR 1.10 1.03 to 1.17; 1.19 1.07 to 1.31). Overall, pre-school children with an overweight or obese range BMI had increased incidence of upper and lower limb fractures in childhood compared to contemporaries of normal weight.
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