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Imazu N, Naito K, Kawakita S, Suzuki T, Yamamoto Y, Kawamura K, Ishijima M. Levels of free thyroxine are higher in displaced pediatric supracondylar humerus fractures compared with non‑displaced fractures. Exp Ther Med 2024; 28:404. [PMID: 39234584 PMCID: PMC11372249 DOI: 10.3892/etm.2024.12693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 08/08/2024] [Indexed: 09/06/2024] Open
Abstract
Relationships between bone metabolic biomarkers and fracture displacement have been reported in the elderly. However, factors related to bone metabolism that predict fracture displacement remain unclear in children. The present study investigated bone metabolic biomarkers associated with the displacement of pediatric supracondylar humerus fractures. A total of 19 patients (7 male and 12 female patients; mean age, 6.3 years) with pediatric supracondylar humerus fractures who underwent surgical treatment at Juntendo University Hospital (Tokyo, Japan) between December 2020 and September 2022 were included. They were divided into two groups according to the Gartland classification: 14 type II patients (6 male and 8 female patients; mean age, 6.3±3.0 years) and 5 type III patients (1 male and 4 female patients; mean age, 6.4±4.0 years). The following bone metabolic biomarkers were examined: 25-hydroxyvitamin D [25(OH)D], intact parathyroid hormone (iPTH), calcium, phosphate, thyroid-stimulating hormone, free triiodothyronine and free thyroxine (FT4). These markers were also compared between the two groups. A total of 16 out of 19 patients (84%) had insufficient serum 25(OH)D levels. Although iPTH levels were elevated, other bone metabolic biomarkers were within normal ranges. When the serum levels of bone metabolic biomarkers were compared, FT4 levels were significantly higher in type III patients than in type II patients (P=0.009). No significant differences were observed in other bone metabolic biomarkers between the two groups. The present results suggest that high FT4 levels are associated with the displacement of pediatric supracondylar humerus fractures.
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Affiliation(s)
- Norizumi Imazu
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
- Department of Orthopaedics, Juntendo University Faculty of Medicine, Tokyo 113-8421, Japan
| | - Kiyohito Naito
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
- Department of Orthopaedics, Juntendo University Faculty of Medicine, Tokyo 113-8421, Japan
| | - So Kawakita
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
- Department of Orthopaedics, Juntendo University Faculty of Medicine, Tokyo 113-8421, Japan
| | - Takamaru Suzuki
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
- Department of Orthopaedics, Juntendo University Faculty of Medicine, Tokyo 113-8421, Japan
| | - Yasuhiro Yamamoto
- Department of Orthopaedics, Juntendo University Faculty of Medicine, Tokyo 113-8421, Japan
| | - Kenjiro Kawamura
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
- Department of Orthopaedics, Juntendo University Faculty of Medicine, Tokyo 113-8421, Japan
| | - Muneaki Ishijima
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
- Department of Orthopaedics, Juntendo University Faculty of Medicine, Tokyo 113-8421, Japan
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Bunker S, Blebea JS, Pandey J. Educational Case: Compare and contrast osteomalacia and rickets with respect to pathogenesis and clinicopathologic features. Acad Pathol 2024; 11:100144. [PMID: 39301310 PMCID: PMC11408811 DOI: 10.1016/j.acpath.2024.100144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 05/19/2024] [Accepted: 07/07/2024] [Indexed: 09/22/2024] Open
Affiliation(s)
- Sarah Bunker
- Central Michigan University College of Medicine, Mount Pleasant, MI, USA
| | - Judy S Blebea
- Central Michigan University College of Medicine, Mount Pleasant, MI, USA
| | - Jyotsna Pandey
- Central Michigan University College of Medicine, Mount Pleasant, MI, USA
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3
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Shimazaki S, Sato J. Idiopathic Juvenile Osteoporosis: A Case Report and Literature Review. Cureus 2024; 16:e68361. [PMID: 39355452 PMCID: PMC11443356 DOI: 10.7759/cureus.68361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2024] [Indexed: 10/03/2024] Open
Abstract
This case report describes the rare occurrence of idiopathic juvenile osteoporosis (IJO) in an 11-year-old boy with bone fragility and fractures, particularly in the thoracic and lumbar vertebrae. After excluding discernible underlying causes, the diagnosis was confirmed using clinical and radiological assessments. Treatment commenced with oral bisphosphonates, leading to notable bone mineral density (BMD) improvements and the absence of subsequent fractures. IJO presents diagnostic challenges owing to its multifaceted nature, necessitating the exclusion of other common causes of pediatric osteoporosis. Although the pathophysiology of IJO remains poorly understood, this case underscores the potential efficacy of bisphosphonate therapy in managing the condition and improving patient outcomes. Notably, the patient's symptoms ameliorated as puberty commenced, aligning with the typical IJO patterns reported in the literature. Although the long-term impact of bisphosphonate treatment in pediatric IJO cases warrants further investigation, this case exemplifies the potential to enhance the quality of life of affected individuals.
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Affiliation(s)
- Shunsuke Shimazaki
- Department of Paediatrics, Funabashi Municipal Medical Center, Funabashi, JPN
| | - Junichi Sato
- Department of Paediatrics, Funabashi Municipal Medical Center, Funabashi, JPN
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Augdal T, Angenete O, Zadig P, Lundestad A, Nordal E, Shi X, Rosendahl K. The assessment of bone health in children with juvenile idiopathic arthritis; comparison of different imaging-based methods. Pediatr Rheumatol Online J 2024; 22:80. [PMID: 39210351 PMCID: PMC11363637 DOI: 10.1186/s12969-024-01018-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 08/20/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Osteoporosis is increasingly being recognized in children, mostly secondary to systemic underlying conditions or medication. However, no imaging modality currently provides a full evaluation of bone health in children. We compared DXA, a radiographic bone health index (BHI (BoneXpert) and cone-beam CT for the assessment of low bone mass in children with juvenile idiopathic arthritis (JIA). METHODS Data used in the present study was drawn from a large multicentre study including 228 children aged 4-16 years, examined between 2015 and 2020. All had a radiograph of the left hand, a DXA scan and a cone-beam CT of the temporomandibular joints within four weeks of each other. For the present study, we included 120 subjects, selected based on DXA BMD and BoneXpert BHI to secure values across the whole range to be tested. RESULTS One hundred and twenty children (60.0% females) were included, mean age 11.6 years (SD 3.1 years). There was a strong correlation between the absolute values of BHI and BMD for both total body less head (TBLH) (r = 0.75, p < 0.001) and lumbar spine (L1-L4) (r = 0.77, p < 0.001). The correlation between BHI standard deviation score (SDS) and BMD TBLH Z-scores was weak (r = 0.34) but significant (0 = 0.001), varying from weak (r = 0.31) to moderate (r = 0.42) between the three study sites. Categorizing BHI SDS and DXA BMD Z-scores on a 0-5 scale yielded a weak agreement between the two for both TBLH and LS, with w-kappa of 0.2, increasing to 0.3 when using quadratic weights. The agreement was notably higher for one of the three study sites as compared to the two others, particularly for spine assessment, yielding a moderate kappa value of 0.4 - 0.5. For cone-beam CT, based on a 1-3 scale, 59 out of 94 left TMJ's were scored as 1 and 31 as score 2 by the first observer vs. 87 and 7 by the second observer yielding a poor agreement (kappa 0.1). CONCLUSIONS Categorizing DXA LS and automated radiographic Z-scores on a 0-5 scale gave a weak to moderate agreement between the two methods, indicating that a hand radiograph might provide an adjuvant tool to DXA when assessing bone health children with JIA, given thorough calibration is performed.
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Affiliation(s)
- Thomas Augdal
- Section of Paediatric Radiology, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Oskar Angenete
- Department of Radiology and Nuclear Medicine, St Olavs Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Pia Zadig
- Section of Paediatric Radiology, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | | | - Ellen Nordal
- Department of Paediatrics, and Research Group for Child and Adolescent Health, Department of Clinical Medicine, University Hospital of North Norway, UiT The Arctic University of Norway, Tromsø, Norway
| | - Xieqi Shi
- Department of Clinical Dentistry, The Faculty of Medicine, University of Bergen, Bergen, Norway
- Department of Oral and Maxillofacial Radiology, Faculty of Odontology, University of Malmö, Malmö, Sweden
| | - Karen Rosendahl
- Section of Paediatric Radiology, University Hospital of North Norway, Tromsø, Norway.
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.
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Cannalire G, Biasucci G, Bertolini L, Patianna V, Petraroli M, Pilloni S, Esposito S, Street ME. Osteoporosis and Bone Fragility in Children: Diagnostic and Treatment Strategies. J Clin Med 2024; 13:4951. [PMID: 39201093 PMCID: PMC11355204 DOI: 10.3390/jcm13164951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2024] [Revised: 07/29/2024] [Accepted: 08/20/2024] [Indexed: 09/02/2024] Open
Abstract
The incidence of osteoporosis in children is increasing because of the increased survival rate of children with chronic diseases and the increased use of bone-damaging drugs. As childhood bone fragility has several etiologies, its management requires a thorough evaluation of all potentially contributing pathogenetic mechanisms. This review focuses on the main causes of primary and secondary osteoporosis and on the benefits and limits of the different radiological methods currently used in clinical practice for the study of bone quality. The therapeutic and preventive strategies currently available and the most novel diagnostic and treatment strategies are also presented. Optimal management of underlying systemic conditions is key for the treatment of bone fragility in childhood. DXA still represents the gold standard for the radiologic evaluation of bone health in children, although other imaging techniques such as computed tomography and ultrasound evaluations, as well as REMS, are increasingly studied and used. Bisphosphonate therapy is the gold standard for pharmacological treatment in both primary and secondary pediatric osteoporosis. Evidence and experience are building up relative to the use of monoclonal antibodies such as denosumab in cases of poor response to bisphosphonates in specific conditions such as osteogenesis imperfecta, juvenile Paget's disease and in some cases of secondary osteoporosis. Lifestyle interventions including adequate nutrition with adequate calcium and vitamin D intake, as well as physical activity, are recommended for prevention.
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Affiliation(s)
- Giuseppe Cannalire
- Paediatrics and Neonatology Unit, University of Parma, Guglielmo da Saliceto Hospital, 43121 Piacenza, Italy;
| | - Giacomo Biasucci
- Paediatrics and Neonatology Unit, University of Parma, Guglielmo da Saliceto Hospital, 43121 Piacenza, Italy;
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (S.P.); (M.E.S.)
| | - Lorenzo Bertolini
- Unit of Paediatric Radiology, University Hospital of Parma, 43126 Parma, Italy
| | - Viviana Patianna
- Unit of Paediatrics, Department of Mother and Child, University Hospital of Parma, 43126 Parma, Italy
| | - Maddalena Petraroli
- Unit of Paediatrics, Department of Mother and Child, University Hospital of Parma, 43126 Parma, Italy
| | - Simone Pilloni
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (S.P.); (M.E.S.)
| | - Susanna Esposito
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (S.P.); (M.E.S.)
- Unit of Paediatrics, Department of Mother and Child, University Hospital of Parma, 43126 Parma, Italy
| | - Maria Elisabeth Street
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (S.P.); (M.E.S.)
- Unit of Paediatrics, Department of Mother and Child, University Hospital of Parma, 43126 Parma, Italy
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Ma G, Xu B, Zhang D, Zhu L, Zhang Y, Yang B, Qin X, Yin H, Wei X. Association between weight-adjusted waist index and bone mineral density in adolescents. Sci Rep 2024; 14:16509. [PMID: 39019936 PMCID: PMC11255232 DOI: 10.1038/s41598-024-66565-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 07/02/2024] [Indexed: 07/19/2024] Open
Abstract
The negative effects of obesity and excess body fat on bone mineral density (BMD) have been widely reported. As opposed to waist circumference (WC) or body mass index (BMI), weight-adjusted waist index (WWI) is a superior method for assessing obesity. WWI also indicates centripetal obesity independently of the weight of the individual. An investigation of WWI and adolescents' BMD was conducted in this study. The National Health and Nutrition Examination Survey (NHANES) 2011-2018 provided the data for this cross-sectional investigation. In this study, weighted multivariate logit models were employed to assess the correlation between teenage BMD and WWI. Additionally, we conducted interaction tests and subgroup analysis. Through multivariate linear regression, we discovered that WWI was negatively linked with lumbar, trunk, and total BMD but not pelvis BMD in this study, which included 6828 subjects. We found that each unit increase in WWI resulted in a lumbar BMD decline of 0.04 g/cm2 (95%CI -0.04, -0.04), a trunk BMD decrease of 0.03 g/cm2 (95%CI -0.03, -0.02), and a total BMD decrease of 0.02 g/cm2 (95%CI -0.02, -0.02). In conclusion, in US teenagers, there were negative connections discovered between WWI and lumbar, trunk, and total BMD, but not pelvis BMD.
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Affiliation(s)
- Guoliang Ma
- Wangjing Hospital, China Academy of Traditional Chinese Medicine, No. 6, Zhonghuan South Road, Chaoyang District, Beijing, 100102, China
| | - Bo Xu
- Wangjing Hospital, China Academy of Traditional Chinese Medicine, No. 6, Zhonghuan South Road, Chaoyang District, Beijing, 100102, China
| | - Dian Zhang
- Wangjing Hospital, China Academy of Traditional Chinese Medicine, No. 6, Zhonghuan South Road, Chaoyang District, Beijing, 100102, China
| | - Liguo Zhu
- Wangjing Hospital, China Academy of Traditional Chinese Medicine, No. 6, Zhonghuan South Road, Chaoyang District, Beijing, 100102, China
- Beijing Key Laboratory of Bone Setting Technology of Traditional Chinese Medicine, Beijing, 100700, China
| | - Yili Zhang
- School of Integrated Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, 210023, China
| | - Bowen Yang
- Wangjing Hospital, China Academy of Traditional Chinese Medicine, No. 6, Zhonghuan South Road, Chaoyang District, Beijing, 100102, China
| | - Xiaokuan Qin
- Wangjing Hospital, China Academy of Traditional Chinese Medicine, No. 6, Zhonghuan South Road, Chaoyang District, Beijing, 100102, China
| | - He Yin
- Wangjing Hospital, China Academy of Traditional Chinese Medicine, No. 6, Zhonghuan South Road, Chaoyang District, Beijing, 100102, China.
| | - Xu Wei
- Wangjing Hospital, China Academy of Traditional Chinese Medicine, No. 6, Zhonghuan South Road, Chaoyang District, Beijing, 100102, China.
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Tong M, Li Y, Rong K, Sun Q, Dai J, Huang Y. Structural equation model analysis of the effect of visceral fat on osteoporosis. J Orthop Surg Res 2024; 19:408. [PMID: 39014367 PMCID: PMC11253341 DOI: 10.1186/s13018-024-04888-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 06/29/2024] [Indexed: 07/18/2024] Open
Abstract
BACKGROUND Osteoporosis is a considerable public health challenge in Moyu County, Xinjiang. Here, we evaluated the influencing factors of osteoporosis in this region. METHODS We recruited 7,761 participants and randomized them into normal and osteoporotic populations based on T-score. The effects of general conditions, body composition, calcium sources and exercise, respiratory exposure, and daily diet on osteoporosis were analyzed. Furthermore, a structural equation model was constructed to uncover the direct and indirect influencing factors of osteoporosis. RESULTS Among the participants, 1,803 (23.23%) had normal bone mass while 1,496 (19.28%) had osteoporosis. The univariate analysis showed significant differences in the general conditions, body composition, calcium sources and exercise, respiratory exposure, and daily diet. Stratification based on age (45 years) and body mass index (BMI) (18.5 kg/m2) showed variations in the body composition between the two groups; however, the visceral fat differed significantly. Logistic regression analysis affirmed the association of visceral fat index as it was included in all equations, except for age and female menopause. The structural equation exhibited that the general conditions, body composition, and, calcium sources, and exercise were direct factors of osteoporosis, while respiratory exposure and daily diet were indirect factors. The standardized path coefficient was highest in general conditions, followed by body composition, and lastly, calcium sources and exercise. CONCLUSION Obesity, besides age and female menopause, is also an influencing factor of osteoporosis. The visceral fat index plays a vital role in osteoporosis. Our findings may provide experimental evidence for early prevention and treatment of osteoporosis.
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Affiliation(s)
- Min Tong
- The Second Spine Department, Traditional Chinese Medicine Affiliated Hospital of Xinjiang Medical University, No. 116 Huanghe Road, Urumqi, 830000, China
| | - Yuanyuan Li
- School of Public Health, Xinjiang Medical University, Urumqi, 830011, China
| | - Kai Rong
- The Fourth Orthopedic Department, Traditional Chinese Medicine Affiliated Hospital of Xinjiang Medical University, Urumqi, 830000, China
| | - Qi Sun
- Medical Research Design and Data Analysis Center, Traditional Chinese Medicine Affiliated Hospital of Xinjiang Medical University, Urumqi, 830000, China
| | - Jianghong Dai
- School of Public Health, Xinjiang Medical University, Urumqi, 830011, China
| | - Yifei Huang
- The Second Spine Department, Traditional Chinese Medicine Affiliated Hospital of Xinjiang Medical University, No. 116 Huanghe Road, Urumqi, 830000, China.
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Hofbauer MH, Babu SS, Bradshaw CDL. Pediatric Trauma. Clin Podiatr Med Surg 2024; 41:571-592. [PMID: 38789171 DOI: 10.1016/j.cpm.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
Pediatric foot and ankle trauma includes a range of injuries affecting the lower extremities in children, typically aged from infancy to adolescence. These incidents can arise from various causes, including sports-related accidents, falls, and high-velocity injuries. Due to the dynamic growth and development of bones and soft tissues in pediatric patients, managing these injuries requires specialized knowledge and care. Early diagnosis and appropriate treatment are crucial to ensure optimal recovery and prevent potential long-term consequences. Treatment depends on severity and type of injury but may involve a combination of immobilization, physical therapy, or surgical intervention.
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Affiliation(s)
- Mark H Hofbauer
- WVU Medicine Wheeling Hospital, 10 Medical Park Road, Suite 203, Wheeling, WV, 26003, USA
| | - Sriya S Babu
- WVU Medicine Wheeling Hospital, 10 Medical Park Road, Suite 203, Wheeling, WV, 26003, USA.
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Ross JD, Diaz-Thomas A. Perioperative Evaluation and Management of Children with Osteoporosis and Low Bone Mineral Density. Orthop Clin North Am 2024; 55:345-353. [PMID: 38782506 DOI: 10.1016/j.ocl.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
As medical and surgical treatment options for children with osteoporosis expand, multidisciplinary strategies for bone health optimization become more important. Each patient's bone mineral density and fracture history should be interpreted in context. Off-label bisphosphonate use is a standard pharmacologic intervention for children with osteoporosis for optimal bone accrual. It is possible to continue this therapy perioperatively under certain circumstances. The rare side effects (osteonecrosis of the jaw and atypical femur fractures) seem less common in children. Physical therapy, vitamin D supplementation, and other interventions are also important tools for optimal bone health perioperatively and for satisfactory surgical outcomes.
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Affiliation(s)
- Jordan D Ross
- University of Tennessee Health Science Center, Faculty Office Building, Room 119, 49 North Dunlap, Memphis, TN 38103, USA.
| | - Alicia Diaz-Thomas
- Division of Pediatric Endocrinology, University of Tennessee Heath Science Center, Suite 1006, 910 Madison Avenue, Memphis, TN 38163, USA; Division of Pediatric Endocrinology, Le Bonheur Children's Hospital, Memphis, TN, USA
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10
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Işın UU, Çakmakçı E, Buluş AD, Yaşartekin Y, Ünal Ö, Dirican O, Husseini AA. Sonographic cortical bone thickness measurement: can it predict bone mineral density in the pediatric population? Diagn Interv Radiol 2024; 30:200-204. [PMID: 38044613 PMCID: PMC11095066 DOI: 10.4274/dir.2023.232392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 10/27/2023] [Indexed: 12/05/2023]
Abstract
PURPOSE To explore sonographic cortical bone thickness (CoT) as a potential indicator of bone mineral density (BMD) measured by dual-energy X-ray absorptiometry for screening and diagnosing pediatric osteoporosis. METHODS A prospective study included 41 osteopenic or osteoporotic patients and 52 healthy children. Radius cortical thickness (R-CoT), tibial cortical thickness (T-CoT), and second metatarsal cortical thickness (M-CoT) were measured by B-mode ultrasound; CoT values were compared between groups and the correlation between BMD and CoT was examined. RESULTS There were no significant differences in R-CoT (P = 0.433), T-CoT (P = 0.057), and M-CoT (P = 0.978) values between the patient and control groups. No significant correlations were found between BMD T-scores and R-CoT (r = -0.073, P = 0.490), T-CoT (r = -0.154, P = 0.141), and M-CoT (r = 0.047, P = 0.657) values. CONCLUSION Sonographic CoT values in children do not correlate with BMD values. Unlike in adults, sonographic CoT measurements do not appear to have a role in assessing BMD in the pediatric population.
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Affiliation(s)
- Uğur Ufuk Işın
- University of Health Sciences Türkiye, Atatürk Sanatorium Training and Research Hospital, Clinic of Pediatrics, Ankara, Türkiye
| | - Emin Çakmakçı
- University of Health Sciences Türkiye, Atatürk Sanatorium Training and Research Hospital, Clinic of Radiology, Ankara, Türkiye
| | - Ayşe Derya Buluş
- University of Health Sciences Türkiye, Atatürk Sanatorium Training and Research Hospital, Clinic of Pediatric Endocrinology, Ankara, Türkiye
| | - Yüksel Yaşartekin
- University of Health Sciences Türkiye, Atatürk Sanatorium Training and Research Hospital, Clinic of Pediatric Endocrinology, Ankara, Türkiye
| | - Öznur Ünal
- University of Health Sciences Türkiye, Atatürk Sanatorium Training and Research Hospital, Clinic of Radiology, Ankara, Türkiye
| | - Onur Dirican
- İstanbul Gelişim University, Vocational School of Health Services, Department of Pathology Laboratory Techniques, İstanbul, Türkiye
| | - Abbas Ali Husseini
- İstanbul Gelişim University, Life Science and Biomedical Engineering Application and Research Center, İstanbul, Türkiye
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11
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Tabaie SA, O'Mara AE, Sheppard ED, Tosi LL. A Comprehensive Review of Bone Health in a Child: From Birth to Adulthood. J Am Acad Orthop Surg 2024; 32:363-372. [PMID: 38261781 DOI: 10.5435/jaaos-d-23-00853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 12/17/2023] [Indexed: 01/25/2024] Open
Abstract
Bone health is critical for growth and development during childhood. Although fractures are common in children, fractures occurring in the absence of trauma should prompt physicians to consider underlying bone health disorders. This article provides an overview of the current definition of osteoporosis in children, highlighting its limitations and the potential for underdiagnosis. It also discusses the timing of screening initiation and various techniques used to assess bone health, along with their respective benefits and limitations. In addition, this article identifies several causes of primary and secondary osteoporosis in children, shedding light on previously overlooked disorders that can contribute to poor bone quality. The article emphasizes the importance of a multidisciplinary approach to therapeutic management and aims to optimize patient outcomes and improve the overall care of pediatric bone health disorders.
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Affiliation(s)
- Sean A Tabaie
- From the Division of Orthopaedic Surgery and Sports Medicine, Children's National Hospital (Tabaie, Sheppard, and Tosi), and Department of Orthopaedic Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC (O'Mara)
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12
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Soucek O, Cinek O, Velentza L, Semjonov V, Bezdicka M, Zaman F, Sävendahl L. Lithium rescues cultured rat metatarsals from dexamethasone-induced growth failure. Pediatr Res 2024:10.1038/s41390-024-03192-6. [PMID: 38684886 DOI: 10.1038/s41390-024-03192-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 02/18/2024] [Accepted: 03/24/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Glucocorticoids are commonly used in children with different chronic diseases. Growth failure represents a so far untreatable undesired side-effect. As lithium chloride (LiCl) is known to induce cell renewal in various tissues, we hypothesized that LiCl may prevent glucocorticoid-induced growth failure. METHODS We monitored growth of fetal rat metatarsals cultured ex-vivo with dexamethasone and/or LiCl, while molecular mechanisms were explored through RNA sequencing by implementing the differential gene expression and gene set analysis. Quantification of β-catenin in human growth plate cartilage cultured with dexamethasone and/or LiCl was added for verification. RESULTS After 14 days of culture, the length of dexamethasone-treated fetal rat metatarsals increased by 1.4 ± 0.2 mm compared to 2.4 ± 0.3 mm in control bones (p < 0.001). The combination of LiCl and dexamethasone led to bone length increase of 1.9 ± 0.3 mm (p < 0.001 vs. dexamethasone alone). By adding lithium, genes for cell cycle and Wnt/β-catenin, Hedgehog and Notch signaling, were upregulated compared to dexamethasone alone group. CONCLUSIONS LiCl has the potential to partially rescue from dexamethasone-induced bone growth impairment in an ex vivo model. Transcriptomics identified cell renewal and proliferation as candidates for the underlying mechanisms. Our observations may open up the development of a new treatment strategy for bone growth disorders. IMPACT LiCl is capable to prevent glucocorticoid-induced growth failure in rat metatarsals in vitro. The accompanying drug-induced transcriptomic changes suggested cell renewal and proliferation as candidate underlying mechanisms. Wnt/beta-catenin pathway could be one of those novel mechanisms.
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Affiliation(s)
- Ondrej Soucek
- Vera Vavrova Lab/VIAL, Department of Paediatrics, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic.
- Paediatric Endocrinology Unit, Department of Children's and Women's Health, Karolinska Institutet, Stockholm, Sweden.
| | - Ondrej Cinek
- Department of Paediatrics and Department of Medical Microbiology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Lilly Velentza
- Paediatric Endocrinology Unit, Department of Children's and Women's Health, Karolinska Institutet, Stockholm, Sweden
| | - Valerij Semjonov
- Department of Paediatrics and Department of Medical Microbiology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Martin Bezdicka
- Vera Vavrova Lab/VIAL, Department of Paediatrics, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Farasat Zaman
- Paediatric Endocrinology Unit, Department of Children's and Women's Health, Karolinska Institutet, Stockholm, Sweden
| | - Lars Sävendahl
- Paediatric Endocrinology Unit, Department of Children's and Women's Health, Karolinska Institutet, Stockholm, Sweden
- Astrid Lindgren Children´s Hospital, Karolinska University Hospital, Stockholm, Sweden
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13
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Rajendran S, Lee ZC, Seow CE, Khaw CH. Right Femoral Fragility Fracture in an Adolescent with Vitamin D Deficiency from COVID-19 Pandemic-Related Confinement. Case Rep Endocrinol 2024; 2024:8354501. [PMID: 38500707 PMCID: PMC10948220 DOI: 10.1155/2024/8354501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 02/14/2024] [Accepted: 03/05/2024] [Indexed: 03/20/2024] Open
Abstract
Background The COVID-19 pandemic has caused major impacts in various aspects of our life. In Malaysia, a Movement Control Order was imposed in March 2020. For almost two years, school going children and adolescents were not able to attend school physically, and their physical activity was confined within their room or house on most days. Case Description. We describe a case of a 14-year-old boy who was previously active in sports and sustained a low trauma fracture at the right neck of the femur following a prolonged period of extreme sedentary life along with poor dietary intake during the COVID-19 pandemic period. He underwent open reduction and screw fixation for the right neck femur fracture. He was thin with a low BMI (15.62 kg/m2) and a significant loss of muscle bulk in all limbs. Laboratory tests showed vitamin D deficiency (15.3 nmol/L) and the dual energy X-ray absorptiometry (DXA) showed a low Z-score for the total spine (-2.2) and total hip (-3.9). He was treated with activated vitamin D and vitamin D3 replacement. Sports physician was involved for individualized postoperative rehabilitation. Successive clinic visits showed remarkable improvements in physical fitness, sports participation, and normalization of vitamin D levels. Conclusion A high degree of suspicion is needed to rule out secondary causes in adolescents who present with unusual fragility fractures.
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Affiliation(s)
| | - Ze Chen Lee
- Department of Internal Medicine, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Chu Ee Seow
- Department of Internal Medicine, Hospital Banting, Banting, Malaysia
| | - Chong Hui Khaw
- Department of Endocrinology, Hospital Pulau Pinang, George Town, Malaysia
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14
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Formosa MM, Christou MA, Mäkitie O. Bone fragility and osteoporosis in children and young adults. J Endocrinol Invest 2024; 47:285-298. [PMID: 37668887 PMCID: PMC10859323 DOI: 10.1007/s40618-023-02179-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 08/16/2023] [Indexed: 09/06/2023]
Abstract
Osteoporosis is a metabolic bone disorder which increases fragility fracture risk. Elderly individuals, especially postmenopausal women, are particularly susceptible to osteoporosis. Although rare, osteoporosis in children and young adults is becoming increasingly evident, highlighting the need for timely diagnosis, management and follow-up. Early-onset osteoporosis is defined as the presence of a low BMD (Z-score of ≤ -2.0 in individuals aged < 20 years; T-score of ≤ -2.5 in those aged between 20 to 50 years) accompanied by a clinically significant fracture history, or the presence of low-energy vertebral compression fractures even in the absence of osteoporosis. Affected children and young adults should undergo a thorough diagnostic workup, including collection of clinical history, radiography, biochemical investigation and possibly bone biopsy. Once secondary factors and comorbidities are excluded, genetic testing should be considered to determine the possibility of an underlying monogenic cause. Defects in genes related to type I collagen biosynthesis are the commonest contributors of primary osteoporosis, followed by loss-of-function variants in genes encoding key regulatory proteins of canonical WNT signalling (specifically LRP5 and WNT1), the actin-binding plastin-3 protein (encoded by PLS3) resulting in X-linked osteoporosis, and the more recent sphingomyelin synthase 2 (encoded by SGMS2) which is critical for signal transduction affecting sphingomyelin metabolism. Despite these discoveries, genetic causes and underlying mechanisms in early-onset osteoporosis remain largely unknown, and if no causal gene is identified, early-onset osteoporosis is deemed idiopathic. This calls for further research to unravel the molecular mechanisms driving early-onset osteoporosis that consequently will aid in patient management and individualised targeted therapy.
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Affiliation(s)
- M M Formosa
- Department of Applied Biomedical Science, Faculty of Health Sciences, University of Malta, Msida, Malta
- Center for Molecular Medicine and Biobanking, University of Malta, Msida, Malta
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - M A Christou
- Department of Endocrinology, School of Medicine, University of Ioannina, Ioannina, Greece
- Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, Ioannina, Greece
| | - O Mäkitie
- Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
- Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
- Folkhälsan Research Centre, Folkhälsan Institute of Genetics, Helsinki, Finland.
- Department of Molecular Medicine and Surgery, Karolinska Institutet, and Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden.
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15
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Rodrick E, Kindler JM. Bone mass accrual in children. Curr Opin Endocrinol Diabetes Obes 2024; 31:53-59. [PMID: 38010050 PMCID: PMC11015822 DOI: 10.1097/med.0000000000000849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
PURPOSE OF REVIEW Bone accrual during childhood and adolescence is critical for the attainment of peak bone mass and is a major contributing factor towards osteoporosis in later life. Bone mass accrual is influenced by nonmodifiable factors, such as genetics, sex, race, ethnicity, and puberty, as well as modifiable factors, such as physical activity and diet. Recent progress in bone imaging has allowed clinicians and researchers to better measure the morphology, density, and strength of the growing skeleton, thereby encompassing key characteristics of peak bone strength. In this review, the patterning of bone accrual and contributors to these changes will be described, as well as new techniques assessing bone mass and strength in pediatric research and clinical settings. RECENT FINDINGS This review discusses factors influencing peak bone mass attainment and techniques used to assess the human skeleton. SUMMARY The rate of bone accrual and the magnitude of peak bone mass attainment occurs in specific patterns varying by sex, race, ethnicity, longitudinal growth, and body composition. Physical activity, diet, and nutritional status impact these processes. There is a need for longitudinal studies utilizing novel imaging modalities to unveil factors involved in the attainment and maintenance of peak bone strength.
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Affiliation(s)
- Eugene Rodrick
- University of Georgia, Department of Nutritional Sciences, Athens, Georgia, USA
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16
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Bindels-de Heus KGCB, Hagenaar DA, Mous SE, Dekker I, van der Kaay DCM, Kerkhof GF, Elgersma Y, Moll HA, de Wit MCY. Bone health in children with Angelman syndrome at the ENCORE Expertise Center. Eur J Pediatr 2024; 183:103-111. [PMID: 37831301 PMCID: PMC10857954 DOI: 10.1007/s00431-023-05231-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 09/11/2023] [Accepted: 09/18/2023] [Indexed: 10/14/2023]
Abstract
Angelman syndrome (AS) is a rare genetic disorder due to lack of UBE3A function on chromosome 15q11.2q13 caused by a deletion, uniparental paternal disomy (UPD), imprinting center disorder (ICD), or pathological variant of the UBE3A gene. AS is characterized by developmental delay, epilepsy, and lack of speech. Although fractures are observed frequently in our clinical practice, there are few studies on bone health in AS. The aim of this study is to investigate bone health in children with AS. In this prospective cohort study, we describe bone health in 91 children with AS visiting the ENCORE Expertise Center for AS between April 2010 and December 2021. Bone health was assessed with the bone health index (BHI) in standard deviation score (SDS) measured by digital radiogrammetry of the left hand using BoneXpert software. Risk factors analyzed were age, sex, genetic subtype, epilepsy, anti-seizure medication use, mobility, body mass index (BMI), and onset of puberty. Children with AS had a mean BHI of -1.77 SDS (SD 1.4). A significantly lower BHI was found in children with a deletion (-2.24 SDS) versus non-deletion (-1.02 SDS). Other factors associated with reduced BHI-SDS were inability to walk and late onset of puberty. Children with a history of one or more fractures (22%) had a significantly lower BHI than children without fractures (-2.60 vs -1.56 SDS). Longitudinal analysis showed a significant decrease in BHI-SDS with age in all genetic subtypes. Conclusions: Children with AS have a reduced bone health. Risk factors are deletion genotype, no independent walking, and late onset of puberty. Bone health decreased significantly with age. What is Known: • Children with neurological disorders often have a low bone health and higher risk of fractures. • Little is known about bone health in children with Angelman syndrome (AS). What is New: • Children with AS showed a reduced bone health and this was significantly associated with having a deletion, not being able to walk independently, and late onset of puberty. • Longitudinal analysis showed a significant decrease in bone health as children got older.
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Affiliation(s)
- Karen G C B Bindels-de Heus
- Dept. of Pediatrics, Erasmus MC Sophia Children's Hospital, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands.
| | - Doesjka A Hagenaar
- Dept. of Pediatrics, Erasmus MC Sophia Children's Hospital, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands
- Dept. of Child- and Adolescent Psychiatry and Psychology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Sabine E Mous
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands
- Dept. of Child- and Adolescent Psychiatry and Psychology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Ilonka Dekker
- Dept. of Pediatrics, Erasmus MC Sophia Children's Hospital, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | | | - Gerthe F Kerkhof
- Dept. of Pediatric Endocrinology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Ype Elgersma
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands
- Dept. of Clinical Genetics, Erasmus MC, Rotterdam, The Netherlands
| | - Henriette A Moll
- Dept. of Pediatrics, Erasmus MC Sophia Children's Hospital, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands
| | - Marie-Claire Y de Wit
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands
- Dept. of Neurology and Pediatric Neurology, Erasmus MC, Rotterdam, The Netherlands
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17
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Amarnath SS, Kumar V, Das SL. Classification of Osteoporosis. Indian J Orthop 2023; 57:49-54. [PMID: 38107823 PMCID: PMC10721754 DOI: 10.1007/s43465-023-01058-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 11/12/2023] [Indexed: 12/19/2023]
Abstract
Osteoporosis is defined by low bone quality, strength and increased fracture risk. Primary and secondary osteoporosis are the two forms of osteoporosis classified on the basis of factors affecting the metabolism of bone. Primary osteoporosis develops as a result of aging or menopause-related bone demineralization. Type I/postmenopausal and type II/senile osteoporosis are two subtypes of primary osteoporosis. Secondary osteoporosis is due to pathological conditions and medications other than aging and menopause that lead to deprivation of bone mass and elevated fracture risk. Classification of osteoporosis based on BMD testing with DEXA devised by the World Health Organization utilizes T-score in BMD reporting of women in menopausal transition or postmenopause and men ≥ 50 years. Z-scores are preferred, while BMD reporting in premenopausal women, adults < 50 years of age, and children. BMD alone is not diagnostic of osteoporosis in men < 50 years. The Fracture Risk Assessment Tool Model (FRAX) is a software algorithm that incorporates significant predictors of fracture risk and BMD in individuals to predict the risk of fracture. FRAX predicts the "10-year probability of a major fracture (hip, clinical spine, humerus, or wrist fracture) and the 10-year probability of a hip fracture".
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Affiliation(s)
- S. S. Amarnath
- Trauma and Orthopedic Surgeon, Trinity Central Hospital, Bangalore, India
| | - Vishal Kumar
- Department of Orthopedics, PGIMER, Chandigarh, India
| | - S. Lakshmana Das
- Department of Orthopedics, All India Institute of Medical Sciences, Bathinda, India
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18
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Naga YS, Sharaki OA, Azzam EZ, Farag EMM, Zeid MMH. Relation of testosterone level and other factors with bone mineral density in male kidney transplant recipients: a cross-sectional study. BMC Nephrol 2023; 24:271. [PMID: 37710199 PMCID: PMC10502991 DOI: 10.1186/s12882-023-03318-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 09/04/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND Although testosterone has a pivotal role in bone health, its correlation with bone mineral density (BMD) is understudied in kidney transplant recipients who are at high risk of osteoporosis. This study aimed to elucidate if there is any correlation between serum free testosterone and BMD in this population. PATIENTS AND METHODS Sixty male kidney transplant recipients were enrolled in this cross-sectional study, and they were subjected to history taking, clinical examination, and laboratory investigations (including total and free testosterone). BMD was assessed in three regions (forearm, hip, and lumbar spine) using DEXA scan. RESULTS The mean age of the included patients was 45.55 ± 13.58 years. Serum total and free testosterone had mean values of 5.17 ± 1.4 ng/ml and 95.46 ± 28.24 pg/ml, respectively, with all levels within the normal range. DEXA scan detected osteoporosis and osteopenia in 9 (15%) and 30 (50%) patients in the lumbar region, 3 (5%) and 36 (60%) in the hip region, as well as 21 (35%) and 33 (55%) in the forearm region, respectively. BMD of the lumbar region had a significant positive correlation with free testosterone, phosphorus, and eGFR, while it had a significant negative correlation with platelets and patient age. BMD of the hip region was positively correlated with serum phosphorus, parathyroid hormone, and duration since the transplant, whereas it was negatively correlated with platelets and total testosterone level. BMD of the forearm had a significant positive correlation with eGFR, whereas it had a significant negative correlation with age and duration since transplantation. In addition, forearm BMD was significantly lower in patients with a radiocephalic AVF. CONCLUSION Even within the normal range, free testosterone has a significant positive correlation with lumbar spine BMD with no significant association with the forearm or hip BMD.
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Affiliation(s)
- Yasmine Salah Naga
- Nephrology Unit, Internal Medicine Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Ola Atef Sharaki
- Clinical and Chemical Pathology Department, Faculty Of Medicine, Alexandria University, Alexandria, Egypt
| | - Eman Zaki Azzam
- Endocrinology Unit, Internal Medicine Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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19
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Mraja HM, Gök H, Daadour IMF, Ulusoy OL, Şanlı T, Karadereler S, Enercan M, Hamzaoglu A. Cement Augmented Pedicle Screw Instrumentation in Pediatric Spine Surgery. World Neurosurg 2023; 174:e126-e130. [PMID: 36894000 DOI: 10.1016/j.wneu.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/28/2023] [Accepted: 03/01/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND Osteoporosis in pediatric patients is rare. Osteomalacia and osteoporosis are known to develop in syndromic or neuromuscular scoliosis children. Spinal deformity surgery for pediatric patients with osteoporosis is challenging, associated with pedicle screw (PS) failure and compression fractures. Cement augmentation of PS is one several measures to prevent screw failure. It provides additional pull-out strength to the PS in the osteoporotic vertebra. METHODS In 2010-2020, an analysis of pediatric patients who had cement augmentation of PS with a minimum follow-up of 2 years was performed. Radiological and clinical evaluations were analyzed. RESULTS The study included 7 patients (4 girls, 3 boys) with a mean age of 13 years (range, 10-14 years) and mean follow-up of 3 years (range, 2-3 years). Only 2 patients underwent revision surgery. Total number of cement augmented PSs was 52 with an average of 7 per patient. Only 1 patient had lower instrumented vertebra vertebroplasty. There was no PS pull-out in the cement augmented levels, and there were no neurological deficits or pulmonary cement embolisms. One patient developed a PS pull-out in uncemented levels. Two patients developed compression fractures, one, with osteogenesis imperfecta, in the supra-adjacent levels (upper instrumented vertebra + 1 and upper instrumented vertebra + 2), and the other, with neuromuscular scoliosis, in the uncemented segments. CONCLUSIONS In this study, all cement augmented PSs provided satisfactory radiological outcomes without PS pull-out and adjacent vertebral compression fracture. In pediatric spine surgery, in osteoporotic patients with a poor bone purchase, cement augmentation may be used, especially in high-risk patients with osteogenesis imperfecta, neuromuscular scoliosis, and syndromic scoliosis.
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Affiliation(s)
| | - Halil Gök
- Scoliosis-Spine Center Istanbul, Istanbul Florence Nightingale Hospital, Istanbul, Turkey
| | | | - Onur Levent Ulusoy
- Radiology Department, Istanbul Florence Nightingale Hospital, Istanbul, Turkey
| | - Tunay Şanlı
- Scoliosis-Spine Center Istanbul, Istanbul Florence Nightingale Hospital, Istanbul, Turkey
| | - Selhan Karadereler
- Scoliosis-Spine Center Istanbul, Istanbul Florence Nightingale Hospital, Istanbul, Turkey
| | - Meriç Enercan
- Scoliosis-Spine Center Istanbul, Demiroglu Bilim University, Istanbul, Turkey
| | - Azmi Hamzaoglu
- Scoliosis-Spine Center Istanbul, Istanbul Florence Nightingale Hospital, Istanbul, Turkey
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20
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Majdoub F, Ferjani HL, Nessib DB, Kaffel D, Maatallah K, Hamdi W. Denosumab use in osteogenesis imperfecta: an update on therapeutic approaches. Ann Pediatr Endocrinol Metab 2023; 28:98-106. [PMID: 37401056 DOI: 10.6065/apem.2346058.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 05/05/2023] [Indexed: 07/05/2023] Open
Abstract
Osteogenesis imperfecta (OI) is an inherited skeletal disorder that leads to bone fragility and multiple fractures. Given advances in the genetic understanding of existing phenotypes and newly discovered mutations, therapeutic management of OI has become challenging. Denosumab, a monoclonal antibody that inhibits the interaction between the receptor activator of nuclear factor kappa B ligand (RANKL) and its receptor RANK, has been approved to treat postmenopausal osteoporosis and emerged as an important therapy for malignancies and other skeletal disorders, including pediatric skeletal conditions such as OI. This review summarizes information about denosumab therapy in OI by exploring its mechanisms of action, main indications, and safety and efficacy. Several case reports and small series have been published about the short-term use of denosumab in children with OI. Denosumab was considered a strong drug candidate for OI patients with bone fragility and a high risk of fracture, particularly for patients with the bisphosphonate (BP)-unresponsive OI-VI subtype. The evidence for denosumab's effects in children with OI indicates that it effectively improves bone mineral density but not fracture rates. A decrease in bone resorption markers was observed after each treatment. Safety was assessed by tracking the effects on calcium homeostasis and reporting side effects. No severe adverse effects were reported. Hypercalciuria and moderate hypercalcemia were reported, suggesting that BPs be used to prevent the bone rebound effect. In other words, denosumab can be used as a targeted intervention in children with OI. The posology and administration protocol require more investigation to achieve secure efficiency.
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Affiliation(s)
- Fatma Majdoub
- Rheumatology Department, Kassab Orthopedics Institute, Ksar Saïd, Tunisia
- Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia
- Research unit UR17SP04, 2010, Ksar Said 2010, Tunis, Tunisia
| | - Hanene Lassoued Ferjani
- Rheumatology Department, Kassab Orthopedics Institute, Ksar Saïd, Tunisia
- Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia
- Research unit UR17SP04, 2010, Ksar Said 2010, Tunis, Tunisia
| | - Dorra Ben Nessib
- Rheumatology Department, Kassab Orthopedics Institute, Ksar Saïd, Tunisia
- Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia
- Research unit UR17SP04, 2010, Ksar Said 2010, Tunis, Tunisia
| | - Dhia Kaffel
- Rheumatology Department, Kassab Orthopedics Institute, Ksar Saïd, Tunisia
- Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia
- Research unit UR17SP04, 2010, Ksar Said 2010, Tunis, Tunisia
| | - Kaouther Maatallah
- Rheumatology Department, Kassab Orthopedics Institute, Ksar Saïd, Tunisia
- Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia
- Research unit UR17SP04, 2010, Ksar Said 2010, Tunis, Tunisia
| | - Wafa Hamdi
- Rheumatology Department, Kassab Orthopedics Institute, Ksar Saïd, Tunisia
- Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia
- Research unit UR17SP04, 2010, Ksar Said 2010, Tunis, Tunisia
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21
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Xu K, Gao B, Liu T, Li J, Xiang Y, Fu Y, Zhao M. Association of blood mercury levels with bone mineral density in adolescents aged 12-19. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:46933-46939. [PMID: 36735129 DOI: 10.1007/s11356-023-25701-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 01/30/2023] [Indexed: 06/18/2023]
Abstract
Bone mass increases rapidly in adolescence, and achieving higher bone mineral density (BMD) during this period can help prevent osteoporosis. However, the effects of metallic mercury on bone health remain controversial. Previous studies have discussed perimenopausal women and older adults, while the association of blood mercury with BMD in adolescents is yet to be studied. Date was collected from the National Health and Nutrition Examination Survey (NHANES) 2011-2018. Weighted multiple linear regression models were used to explore the association of blood mercury levels with BMD in adolescents, while smooth curve fittings and weighted generalized additive models were used to identify the potential nonlinear association. We found that blood mercury levels were negatively associated with BMD in adolescents, though not significantly, based on the results of statistical analyses of 2818 participants. Additionally, the trend in BMD with changes in blood mercury was different in male and female adolescents. We also found an inverted U-shaped association between blood mercury and BMD in male and Mexican-American adolescents. This suggests that increased blood mercury levels within a range may benefit bone health in male adolescents (inflection point: 5.44 nmol/L) and Mexican-American adolescents (inflection point: 5.49 nmol/L), while higher blood mercury levels may harm bone health. More prospective research is needed to confirm our findings.
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Affiliation(s)
- Ke Xu
- Department of Pediatrics, The Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan, China
- Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Bingqian Gao
- Department of Pediatrics, The Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan, China
- Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Tingfeng Liu
- Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Jiayi Li
- Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Yixin Xiang
- Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Yicheng Fu
- Department of Pediatrics, Wuhan University Renmin Hospital, Wuhan University, Wuhan, 430060, Hubei, China
| | - Mingyi Zhao
- Department of Pediatrics, The Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan, China.
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22
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Gevers EF, de Winter JP. New developments and therapies in pediatric endocrinology. Eur J Pediatr 2023; 182:1439-1443. [PMID: 36567374 DOI: 10.1007/s00431-022-04772-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Evelien F Gevers
- Centre for Endocrinology, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom.
- Department of Paediatric Endocrinology and Diabetes, Barts Health NHS Trust - The Royal London Children's Hospital, London, United Kingdom.
| | - J Peter de Winter
- Department of Pediatrics, Spaarne Gasthuis, Haarlem/Hoofddorp, The Netherlands
- Leuven Child and Health Institute, KU Leuven, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
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23
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Ciancia S, Högler W, Sakkers RJB, Appelman-Dijkstra NM, Boot AM, Sas TCJ, Renes JS. Osteoporosis in children and adolescents: how to treat and monitor? Eur J Pediatr 2023; 182:501-511. [PMID: 36472650 DOI: 10.1007/s00431-022-04743-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 11/25/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022]
Abstract
UNLABELLED Osteoporosis is a condition of increased bone fragility associated with fractures. Apart from primary genetic osteoporotic conditions, secondary osteoporosis in children is being increasingly recognized. As a result, there is growing interest in its prevention and treatment. Important goals of care are to prevent fractures, increase bone mass and trabecular and cortical thickness, reshape vertebral fractures, prevent (or correct) skeletal deformities, and improve mobility, independence, and quality of life. Secondary pediatric osteoporosis is often of multifactorial origin since affected children frequently have more than one acquired factor that is detrimental to bone health. Typical conditions causing osteoporosis are leukemias, progressive muscle or neurological disorders, as well as chronic inflammatory conditions and their treatment. Management of children with osteoporosis involves a multidisciplinary team involving pediatric experts from different subspecialties. With regard to prevention and early intervention, it is important to provide optimal management of any underlying systemic conditions including avoidance, or dose-reduction, of osteotoxic medications. Basic supporting life-style measures, such as appropriate nutrition, including adequate calcium intake and vitamin D, and physical activity are recommended, where possible. When pediatric treatment criteria for osteoporosis are met, antiresorptive drugs constitute the first pharmacological line treatment. CONCLUSION This clinical review focuses on the prevention, treatment, and follow-up of children with, or at risk of developing, osteoporosis and the transition from pediatric to adult care. WHAT IS KNOWN • Osteoporosis and associated fractures can cause significant morbidity and reduce the quality of life. • The developing skeleton has huge potential for recovery and reshaping, thus early detection of fractures, assessment of recovery potential, and treatment of children with osteoporosis can prevent future fractures, deformities, and scoliosis, improve function and mobility, and reduce pain. WHAT IS NEW • Osteoporosis in children and adolescents requires a multidisciplinary approach with a thorough assessment of recovery potential, and indication for therapy should be personalized. • Although bisphosphonates still represent the drug most commonly used to increase bone mass, improve mobility, and reduce pain and recurrence of fractures, new agents are being developed and could be beneficial in children with specific conditions.
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Affiliation(s)
- Silvia Ciancia
- Department of Pediatrics, Subdivision of Endocrinology, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands.
| | - Wolfgang Högler
- Department of Pediatrics and Adolescent Medicine, Johannes Kepler University Linz, Linz, Austria
| | - Ralph J B Sakkers
- Department of Orthopedic Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Natasha M Appelman-Dijkstra
- Department of Internal Medicine, Subdivision of Endocrinology, Center for Bone Quality, Leiden University Medical Center, Leiden, The Netherlands
| | - Annemieke M Boot
- Department of Pediatrics, Subdivision of Endocrinology, University Medical Center Groningen, Beatrix Childrens Hospital, University of Groningen, Groningen, The Netherlands
| | - Theo C J Sas
- Department of Pediatrics, Subdivision of Endocrinology, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands.,Center for Pediatric and Adult Diabetes Care and Research, Rotterdam, The Netherlands
| | - Judith S Renes
- Department of Pediatrics, Albert Schweitzer Hospital, Dordrecht, The Netherlands.,Dutch Growth Research Foundation, Rotterdam, The Netherlands
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Madhuchani D, Seneviratne SN, Ward LM. Bone health in childhood and adolescence: an overview on dual-energy X-ray absorptiometry scanning, fracture surveillance and bisphosphonate therapy for low-middle-income countries. Front Endocrinol (Lausanne) 2023; 14:1082413. [PMID: 37139332 PMCID: PMC10150014 DOI: 10.3389/fendo.2023.1082413] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 02/16/2023] [Indexed: 05/05/2023] Open
Abstract
Bone accrual in childhood determines bone health in later life. Loss of bone strength in early life can lead to increased morbidity and reduced quality of life in childhood and adolescence. Increased availability of assessment tools and bisphosphonate therapy, together with increased awareness on the significance of fracture history and risk factors, have led to greater opportunities, to improve detection and optimize management of children and adolescents with bone fragility globally, including those in lower resource settings. Bone mineral density z-scores and bone mineral content are surrogate measures of bone strength, which can be measured by dual-energy X-ray absorptiometry (DXA), in growing individuals. DXA can aid in the diagnosis and management of primary and secondary bone fragility disorders in childhood. DXA helps evaluate children with clinically significant fractures, and monitor those with bone fragility disorders, or at high risk for compromised bone strength. Obtaining DXA images can however be challenging, especially in younger children, due to difficulty in positioning and movement artefacts, while paediatric DXA interpretation can be confounded by effects of growth and puberty. Furthermore, access to DXA facilities as well as appropriate paediatric reference norms and expertise for interpretation, may not be easily available especially in lower resource settings. Pediatric bone experts are now placing increasing emphasis on the fracture phenotype and clinical context to diagnose osteoporosis over bone mineral density (BMD) by DXA. Low trauma vertebral fractures are now recognized as a hallmark of bone fragility, and spinal fracture surveillance by either conventional lateral thoracolumbar radiographs or vertebral fracture assessment by DXA is gaining increasing importance in diagnosing childhood osteoporosis, and initiating bone protective therapy. Furthermore, it is now understood that even a single, low-trauma long bone fracture can signal osteoporosis in those with risk factors for bone fragility. Intravenous bisphosphonate therapy is the mainstay of treatment for childhood bone fragility disorders. Other supportive measures to improve bone strength include optimizing nutrition, encouraging weight bearing physical activity within the limits of the underlying condition, and treating any associated endocrinopathies. With this paradigm shift in childhood osteoporosis evaluation and management, lack of DXA facilities to assess BMD at baseline and/or provide serial monitoring is not a major barrier for initiating IV bisphosphonate therapy in children in whom it is clinically indicated and would benefit from its use. DXA is useful, however, to monitor treatment response and optimal timing for treatment discontinuation in children with transient risk factors for osteoporosis. Overall, there is lack of awareness and paucity of guidelines on utilizing and adopting available resources to manage paediatric bone disorders optimally in lower-resource settings. We provide an evidence-based approach to the assessment and management of bone fragility disorders in children and adolescents, with appropriate considerations for lower resource settings including LMIC countries.
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Affiliation(s)
| | - Sumudu Nimali Seneviratne
- Department of Paediatrics, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
- *Correspondence: Sumudu Nimali Seneviratne,
| | - Leanne M. Ward
- Department of Pediatrics, University of Ottawa and Division of Endocrinology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
- The Ottawa Pediatric Bone Health Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
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25
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Ross J, Bowden MR, Yu C, Diaz-Thomas A. Transition of young adults with metabolic bone diseases to adult care. Front Endocrinol (Lausanne) 2023; 14:1137976. [PMID: 37008909 PMCID: PMC10064010 DOI: 10.3389/fendo.2023.1137976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 03/06/2023] [Indexed: 03/19/2023] Open
Abstract
As more accurate diagnostic tools and targeted therapies become increasingly available for pediatric metabolic bone diseases, affected children have a better prognosis and significantly longer lifespan. With this potential for fulfilling lives as adults comes the need for dedicated transition and intentional care of these patients as adults. Much work has gone into improving the transitions of medically fragile children into adulthood, encompassing endocrinologic conditions like type 1 diabetes mellitus and congenital adrenal hyperplasia. However, there are gaps in the literature regarding similar guidance concerning metabolic bone conditions. This article intends to provide a brief review of research and guidelines for transitions of care more generally, followed by a more detailed treatment of bone disorders specifically. Considerations for such transitions include final adult height, fertility, fetal risk, heritability, and access to appropriately identified specialists. A nutrient-dense diet, optimal mobility, and adequate vitamin D stores are protective factors for these conditions. Primary bone disorders include hypophosphatasia, X-linked hypophosphatemic rickets, and osteogenesis imperfecta. Metabolic bone disease can also develop secondarily as a sequela of such diverse exposures as hypogonadism, a history of eating disorder, and cancer treatment. This article synthesizes research by experts of these specific disorders to describe what is known in this field of transition medicine for metabolic bone diseases as well as unanswered questions. The long-term objective is to develop and implement strategies for successful transitions for all patients affected by these various conditions.
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Affiliation(s)
- Jordan Ross
- Division of Pediatric Endocrinology, University of Tennessee Health Science Center, Memphis, TN, United States
- *Correspondence: Jordan Ross,
| | - Michelle R. Bowden
- Division of General Pediatrics, University of Tennessee Health Science Center, Memphis, TN, United States
- Le Bonheur Children’s Hospital, Memphis, TN, United States
| | - Christine Yu
- Endocrinology Division, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Alicia Diaz-Thomas
- Division of Pediatric Endocrinology, University of Tennessee Health Science Center, Memphis, TN, United States
- Le Bonheur Children’s Hospital, Memphis, TN, United States
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26
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Soti Khiabani M, Tahghighi Sharabian F, Raeeskarami SR, Ziaee V. Evaluation of Bone Mineral Density in Juvenile Systemic Lupus Erythematosus. THE ARCHIVES OF BONE AND JOINT SURGERY 2023; 11:777-782. [PMID: 38146515 PMCID: PMC10748809 DOI: 10.22038/abjs.2023.70697.3311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 07/09/2023] [Indexed: 12/27/2023]
Abstract
Objectives The present study aimed to determine the prevalence of low bone mineral density (BMD) and low bone mineral content (BMC) as chronic complications of juvenile systemic lupus erythematosus (JSLE) and identify the associated variables and patient characteristics to investigate the relationship between BMD and influential factors. Methods This cross-sectional study enrolled 54 patients with JSLE, including 38 females and 16 males. The BMD and BMC were assessed by dual-energy X-ray absorptiometry in the hip (femoral neck) and the lumbar spine. Low BMD was considered a Z-score < -2. The study investigated the association of BMC and Z-score with the current daily dose of corticosteroids, the daily dose of corticosteroids at disease onset, the duration of disease, the duration of steroid treatment, the time from the onset of symptoms to diagnosis, and renal involvement. Results The prevalence of low BMD in the lumbar spine and the femoral neck was 14.8% and 18.5%, respectively; the reduction of BMD was more significant in the femoral neck compared to the lumbar spine. Osteoporosis was detected in one patient. The multiple linear regression analysis found a significant association between a higher daily corticosteroid dose and lower BMC of the femoral neck and the lumbar spine. In addition, patients receiving higher doses of corticosteroids at disease onset showed better follow-up bone mineral densitometry results. Conclusion Based on the findings of this study, JSLE more affects the femoral neck than the lumbar spine. Patients receiving a more robust treatment with higher doses of corticosteroids at disease onset (to control the inflammatory processes) showed better spinal BMC results. A higher dose of daily corticosteroid treatment during assessment was identified as a risk factor for low BMD.
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Affiliation(s)
- Mahsa Soti Khiabani
- Children’s Medical Center, Pediatrics Center of Excellence, Tehran, Iran
- Department of Pediatrics, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Tahghighi Sharabian
- Children’s Medical Center, Pediatrics Center of Excellence, Tehran, Iran
- Department of Pediatrics, Tehran University of Medical Sciences, Tehran, Iran
- Pediatric Rheumatology Society of Iran, Tehran, Iran
| | - Seyyed Reza Raeeskarami
- Department of Pediatrics, Tehran University of Medical Sciences, Tehran, Iran
- Pediatric Rheumatology Society of Iran, Tehran, Iran
| | - Vahid Ziaee
- Children’s Medical Center, Pediatrics Center of Excellence, Tehran, Iran
- Department of Pediatrics, Tehran University of Medical Sciences, Tehran, Iran
- Pediatric Rheumatology Society of Iran, Tehran, Iran
- Pediatric Rheumatology Research Group, Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Ciancia S, Dubois V, Cools M. Impact of gender-affirming treatment on bone health in transgender and gender diverse youth. Endocr Connect 2022; 11:e220280. [PMID: 36048500 PMCID: PMC9578106 DOI: 10.1530/ec-22-0280] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 08/30/2022] [Indexed: 11/13/2022]
Abstract
Both in the United States and Europe, the number of minors who present at transgender healthcare services before the onset of puberty is rapidly expanding. Many of those who will have persistent gender dysphoria at the onset of puberty will pursue long-term puberty suppression before reaching the appropriate age to start using gender-affirming hormones. Exposure to pubertal sex steroids is thus significantly deferred in these individuals. Puberty is a critical period for bone development: increasing concentrations of estrogens and androgens (directly or after aromatization to estrogens) promote progressive bone growth and mineralization and induce sexually dimorphic skeletal changes. As a consequence, safety concerns regarding bone development and increased future fracture risk in transgender youth have been raised. We here review published data on bone development in transgender adolescents, focusing in particular on differences in age and pubertal stage at the start of puberty suppression, chosen strategy to block puberty progression, duration of puberty suppression, and the timing of re-evaluation after estradiol or testosterone administration. Results consistently indicate a negative impact of long-term puberty suppression on bone mineral density, especially at the lumbar spine, which is only partially restored after sex steroid administration. Trans girls are more vulnerable than trans boys for compromised bone health. Behavioral health measures that can promote bone mineralization, such as weight-bearing exercise and calcium and vitamin D supplementation, are strongly recommended in transgender youth, during the phase of puberty suppression and thereafter.
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Affiliation(s)
- Silvia Ciancia
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Vanessa Dubois
- Basic and Translational Endocrinology (BaTE), Department of Basic and Applied Medical Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Martine Cools
- Department of Internal Medicine and Pediatrics, Ghent University, Pediatric Endocrinology Service, Ghent University Hospital, Ghent, Belgium
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