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A dynamic cohort was created from children presenting for routine preschool 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 centers representing 74% of the regional pediatric population. A total of 466,997 children (48.6% female) with a validated weight and height measurement within routine health care screening at age 4\u2009years (\u00b16\u2009months) between 2006 and 2013 were included, and followed up to the age of 15, migration out of region, death, or until December 31, 2016. BMI was calculated at age 4\u2009years 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\u2009years (interquartile range [IQR] 2.50 to 7.61). Cumulative incidence of any fracture during childhood was 9.20% (95% confidence interval [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 with children of normal range weight, having an overweight and obese range BMI was associated with an excess risk of lower limb fracture (adjusted hazard ratio [HR] =\u20091.42 [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, preschool children with an overweight or obese range BMI had increased incidence of upper and lower limb fractures in childhood compared with contemporaries of normal weight. \u00a9 2020 The Authors. Journal of Bone and Mineral Research published by American Society for Bone and Mineral Research.<\/jats:p>","DOI":"10.1002\/jbmr.3984","type":"journal-article","created":{"date-parts":[[2020,4,8]],"date-time":"2020-04-08T00:04:29Z","timestamp":1586304269000},"page":"1022-1030","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":39,"title":["Preschool Obesity Is Associated With an Increased Risk of Childhood Fracture: A Longitudinal Cohort Study of 466,997 Children and Up to 11\u2009Years of Follow-up in Catalonia, Spain"],"prefix":"10.1093","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1729-8654","authenticated-orcid":false,"given":"Jennifer CE","family":"Lane","sequence":"first","affiliation":[{"name":"NIHR BRC, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine L","family":"Butler","sequence":"additional","affiliation":[{"name":"Department of Trauma and Orthopaedic Surgery Stoke Mandeville Hospital Aylesbury UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose Luis","family":"Poveda-Marina","sequence":"additional","affiliation":[{"name":"GREMPAL Research Group, Fundaci\u00f3 Institut Universitari per a la Recerca a l'Atenci\u00f3 Prim\u00e0ria de Salut Jordi Gol i Gurina (IDIAPJGol) and CIBERFes, Universitat Autonoma de Barcelona and Instituto de Salud Carlos III Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Martinez-Laguna","sequence":"additional","affiliation":[{"name":"GREMPAL Research Group, Fundaci\u00f3 Institut Universitari per a la Recerca a l'Atenci\u00f3 Prim\u00e0ria de Salut Jordi Gol i Gurina (IDIAPJGol) and CIBERFes, Universitat Autonoma de Barcelona and Instituto de Salud Carlos III Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlen","family":"Reyes","sequence":"additional","affiliation":[{"name":"GREMPAL Research Group, Fundaci\u00f3 Institut Universitari per a la Recerca a l'Atenci\u00f3 Prim\u00e0ria de Salut Jordi Gol i Gurina (IDIAPJGol) and CIBERFes, Universitat Autonoma de Barcelona and Instituto de Salud Carlos III Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeroen","family":"de Bont","sequence":"additional","affiliation":[{"name":"GREMPAL Research Group, Fundaci\u00f3 Institut Universitari per a la Recerca a l'Atenci\u00f3 Prim\u00e0ria de Salut Jordi Gol i Gurina (IDIAPJGol) and CIBERFes, Universitat Autonoma de Barcelona and Instituto de Salud Carlos III Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7985-0048","authenticated-orcid":false,"given":"Muhammad Kassim","family":"Javaid","sequence":"additional","affiliation":[{"name":"NIHR BRC, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Logue","sequence":"additional","affiliation":[{"name":"Department of Metabolic Medicine Lancaster Medical School, Lancaster University Lancaster UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5660-4151","authenticated-orcid":false,"given":"Juliet E","family":"Compston","sequence":"additional","affiliation":[{"name":"Department of Medicine Cambridge Biomedical Campus Cambridge UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cyrus","family":"Cooper","sequence":"additional","affiliation":[{"name":"MRC Lifecourse Epidemiology Unit University of Southampton Southampton UK"},{"name":"NIHR BRC, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Talita","family":"Duarte-Salles","sequence":"additional","affiliation":[{"name":"GREMPAL Research Group, Fundaci\u00f3 Institut Universitari per a la Recerca a l'Atenci\u00f3 Prim\u00e0ria de Salut Jordi Gol i Gurina (IDIAPJGol) and CIBERFes, Universitat Autonoma de Barcelona and Instituto de Salud Carlos III Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominic","family":"Furniss","sequence":"additional","affiliation":[{"name":"NIHR BRC, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3950-6346","authenticated-orcid":false,"given":"Daniel","family":"Prieto-Alhambra","sequence":"additional","affiliation":[{"name":"GREMPAL Research Group, 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