Differential Risk Profiles for Slipped Capital Femoral Epiphysis in Pediatric Patients: A Comparative Analysis of Normal and Elevated BMI Groups

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INTRODUCTION: Slipped capital femoral epiphysis (SCFE) is a common hip disorder in adolescents that primarily affects those with higher body mass index (BMI). This study aimed to compare risk factors between pediatric patients with normal BMI (<85th percentile, normal-weight group) and obese BMI (≥85th percentile, classic group) in the context of SCFE. METHODS: In this multi-institution case-control study, data from 1,200 pediatric patients diagnosed with SCFE from 2003 to 2023 were analyzed. Patients were dichotomized based on their BMI percentiles into normal-weight and classic groups. Multivariate logistic regression models that adjusted for various demographic and other patient characteristics were employed to calculate adjusted odds ratios (ORs) for the target risk factors. RESULTS: The study included 172 patients in the normal-weight group and 1,028 in the classic group. Notable differences were noted in age ( P < 0.001), thyrotropin levels ( P < 0.001), and calcidiol levels ( P < 0.001) between the two groups. Regression analysis revealed that patients in the normal-weight group had higher odds of being White (OR = 2.10; 95% CI: 1.49 to 2.95; P < 0.001) compared with the classic group. Additional findings indicated increased odds of hypothyroidism (OR = 1.86; P = 0.01) and lower odds of vitamin D deficiency (OR = 0.51; P = 0.02) in the normal-weight group compared with the classic group. CONCLUSION: This study highlights notable differences in risk factors between normal-weight and overweight pediatric patients with SCFE. Race and ethnicity, thyroid function, and vitamin D levels emerged as differential risk factors with normal-weight patients having two times higher the risk of hypothyroidism (incidence 19.85% in normal-weight vs. 10.89% classic). These findings suggest that risk profiles for SCFE are more complex than previously understood and vary markedly with BMI. We recommend evaluation of hypothyroidism in normal weight patients with SCFE because one in every five patients in this group was diagnosed with hypothyroidism. LEVEL OF EVIDENCE: Level III.

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