Published online February 29, 2008
PEDIATRICS Vol. 121 No. 3 March 2008, pp. 540-546 (doi:10.1542/peds.2007-1641)
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ARTICLE

Early Determinants of Fractures in Rett Syndrome

Jennepher Downs, PhDa, Ami Bebbington, BSca, Helen Woodhead, PhDb, Peter Jacoby, MSca, Le Jian, PhDa, Amanda Jefferson, BScc and Helen Leonard, MBChBa

a Centre for Child Health Research, Telethon Institute for Child Health Research, Perth, Australia
b Sydney Children's Hospital and School of Women's and Children's Health, University of New South Wales, Sydney, Australia
c School of Public Health, Curtin University of Technology, Perth, Australia

OBJECTIVES. The goals were to compare the fracture incidence in Rett syndrome with that in the general population and to investigate the impact of genotype, epilepsy, and early motor skills on subsequent fracture incidence in girls and young women with Rett syndrome.

METHODS. The Australian Rett syndrome study, a population-based study operating since 1993, investigated Australian subjects with Rett syndrome born since 1976. The 234 (81.2%) of 288 verified cases in the Australian Rett syndrome database in 2004 whose families had completed follow-up questionnaires and provided information about fracture history were included in the analyses. The main outcomes were fracture incidence in the Rett syndrome population and fracture risk according to genotype, presence of epilepsy, and early motor profile.

RESULTS. Fracture incidence in this cohort was 43.3 episodes per 1000 person-years, nearly 4 times greater than the population rate. Risk was increased specifically in cases with p.R270X mutations and in cases with p.R168X mutations. Having epilepsy also increased fracture risk, even after adjustment for genotype.

CONCLUSIONS. Girls and young women with Rett syndrome are at increased risk of fracture. Those with mutations found previously to be more severe and those with epilepsy have an increased propensity toward fractures. Improved understanding of the risk factors for fracture could contribute to better targeting of interventions to decrease fracture incidence in this vulnerable population.

Key Words: Rett syndrome • MECP2 • population-based • epilepsy • fractures

Abbreviations: AED—antiepileptic drug • HR—hazard ratio • CI—confidence interval • BMD—bone mineral density

Accepted Jul 31, 2007.