ASSOCIATION BETWEEN BODY MASS INDEX AND PEDIATRIC FRACTURES

Body mass index (BMI) significantly influences pediatric skeletal health, presenting unique challenges across a spectrum of body weights. This chapter examines the multifaceted relationship between BMI and fracture risks in children, exploring biomechanical, nutritional, hormonal, and socioeconomic di-mensions. High BMI is associated with increased mechanical stress on weight-bearing bones, poten-tially enhancing cortical bone density but simultaneously heightening susceptibility to fractures due to altered soft tissue mechanics and joint instability. Conversely, low BMI is linked to reduced bone mineral density, diminished cortical thickness, and increased skeletal fragility, particularly in non-weight-bearing regions. Nutritional deficiencies, including insufficient calcium and vitamin D intake, alongside hormonal imbalances such as elevated leptin levels or reduced growth hormone activity, exacerbate these vulnerabilities. Socioeconomic disparities further amplify risks, as children from low-income families often face limited access to nutritious food, safe recreational spaces, and health-care resources, compounding the prevalence of obesity and its skeletal consequences. Urbanization and cultural norms exacerbate these trends, influencing dietary habits and physical activity levels. Diagnostic challenges, including the limitations of traditional imaging techniques in obese patients due to excessive adipose tissue, complicate timely fracture identification and management, underscoring the need for advanced diagnostic tools capable of assessing bone microarchitecture. Effective manage-ment and prevention strategies require a multidisciplinary approach that includes weight management programs, nutritional interventions, physical activity promotion, and public health initiatives targeting at-risk populations. Emerging pharmacological treatments, such as bisphosphonates for pediatric oste-oporosis, offer potential benefits but require further longitudinal studies to establish safety and efficacy. This chapter emphasizes the importance of addressing both high and low BMI through holistic and evidence-based strategies, leveraging clinical insights and policy-driven solutions to mitigate fracture risks and improve skeletal health in vulnerable pediatric populations. By bridging the gaps in research, policy, and clinical practice, this work contributes to a deeper understanding of the intricate interplay between BMI and pediatric skeletal health, fostering better outcomes for affected children.