{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T04:50:29Z","timestamp":1791435029110,"version":"4.3.3"},"reference-count":32,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:00:00Z","timestamp":1791331200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:00:00Z","timestamp":1791331200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["American J of Med Genetics Pt A"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Previous series have questioned bone fragility in those with hypermobility spectrum disorders (HSD) or hypermobile Ehlers\u2010Danlos syndrome (hEDS). These conclusions have been extrapolated to infants and children often in the setting of suspected child abuse. Few studies address this in non\u2010ambulatory children, leaving medical professionals and the courts alike to debate the reported observations. One hundred patients with HSD\/hEDS were recruited from a large hypermobility clinic. Each was required to have a guardian\/parent present to attest to the fracture history for the entire age of the individual. Each was asked for the number of fractures, age at incident for each, and qualitative data regarding the mechanism of injury. Those experiencing a fracture in their lifetime were 55.6% (55\/99). Only two fractures were recorded in the infantile period. There was only one rib fracture from trauma and no skull fractures. While fracture prevalence was higher than expected in ambulatory individuals with HSD\/hEDS, no fractures occurred within the first year of life not known from the birthing process. The pattern of fractures was consistent with that normally seen in childhood. Qualitative data suggest no significant evidence of fragility fractures, especially in non\u2010ambulatory children.<\/jats:p>","DOI":"10.1002\/ajmg.a.70324","type":"journal-article","created":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T04:13:48Z","timestamp":1791432828000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Fracture Prevalence Among Those With Hypermobility Spectrum Disorder\/Hypermobile Ehlers\u2010Danlos Syndrome"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6987-1208","authenticated-orcid":false,"given":"Brad T.","family":"Tinkle","sequence":"first","affiliation":[{"name":"Peyton Manning Children's Hospital Ascension St. Vincent  Indianapolis Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,7]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"crossref","first-page":"40529","DOI":"10.1038\/s41598-025-24199-x","article-title":"The Effects of Joint Hypermobility on Strength, Proprioception, and Functional Performance","volume":"15","author":"Akaras E.","year":"2025","journal-title":"Scientific Reports"},{"key":"e_1_2_11_3_1","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2016-2398","article-title":"Bone Densitometry in Children and Adolescents","volume":"38","author":"Bachrach L. K.","year":"2016","journal-title":"Pediatrics"},{"key":"e_1_2_11_4_1","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1007\/s11914-020-00568-5","article-title":"Bone Disease in Patients With Ehlers\u2010Danlos Syndromes","volume":"18","author":"Basalom S.","year":"2020","journal-title":"Current Osteoporosis Reports"},{"key":"e_1_2_11_5_1","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1136\/ard.32.5.413","article-title":"Articular Mobility in an African Population","volume":"32","author":"Beighton P. H.","year":"1973","journal-title":"Annals of the Rheumatic Diseases"},{"key":"e_1_2_11_6_1","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1002\/ajmg.c.31550","article-title":"The Ehlers\u2010Danlos Syndromes, Rare Types","volume":"175","author":"Brady A. F.","year":"2017","journal-title":"American Journal of Medical Genetics, Part C: Seminars in Medical Genetics"},{"key":"e_1_2_11_7_1","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1007\/s001980070104","article-title":"Bone Density in Ehlers\u2010Danlos Syndrome","volume":"11","author":"Carbone L.","year":"2000","journal-title":"Osteoporosis International"},{"key":"e_1_2_11_8_1","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1002\/ajmg.c.31539","article-title":"A Framework for the Classification of Joint Hypermobility and Related Conditions","volume":"175","author":"Castori M.","year":"2017","journal-title":"American Journal of Medical Genetics Part C: Seminars in Medical Genetics"},{"key":"e_1_2_11_9_1","doi-asserted-by":"crossref","DOI":"10.1186\/s40064-015-1089-1","article-title":"Proprioceptive Precision Is Impaired in Ehlers\u2010Danlos Syndrome","volume":"4","author":"Clayton H. A.","year":"2015","journal-title":"Springerplus"},{"key":"e_1_2_11_10_1","doi-asserted-by":"crossref","first-page":"1976","DOI":"10.1359\/jbmr.040902","article-title":"Epidemiology of Childhood Fractures in Britain: A Study Using the General Practice Research Database","volume":"19","author":"Cooper C.","year":"2004","journal-title":"Journal of Bone and Mineral Research"},{"key":"e_1_2_11_11_1","doi-asserted-by":"crossref","first-page":"630","DOI":"10.1136\/ard.57.10.630","article-title":"Assessment of Bone in Ehlers Danlos Syndrome by Ultrasound and Densitometry","volume":"57","author":"Dolan A. L.","year":"1998","journal-title":"Annals of the Rheumatic Diseases"},{"key":"e_1_2_11_12_1","doi-asserted-by":"crossref","first-page":"1023","DOI":"10.1007\/s00247-020-04856-1","article-title":"Ehlers\u2010Danlos Syndrome: What the Radiologist Needs to Know","volume":"51","author":"George M. P.","year":"2012","journal-title":"Pediatric Radiology"},{"key":"e_1_2_11_13_1","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1007\/s10067-005-0103-3","article-title":"Hypermobility Syndrome Increases the Risk for Low Bone Mass","volume":"25","author":"Gulbahar S.","year":"2006","journal-title":"Clinical Rheumatology"},{"key":"e_1_2_11_14_1","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2024-070074","article-title":"Evaluating Young Children With Fractures for Child Abuse: Clinical Report","volume":"155","author":"Haney S.","year":"2025","journal-title":"Pediatrics"},{"key":"e_1_2_11_15_1","doi-asserted-by":"crossref","first-page":"148","DOI":"10.3109\/17453671003628780","article-title":"Epidemiology of Fractures in Children and Adolescents. Increased Incidence Over the Past Decade: A Population\u2010Based Study From Northern Sweden","volume":"81","author":"Hedstr\u00f6m E. M.","year":"2010","journal-title":"Acta Orthopaedica"},{"key":"e_1_2_11_16_1","doi-asserted-by":"crossref","DOI":"10.1080\/19381980.2017.1279768","article-title":"Multiple Fractures in Infants Who Have Ehlers\u2010Danlos\/Hypermobility Syndrome and or Vitamin D Deficiency: A Case Series of 72 Infants Whose Parents Were Accused of Child Abuse and Neglect","volume":"9","author":"Holick M. F.","year":"2017","journal-title":"Dermato\u2010Endocrinology"},{"key":"e_1_2_11_17_1","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.a1518","article-title":"Patterns of Skeletal Fractures in Child Abuse: Systematic Review","volume":"337","author":"Kemp A. M.","year":"2008","journal-title":"British Medical Journal"},{"key":"e_1_2_11_18_1","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1097\/01202412-199704000-00002","article-title":"Epidemiology of Children's Fractures","volume":"6","author":"Landin L. A.","year":"1997","journal-title":"Journal of Pediatric Orthopedics. Part B"},{"key":"e_1_2_11_19_1","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1080\/17453674.2020.1772555","article-title":"Development of the Annual Incidence Rate of Fracture in Children 1980\u20132018: A Population\u2010Based Study of 32,375 Fractures","volume":"91","author":"Larsen A. V.","year":"2020","journal-title":"Acta Orthopaedica"},{"key":"e_1_2_11_20_1","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1002\/ajmg.c.31552","article-title":"The 2017 International Classification of the Ehlers\u2010Danlos Syndromes","volume":"175","author":"Malfait F.","year":"2017","journal-title":"American Journal of Medical Genetics, Part C: Seminars in Medical Genetics"},{"key":"e_1_2_11_21_1","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1016\/j.bone.2015.12.007","article-title":"High Prevalence of Radiologic Vertebral Fractures in Adult Patients With Ehlers\u2010Danlos Syndrome","volume":"84","author":"Mazziotti G.","year":"2016","journal-title":"Bone"},{"key":"e_1_2_11_22_1","doi-asserted-by":"crossref","first-page":"e45","DOI":"10.1097\/BPO.0000000000000595","article-title":"Epidemiology of Pediatric Fractures Presenting to Emergency Departments in the United States","volume":"36","author":"Naranje S. M.","year":"2016","journal-title":"Journal of Pediatric Orthopaedics"},{"key":"e_1_2_11_23_1","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1007\/s00223001093","article-title":"Ultrasonographic, Axial, and Peripheral Measurements in Female Patients With Benign Hypermobility Syndrome","volume":"67","author":"Nijs J.","year":"2000","journal-title":"Calcified Tissue International"},{"key":"e_1_2_11_24_1","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/j.chiabu.2019.03.008","article-title":"Fracture Incidence in Ehlers\u2010Danlos Syndrome \u2010 A Population\u2010Based Case\u2013Control Study","volume":"91","author":"Rolfes M. C.","year":"2019","journal-title":"Child Abuse and Neglect"},{"key":"e_1_2_11_25_1","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1097\/MOP.0000000000000986","article-title":"Genetic Consultations in Cases of Unexplained Fractures and Haemorrhage: An Evidence\u2010Based Approach","volume":"33","author":"Shur N.","year":"2021","journal-title":"Current Opinion in Pediatrics"},{"key":"e_1_2_11_26_1","doi-asserted-by":"crossref","first-page":"1029","DOI":"10.1007\/s00247-020-04865-0","article-title":"Genetic Causes of Fractures and Subdural Hematomas: Fact Versus Fiction","volume":"51","author":"Shur N. E.","year":"2021","journal-title":"Pediatric Radiology"},{"key":"e_1_2_11_27_1","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1016\/j.jpeds.2016.10.078","article-title":"Musculoskeletal Conditions in a Pediatric Population With Ehlers\u2010Danlos Syndrome","volume":"181","author":"Stern C.","year":"2017","journal-title":"Journal of Pediatrics"},{"key":"e_1_2_11_28_1","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1002\/ajmg.c.31538","article-title":"Hypermobile Ehlers\u2010Danlos Syndrome (a.k.a. Ehlers\u2010Danlos Syndrome Type III and Ehlers\u2010Danlos Syndrome Hypermobility Type): Clinical Description and Natural History","volume":"175","author":"Tinkle B.","year":"2017","journal-title":"American Journal of Medical Genetics, Part C: Seminars in Medical Genetics"},{"key":"e_1_2_11_29_1","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1186\/s13023-023-02717-2","article-title":"Pediatric Joint Hypermobility: A Diagnostic Framework and Narrative Review","volume":"18","author":"Tofts L. J.","year":"2023","journal-title":"Orphanet Journal of Rare Diseases"},{"key":"e_1_2_11_30_1","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1017\/9781009106863.008","volume-title":"Kleinman's Diagnostic Imaging of Child Abuse","author":"Tsai A.","year":"2026"},{"key":"e_1_2_11_31_1","doi-asserted-by":"crossref","DOI":"10.1186\/s12891-025-08318-3","article-title":"Falls and Balance Impairment; What and How Has This Been Measured in Adults With Joint Hypermobility? A Scoping Review","volume":"26","author":"Wang Y.","year":"2025","journal-title":"BMC Musculoskeletal Disorders"},{"key":"e_1_2_11_32_1","doi-asserted-by":"crossref","DOI":"10.3389\/fmed.2023.1135473","article-title":"A Novel Method of Assessing Balance and Postural Sway in Patients With Hypermobile Ehlers\u2010Danlos Syndrome","volume":"10","author":"Whitmore M.","year":"2023","journal-title":"Frontiers in Medicine"},{"key":"e_1_2_11_33_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.chiabu.2024.106828","article-title":"Fracture Prevalence in Children Diagnosed With Ehlers\u2010Danlos Syndrome and Generalized Joint Hypermobility","volume":"153","author":"Yeung F.","year":"2024","journal-title":"Child Abuse and Neglect"}],"container-title":["American Journal of Medical Genetics Part A"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ajmg.a.70324","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ajmg.a.70324","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ajmg.a.70324","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T04:13:52Z","timestamp":1791432832000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ajmg.a.70324"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,7]]},"references-count":32,"alternative-id":["10.1002\/ajmg.a.70324"],"URL":"https:\/\/doi.org\/10.1002\/ajmg.a.70324","archive":["Portico"],"relation":{},"ISSN":["1552-4825","1552-4833"],"issn-type":[{"value":"1552-4825","type":"print"},{"value":"1552-4833","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,7]]},"assertion":[{"value":"2026-07-19","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-30","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-07","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"ajmg.a.70324"}}