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Palaiothodorou D, Vagenas G. Inter-arm bone mass and size asymmetries in children tennis players are maturity status specific: a 9-month study on the effects of training time across pubertal change and somatic growth. Eur J Appl Physiol 2024; 124:2081-2092. [PMID: 38413390 PMCID: PMC11199266 DOI: 10.1007/s00421-024-05425-2] [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: 09/06/2023] [Accepted: 01/22/2024] [Indexed: 02/29/2024]
Abstract
PURPOSE Bone growth with exercise is best assessed by tennis-induced inter-arm asymmetries. Yet, the effects of training and maturation across puberty were unclear. This study explored arm bone growth across 9 months of training in 46 tennis players 7-14 years (25 boys, 21 girls). METHODS Bone mineral content (BMC) and bone area (BA) were measured from DXA scans. Pubertal status was assessed by Tanner stage (TS) and somatic growth by maturity offset (MO). Children were grouped as pre- (TS I-I), early (TS I-II), and mid/late pubertal (TS II-III). RESULTS Training time (TT) change in the three groups was 160-170, 190-230, and 200-220 h, respectively. Bone asymmetries were large in all groups (d > 0.8, P < 0.001): 5-18 g (9-21%) and 9-17 g (17-23%) in girls and boys, respectively, for BMC, and 5-15 cm2 (6-13%) and 9-15 cm2 (12-15%) in girls and boys (10-13%), respectively, for BA. BMC and BA change asymmetry peaked at pre-puberty in girls (56%, 46%) and at early puberty in boys (57%, 43%). Asymmetry gains varied with baseline asymmetry (41%) and change in TT (38%) and TS (17%) in BMC, and with baseline asymmetry (58%) and change in MO (17%) and TS (12%) in BA. CONCLUSION All bone asymmetries were substantial. Tennis-induced bone gains were higher at pre- to early puberty in girls and at early to mid/late puberty in boys. Training enhanced mostly bone mass and maturity status enhanced mostly bone size; sex was not bone-change modeling impactful. Implications are discussed considering certain limitations.
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Affiliation(s)
- Dimitria Palaiothodorou
- School of Physical Education and Sport Science, National and Kapodistrian University of Athens, Athens, Greece.
| | - George Vagenas
- School of Physical Education and Sport Science, National and Kapodistrian University of Athens, Athens, Greece
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2
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Videira-Silva A, Santos I, Freaza D, Gameiro M, Sardinha LB, Fonseca H. Dietary content and combined training, but not daily physical activity, are associated with 6-month bone mineral changes in adolescents with obesity: A Secondary analysis of the PAC-MAnO trial. Eur J Pediatr 2024:10.1007/s00431-024-05659-4. [PMID: 38937331 DOI: 10.1007/s00431-024-05659-4] [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: 12/06/2023] [Revised: 06/12/2024] [Accepted: 06/18/2024] [Indexed: 06/29/2024]
Abstract
PURPOSE The present study aimed to explore the influence of diet and physical activity (PA) changes on bone mineral content (BMC) and density (BMD) alterations in adolescents with obesity undergoing a weight loss program. METHODS Six-month longitudinal data from 71 adolescents (aged 15.1 [± 1.6] years; 57.7% girls) with a BMI z-score of 3.03 (± 0.78), previously recruited for the PAC-MAnO trial, were analyzed using Generalized Estimation Equations for over time changes and linear regressions with BMC, BMD and BMD z-score as dependent variables, adjusting for confounders (including type of exercise- aerobic vs. combined). RESULTS Adjusting for confounders, changes in carbohydrate (CH) and protein content showed to positively and negatively predict BMD z-score variance, respectively (β = 0.44, 95%CI: 0.01, 0.04, p < .001); β = -0.57, 95%CI: -0.06, -0.03, p < .001), yet no associations were found between PA and bone-related parameters. Combined exercise showed better results on BMC compared to aerobic exercise (β = 0.09, 95%CI: 0.05 to 0.13, p < .001). CONCLUSIONS Increased CH content, instead of protein, may be associated with BMD improvements in adolescents with obesity. Type of exercise may moderate the impact of PA on bone health. TRIAL REGISTRATION Clinicaltrials.gov NCT02941770. What is Known • Adolescents with obesity may be at a higher risk of osteopenia/osteoporosis • Obesity and inadequate diet and physical activity (PA) may have an adverse effect on bone metabolism What is New • Improvements in adiposity and muscle mass and increased diet carbohydrate content are associated with bone mineral density (BMD) improvements • Type of exercise (i.e., combined training vs. aerobic) may moderate the impact of PA on BMD, and calcium intake may mediate this impact.
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Affiliation(s)
- Antonio Videira-Silva
- Centro de Investigação Em Desporto, Educação Física, Exercício E Saúde (CIDEFES), Universidade Lusófona, Lisbon, Portugal.
- Clínica Universitária de Pediatria, Faculdade de Medicina, Universidade de Lisboa Av. Prof. Egas Moniz, 1649-035, Lisbon, Portugal.
- Research Centre in Physical Activity, Health and Leisure (CIFI2D), Faculty of Sport, University of Porto, Porto, Portugal.
| | - Inês Santos
- Centro de Investigação Em Desporto, Educação Física, Exercício E Saúde (CIDEFES), Universidade Lusófona, Lisbon, Portugal
- Laboratório de Nutrição, Faculdade de Medicina, Centro Académico de Medicina de Lisboa, Universidade de Lisboa, Lisbon, Portugal
- Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Dalise Freaza
- Centro Académico de Medicina de Lisboa, Universidade de Lisboa, Lisbon, Portugal
| | - Mariana Gameiro
- Centro Académico de Medicina de Lisboa, Universidade de Lisboa, Lisbon, Portugal
| | - Luis B Sardinha
- Exercise and Health Laboratory, Faculty of Human Kinetics, University of Lisbon, Lisbon, Portugal
| | - Helena Fonseca
- Clínica Universitária de Pediatria, Faculdade de Medicina, Universidade de Lisboa Av. Prof. Egas Moniz, 1649-035, Lisbon, Portugal
- Department of Pediatrics, Pediatric Obesity Clinic, Hospital de Santa Maria, Lisbon, Portugal
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Fagundes U, Vancini RL, de Almeida AA, Nikolaidis PT, Weiss K, Knechtle B, Andrade MS, de Lira CAB. Reference values for bone mass in young athletes: a cross-sectional study in São Paulo, Brazil. Sci Rep 2023; 13:286. [PMID: 36609534 PMCID: PMC9822898 DOI: 10.1038/s41598-023-27582-8] [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] [Received: 08/05/2022] [Accepted: 01/04/2023] [Indexed: 01/09/2023] Open
Abstract
Reference values for bone mass in young athletes need to be used for screening purposes, and country/regional reference values should be used to improve precision of comparisons. The aim of the present study was to develop reference values for bone health variables in Brazilian young athletes. The bone mass content (BMC), bone mass density (BMD), and total body less head (TBLH) BMD using dual-energy X-ray absorptiometry were measured in 702 young athletes (327 men and 375 women) aged 8.5-18.5 years, divided into 5 groups, according to their age: group 1 (8.5-10.5 years), group 2 (10.6-12.5 years), group 3 (12.6-14.5 years), group 4 (14.6-16.5 years), and group 5 (16.6-18.5 years). Comparisons between the sexes and ages were performed and age-sex-smoothed reference values were constructed. Male athletes presented high BMC and BMD than female athletes in age groups 3, 4, and 5 (p < 0.005) and high TBLH BMD than female athletes in age groups 4 and 5 (p < 0.005). Reference values, including the percentiles are presented for the bone health variables of each sex and age group. The age-, sex-, and ethnic-specific reference data for bone variables presented in this study enabled more precise reference data for young Brazilian athletes. These data may assist in monitoring changes during an athletes' growth and different phases of athletic training.
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Affiliation(s)
- Ulysses Fagundes
- grid.411249.b0000 0001 0514 7202Graduate Program in Translational Medicine, Federal University of Sao Paulo, São Paulo, Brazil
| | - Rodrigo Luiz Vancini
- grid.412371.20000 0001 2167 4168Center of Physical Education and Sports, Federal University of Espírito Santo, São Paulo, Brazil
| | | | - Pantelis Theo Nikolaidis
- grid.499377.70000 0004 7222 9074School of Health and Caring Sciences, University of West Attica, Athens, Greece
| | - Katja Weiss
- grid.7400.30000 0004 1937 0650Institute of Primary Care, University of Zurich, Zurich, Switzerland
| | - Beat Knechtle
- Institute of Primary Care, University of Zurich, Zurich, Switzerland. .,Medbase St. Gallen Am Vadianplatz, St. Gallen, Switzerland.
| | - Marilia Santos Andrade
- grid.411249.b0000 0001 0514 7202Department of Physiology, Federal University of Sao Paulo, São Paulo, Brazil
| | - Claudio Andre Barbosa de Lira
- grid.411195.90000 0001 2192 5801Human and Exercise Physiology Division, Faculty of Physical Education and Dance, Federal University of Goiás, Goiânia, Brazil
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Franceschi R, Radetti G, Soffiati M, Maines E. Forearm Fractures in Overweight-Obese Children and Adolescents: A Matter of Bone Density, Bone Geometry or Body Composition? Calcif Tissue Int 2022; 111:107-115. [PMID: 35316361 DOI: 10.1007/s00223-022-00971-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 03/10/2022] [Indexed: 01/06/2023]
Abstract
Forearm fractures in children and adolescents are associated with increased body mass index (BMI). This bone site is non-weight-bearing and therefore is appropriate to explore the effect of BMI on bone mineral density (BMD) and bone geometry, avoiding the confounding effect of increased weight-associated mechanical loading. The aim of this review was to summarize available evidence on bone indices and body composition assessed by peripheral quantitative computed tomography (pQCT) or dual X-ray absorptiometry (DXA) at the forearm level in overweight (Ow) or obese (Ob) subjects. We conducted a review of the literature according to the PICOS model. A total of 46 studies were identified following the literature search. A final number of 12 studies were included in this review. pQCT studies evidenced that Ow and Ob children typically have normal or increased volumetric BMD (vBMD), total bone area and cortical area, with normal or reduced cortical thickness at the forearm. Outcomes from DXA evaluations are less conclusive. In almost all the studies fat mass and lean mass area at the forearm are increased. A higher fat-to-lean mass ratio has been observed in few studies. Bone strength was reported as normal or increased compared to normal weight peers. In Ow or Ob children-adolescents, vBMD, bone size and bone strength are not reduced compared to normal weight peers. The local higher fat-to-lean mass ratio may give a mismatch between bone strength and the load experienced by the distal forearm during a fall, resulting in increased risk of forearm fractures.
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Affiliation(s)
- Roberto Franceschi
- Pediatric Department, S. Chiara General Hospital, Largo Medaglie d'Oro, 9, 38122, Trento, Italy.
| | - Giorgio Radetti
- Division of Pediatrics, General Hospital Bolzano, Bolzano, Italy
| | - Massimo Soffiati
- Pediatric Department, S. Chiara General Hospital, Largo Medaglie d'Oro, 9, 38122, Trento, Italy
| | - Evelina Maines
- Pediatric Department, S. Chiara General Hospital, Largo Medaglie d'Oro, 9, 38122, Trento, Italy
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Baxter-Jones ADG, Jackowski SA. Sex differences in bone mineral content and bone geometry accrual: a review of the Paediatric Bone Mineral Accural Study (1991-2017). Ann Hum Biol 2022; 48:503-516. [PMID: 35105203 DOI: 10.1080/03014460.2021.2014568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
CONTEXT Girls' and boys' growth patterns differ in timing and tempo, and they have different lifestyles with regards to diet and physical activity. These factors have all been linked with bone mineral accrual. OBJECTIVE To identify the associations of boys' and girls' growth, maturation, and lifestyle choices relating to parameters of bone geometry and mineral accrual. METHODS Between 1991 and 1993, 251 children aged 8-15 years were recruited into a mixed-longitudinal cohort study (The Paediatric Bone Mineral Accrual Study (PBMAS)) and followed repeatedly over 26 years. RESULTS It was found that girls matured approximately two years earlier than boys (11.8 vs. 13.4 years) but on average were shorter, had less lean mass and had greater fat mass (p < 0.05). There was a dissociation between the growth of bone and its mineralisation in both sexes. Boys had greater bone mass and bone geometry (p < 0.05). Both a healthy childhood diet and high levels of physical activity were associated with improved bone parameters. CONCLUSIONS Most, but not all, of the sex differences observed, were explained by height and lean mass differences. The importance of diet and physical activity on obtaining optimal bone mass during adolescence in both sexes was also paramount.
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Affiliation(s)
| | - Stefan A Jackowski
- College of Kinesiology, University of Saskatchewan, Saskatoon, SK, Canada.,Research Institute, Children's Hospital of Eastern Ontario, Ottawa, Canada
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Brustad N, Chawes BL, Thorsen J, Krakauer M, Lasky-Su J, Weiss ST, Stokholm J, Bønnelykke K, Bisgaard H. High-dose vitamin D supplementation in pregnancy and 25(OH)D sufficiency in childhood reduce the risk of fractures and improve bone mineralization in childhood: Follow-up of a randomized clinical trial. EClinicalMedicine 2022; 43:101254. [PMID: 35005585 PMCID: PMC8718890 DOI: 10.1016/j.eclinm.2021.101254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 11/18/2021] [Accepted: 12/10/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Exposure to vitamin D in early life has been associated with improved bone mineralization, but no studies have investigated the combined effect of pregnancy supplementation and childhood 25(OH)D concentrations on bone health. METHODS We analyzed the effect of serum 25(OH)D concentrations at age 6 months and 6 years and the combined effect with prenatal high-dose vitamin D (2800 vs. 400 IU/day) on bone mineral density (BMD) and content (BMC) assessed by dual-energy X-ray absorptiometry (DXA) scans at age 3 and 6 years and longitudinal risk of fractures in a double-blinded, randomized clinical trial in the Copenhagen Prospective Studies on Asthma in Childhood 2010 (COPSAC2010) mother-child cohort with enrollment from March 4, 2009, to November 17, 2010, and clinical follow-up until January 31, 2019 (NCT00856947). All participants randomized to intervention and with complete data were included in the analyses. FINDINGS At age 6 months, serum 25(OH)D concentration was measured in 93% (n = 541) of 584 children. Children with sufficient (≥ 75 nmol/l) vs. insufficient (< 75 nmol/l) concentrations did not have lower risk of fractures: incidence rate ratio (95% CI); 0.64 (0.37;1.11), p = 0.11. However, vitamin D sufficient children from mothers receiving high-dose supplementation during pregnancy had a 60% reduced incidence of fractures compared with vitamin D insufficient children from mothers receiving standard-dose: 0.40 (0.19;0.84), p = 0.02.At age 6 years, serum 25(OH)D concentration was measured in 83% (n = 318) of 383 children with available DXA data. Whole-body bone mineralization was higher in vitamin D sufficient children at age 6 years; BMD, adjusted mean difference (aMD) (95% CI): 0.011 g/cm2 (0.001;0.021), p = 0.03, and BMC, aMD: 12.3 g (-0.8;25.4), p = 0.07, with the largest effect in vitamin D sufficient children from mothers receiving high-dose vitamin D supplementation; BMD, aMD: 0.016 g/cm2 (0.002;0.030), p = 0.03, and BMC, aMD: 23.5 g (5.5;41.5), p = 0.01. INTERPRETATION Childhood vitamin D sufficiency improved bone mineralization and in combination with prenatal high-dose vitamin D supplementation reduced the risk of fractures. FUNDING The study was supported by The Lundbeck Foundation R16-A1694, The Danish Ministry of Health 903,516, The Danish Council for Strategic Research 0603-00280B and The European Research Council 946,228.
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Affiliation(s)
- Nicklas Brustad
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Bo L. Chawes
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jonathan Thorsen
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Martin Krakauer
- Department of Clinical Physiology and Nuclear Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Denmark
| | - Jessica Lasky-Su
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Scott T. Weiss
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Jakob Stokholm
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Pediatrics, Naestved Hospital, Naestved, Denmark
| | - Klaus Bønnelykke
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Hans Bisgaard
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Corresponding author at: COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.
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7
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Rosendahl K, Lundestad A, Bjørlykke JA, Lein RK, Angenete O, Augdal TA, Müller LSO, Jaramillo D. Revisiting the radiographic assessment of osteoporosis-Osteopenia in children 0-2 years of age. A systematic review. PLoS One 2020; 15:e0241635. [PMID: 33137162 PMCID: PMC7605664 DOI: 10.1371/journal.pone.0241635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 10/18/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Imaging for osteoporosis has two major aims, first, to identify the presence of low bone mass (osteopenia), and second, to quantify bone mass using semiquantitative (conventional radiography) or quantitative (densitometry) methods. In young children, densitometry is hampered by the lack of reference values, and high-quality radiographs still play a role although the evaluation of osteopenia as a marker for osteoporosis is subjective and based on personal experience. Medical experts questioned in court over child abuse, often refer to the literature and state that 20-40% loss of bone mass is warranted before osteopenia becomes evident on radiographs. In our systematic review, we aimed at identifying evidence underpinning this statement. A secondary outcome was identifying normal references for cortical thickness of the skeleton in infants born term, < 2 years of age. METHODS We undertook systematic searches in Medline, Embase and Svemed+, covering 1946-2020. Unpublished material was searched in Clinical trials and International Clinical Trials Registry Platform (ICTRP). Both relevant subject headings and free text words were used for the following concepts: osteoporosis or osteopenia, radiography, children up to 6 years. RESULTS A total 5592 publications were identified, of which none met the inclusion criteria for the primary outcome; the degree of bone loss warranted before osteopenia becomes visible radiographically. As for the secondary outcome, 21 studies were identified. None of the studies was true population based and none covered the pre-defined age range from 0-2 years. However, four studies of which three having a crossectional and one a longitudinal design, included newborns while one study included children 0-2 years. CONCLUSIONS Despite an extensive literature search, we did not find any studies supporting the assumption that a 20-40% bone loss is required before osteopenia becomes visible on radiographs. Reference values for cortical thickness were sparse. Further studies addressing this important topic are warranted.
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Affiliation(s)
- Karen Rosendahl
- Faculty of Health Sciences, Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway
- Section of Paediatric Radiology, University Hospital of North Norway, Tromsø, Norway
- * E-mail:
| | | | - John Asle Bjørlykke
- Section of Paediatric Radiology, Haukeland University Hospital, Bergen, Norway
| | | | - Oskar Angenete
- Department of Radiology and Nuclear Medicine, St Olav Hospital, Trondheim, Norway
- Department of Circulation and Medical imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Thomas Angell Augdal
- Faculty of Health Sciences, Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway
- Section of Paediatric Radiology, University Hospital of North Norway, Tromsø, Norway
| | | | - Diego Jaramillo
- Columbia University Medical Center, New York, New York, United States of America
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Annexstad EJ, Bollerslev J, Westvik J, Myhre AG, Godang K, Holm I, Rasmussen M. The role of delayed bone age in the evaluation of stature and bone health in glucocorticoid treated patients with Duchenne muscular dystrophy. INTERNATIONAL JOURNAL OF PEDIATRIC ENDOCRINOLOGY 2019; 2019:4. [PMID: 31889957 PMCID: PMC6927168 DOI: 10.1186/s13633-019-0070-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 10/23/2019] [Indexed: 12/17/2022]
Abstract
Background Low bone mineral density and an increased risk of appendicular and vertebral fractures are well-established consequences of Duchenne muscular dystrophy (DMD) and the risk of fractures is exacerbated by long-term glucocorticoid treatment. Monitoring of endocrine and skeletal health and timely intervention in at-risk patients is important in the management of children with DMD. Methods As part of the Norwegian Duchenne muscular dystrophy cohort study, we examined the skeletal maturation of 62 boys less than 18 years old, both currently glucocorticoid treated (n = 44), previously treated (n = 6) and naïve (n = 12). The relationship between bone age, height and bone mineral density (BMD) Z-scores was explored. Results The participants in the glucocorticoid treated group were short in stature and puberty was delayed. Bone age was significantly delayed, and the delay increased with age and duration of treatment. The difference in height between glucocorticoid treated and naïve boys was no longer significant when height was corrected for delayed skeletal maturation. Mean BMD Z-scores fell below − 2 before 12 years of age in the glucocorticoid treated group, with scores significantly correlated with age, duration of treatment and pubertal development. When BMD Z-scores were corrected for by retarded bone age, the increase in BMD Z-scores was significant for all age groups. Conclusion Our results suggest that skeletal maturation should be assessed in the evaluation of short stature and bone health in GC treated boys with DMD, as failing to consider delayed bone age leads to underestimation of BMD Z-scores and potentially overestimation of fracture risk.
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Affiliation(s)
- E J Annexstad
- 1Department of Neurology, Unit for Congenital and Inherited Neuromuscular Disorders, Oslo University Hospital, PoBox 4950, Nydalen, 0424 Oslo, Norway.,2Faculty of Medicine, University of Oslo, Oslo, Norway.,3Department of Clinical Neurosciences for Children, Oslo University Hospital, Oslo, Norway.,8Children's Department, Ostfold Hospital Trust, Sarpsborg, Norway
| | - J Bollerslev
- 4Department of Endocrinology, Section of Specialized Endocrinology, Oslo University Hospital Rikshospitalet, Oslo, Norway.,2Faculty of Medicine, University of Oslo, Oslo, Norway
| | - J Westvik
- 5Department of Radiology, Section for Paediatric Radiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - A G Myhre
- Frambu Resource Centre for Rare Disorders, Siggerud, Norway
| | - K Godang
- 4Department of Endocrinology, Section of Specialized Endocrinology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - I Holm
- 2Faculty of Medicine, University of Oslo, Oslo, Norway.,7Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - M Rasmussen
- 1Department of Neurology, Unit for Congenital and Inherited Neuromuscular Disorders, Oslo University Hospital, PoBox 4950, Nydalen, 0424 Oslo, Norway.,3Department of Clinical Neurosciences for Children, Oslo University Hospital, Oslo, Norway
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9
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Dimitri P. The Impact of Childhood Obesity on Skeletal Health and Development. J Obes Metab Syndr 2019; 28:4-17. [PMID: 31089575 PMCID: PMC6484936 DOI: 10.7570/jomes.2019.28.1.4] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 01/24/2019] [Accepted: 02/18/2019] [Indexed: 12/26/2022] Open
Abstract
Increased risk of fracture identified in obese children has led to a focus on the relationship between fat, bone, and the impact of obesity during skeletal development. Early studies have suggested that despite increased fracture risk, obese children have a higher bone mass. However, body size corrections applied to account for wide variations in size between children led to the finding that obese children have a lower total body and regional bone mass relative to their body size. Advances in skeletal imaging have shifted the focus from quantity of bone in obese children to evaluating the changes in bone microarchitecture that result in a change in bone quality and strength. The findings suggest that bone strength in the appendicular skeleton does not appropriately adapt to an increase in body size which results in a mismatch between bone strength and force from falls. Recent evidence points to differing influences of fat compartments on skeletal development-visceral fat may have a negative impact on bone which may be related to the associated adverse metabolic environment, while marrow adipose tissue may have an independent effect on trabecular bone development in obese children. The role of brown fat has received recent attention, demonstrating differences in the influence on bone mass between white and brown adipose tissues. Obesity results in a shift in growth and pubertal hormones as well as influences bone development through the altered release of adipokines. The change in the hormonal milieu provides an important insight into the skeletal changes observed in childhood obesity.
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Affiliation(s)
- Paul Dimitri
- Academic Unit of Child Health, The University of Sheffield, Sheffield, UK
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10
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Mostoufi-Moab S, Ward LM. Skeletal Morbidity in Children and Adolescents during and following Cancer Therapy. Horm Res Paediatr 2019; 91:137-151. [PMID: 30481777 PMCID: PMC6536370 DOI: 10.1159/000494809] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 10/23/2018] [Indexed: 01/07/2023] Open
Abstract
Skeletal abnormalities are common in children and adolescents diagnosed and treated for a malignancy. The spectrum ranges from mild pain to debilitating osteonecrosis and fractures. In this review, we summarize the impact of cancer therapy on the developing skeleton, provide an update on therapeutic strategies for prevention and treatment, and discuss the most recent advances in musculoskeletal research. Early recognition of skeletal abnormalities and strategies to optimize bone health are essential to prevent long-term skeletal sequelae and diminished quality of life in childhood cancer survivors.
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Affiliation(s)
- Sogol Mostoufi-Moab
- Department of Pediatrics, The Children's Hospital of Philadelphia, The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA,
| | - Leanne M. Ward
- Department of Pediatrics, The Children’s Hospital of Eastern Ontario, University of Ottawa, Ontario, Canada, K1H 8L1
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11
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Ersoy B, Kizilay DÖ, Yilmaz SK, Taneli F, Gümüşer G. Bone mineral density, vitamin D status, and calcium intake in healthy female university students from different socioeconomic groups in Turkey. Arch Osteoporos 2018; 13:135. [PMID: 30515581 DOI: 10.1007/s11657-018-0482-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 05/31/2018] [Indexed: 02/03/2023]
Abstract
UNLABELLED Peak bone mass is reached in late adolescence. Low peak bone mass is a well recognized risk factor for osteoporosis later in life. Our data do not support a link between vitamin D status, bone mineral density (BMD), and socioeconomic status (SES). However, there was a marked inadequacy of daily calcium intake and a high presence of osteopenia in females with low SES. PURPOSE Our aims were to (1) examine the effects of different SES on BMD, vitamin D status, and daily calcium intake and (2) investigate any association between vitamin D status and BMD in female university students. SUBJECTS AND METHODS A questionnaire was used to obtain information about SES, daily calcium intake, and physical activity in 138 healthy, female university students (age range 18-22 years). Subjects were stratified into lower, middle, and higher SES according to the educational and occupational levels of their parents. All serum samples were collected in spring for 25-hydroxyvitamin D concentration (25OHD). Lumbar spine and total body BMD was obtained by dual-energy X-ray absorptiometry (DXA) scan (Lunar DPX series). Osteopenia was defined as a BMD between - 1.0 and - 2.5 standard deviations (SDs) below the mean for healthy young adults on lumbar spine DXA. RESULTS No significant difference was found between the three socioeconomic groups in terms of serum 25OHD concentration, BMD levels, or BMD Z scores (p > 0.05). Both the daily intake of calcium was significantly lower (p = 0.02), and the frequency of osteopenia was significantly higher in girls with low SES (p = 0.02). There was no correlation between serum 25OHD concentration and calcium intake and BMD values and BMD Z scores (p > 0.05). The most important factor affecting BMD was weight (β = 0.38, p < 0.001). CONCLUSIONS Low SES may be associated with sub-optimal bone health and predispose to osteopenia in later life, even in female university students.
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Affiliation(s)
- Betül Ersoy
- Division of Pediatric Endocrinology and Metabolism, School of Medicine, Celal Bayar University, Manisa, Turkey.
| | - Deniz Özalp Kizilay
- Division of Pediatric Endocrinology and Metabolism, School of Medicine, Celal Bayar University, Manisa, Turkey
| | - Seniha Kiremitci Yilmaz
- Division of Pediatric Endocrinology and Metabolism, School of Medicine, Celal Bayar University, Manisa, Turkey
| | - Fatma Taneli
- Department of Clinical Biochemistry, School of Medicine, Celal Bayar University, Manisa, Turkey
| | - Gül Gümüşer
- Department of Nuclear Medicine, School of Medicine, Celal Bayar University, Manisa, Turkey
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12
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Zulfarina MS, Sharif R, Syarifah-Noratiqah SB, Sharkawi AM, Aqilah-SM ZSM, Mokhtar SA, Nazrun SA, Naina-Mohamed I. Modifiable factors associated with bone health in Malaysian adolescents utilising calcaneus quantitative ultrasound. PLoS One 2018; 13:e0202321. [PMID: 30106982 PMCID: PMC6091955 DOI: 10.1371/journal.pone.0202321] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 08/01/2018] [Indexed: 12/02/2022] Open
Abstract
Maximizing bone mineral accrual to attain an optimal peak bone mass (PBM), particularly during adolescence, appears to be an effective protective strategy in the prevention of osteoporosis. This study aimed to evaluate the influence of physical activity (PA), fat mass (FM), lean mass (LM), body mass index (BMI), calcium, or combination of vitamin D supplement intake, smoking and alcohol drinking status on bone health assessed by calcaneus quantitative ultrasound (QUS) in a healthy adolescent population. The participants comprised of 920 male and female secondary school adolescents aged 15–17 years old. Quantitative ultrasound measurements of the left heel were performed using Lunar Achilles EX II, which included results of broadband ultrasound attenuation (BUA), speed of sound (SOS), and a calculated stiffness index (SI). Multivariable linear regression analyses revealed that—PA was positively associated with all three QUS indices in both genders; BMI was positively associated with SI and SOS in females; LM was positively associated with BUA in both genders; and FM was negatively associated with SI in females. These variables accounted for 32.1%, 21.2% and 29.4% of females’ SOS, BUA and SI variances (p<0.001), respectively and 23.6%, 15.4% and 17.2% of males’ SOS, BUA and SI variances (p<0.001), respectively. Promoting health benefits from physical activity could influence bone status and consequently improve PBM, which is a potent protective determinant against osteoporosis in adulthood.
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Affiliation(s)
- Mohamed S. Zulfarina
- Pharmacoepidemiology and Drug Safety Unit, Department of Pharmacology, Faculty of Medicine, UKM Medical Centre, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Razinah Sharif
- Nutritional Sciences Programme, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Syed-Badrul Syarifah-Noratiqah
- Pharmacoepidemiology and Drug Safety Unit, Department of Pharmacology, Faculty of Medicine, UKM Medical Centre, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Ahmad M. Sharkawi
- Pharmacoepidemiology and Drug Safety Unit, Department of Pharmacology, Faculty of Medicine, UKM Medical Centre, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Zaris-SM Aqilah-SM
- Department of Orthopaedic, Faculty of Medicine, UKM Medical Centre, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Sabarul-Afian Mokhtar
- Department of Orthopaedic, Faculty of Medicine, UKM Medical Centre, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Shuid A. Nazrun
- Pharmacoepidemiology and Drug Safety Unit, Department of Pharmacology, Faculty of Medicine, UKM Medical Centre, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Isa Naina-Mohamed
- Pharmacoepidemiology and Drug Safety Unit, Department of Pharmacology, Faculty of Medicine, UKM Medical Centre, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
- * E-mail:
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13
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Gupta T, Das N, Imran S. The Prevention and Therapy of Osteoporosis: A Review on Emerging Trends from Hormonal Therapy to Synthetic Drugs to Plant-Based Bioactives. J Diet Suppl 2018; 16:699-713. [PMID: 29985715 DOI: 10.1080/19390211.2018.1472715] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Osteoporosis is one of the major health problems worldwide. It is characterized by increased bone fragility and loss of bone matter due to the action of osteoclast cells, which are associated with modified hormone levels and factors such as aging. Bisphosphonates are the primary treatment for osteoporosis. Apart from bisphosphonates, hormone therapy, calcitonin treatment, selective estrogen receptor modulators (SERMs), and strontium ranelate (SR) are some of the other treatments available for osteoporosis. However, these treatments have some side effects, such as oily skin, fluid retention, nausea, long-term toxicity, and even prostate cancer in males, and thus natural therapies that incur fewer side effects are sought. Phytochemicals, antioxidants, and other plant-based bioactives are important in the human diet. They are abundant in fruits and help against various chronic diseases, including bone disorders. Other providers of these important compounds are the medicinal plant parts. In this article, we highlight the various species of plants and herbs that are useful for the treatment of osteoporosis. The prospect of using these plant-based bioactives in amelioration of osteoporosis as an alternative to hormonal and synthetic drug-based therapy is also discussed.
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Affiliation(s)
- Twinkle Gupta
- Department of Biotechnology, Manav Rachna International Institute of Research and Studies , Haryana , India
| | - Nilanjan Das
- Department of Biotechnology, Manav Rachna International Institute of Research and Studies , Haryana , India.,Accendere, CL Educate , New Delhi , India
| | - Sabiha Imran
- Department of Biotechnology, Manav Rachna International Institute of Research and Studies , Haryana , India
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14
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Wasserman H, O'Donnell JM, Gordon CM. Use of dual energy X-ray absorptiometry in pediatric patients. Bone 2017; 104:84-90. [PMID: 27989544 PMCID: PMC7055510 DOI: 10.1016/j.bone.2016.12.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 12/12/2016] [Accepted: 12/13/2016] [Indexed: 12/27/2022]
Abstract
Dual Energy X-ray Absorptiometry (DXA) is a vital tool for assessing bone health in patients at risk for fragility fractures. In pediatric patients, this technology is used in conjunction with clinical fracture history to diagnosis osteoporosis and monitor treatment response. Childhood and adolescence is characterized by linear growth and bone mass accrual; thus there are important differences in the interpretation of bone measurements obtained by DXA in these young patients. This review aims to explore the current indications for DXA use and interpretation of DXA in the pediatric age group using currently available reference databases. Limitations of DXA in pediatric patients, specifically in children with short stature, will be explored. We will review several pathophysiologic mechanisms that may lead to low bone density in children, discussing representative diseases and the recommendations for monitoring bone health with DXA in these conditions. Finally, we will highlight new methods by which DXA imaging can gather additional information on bone health in children and may improve our ability to predict fractures and osteoporosis.
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Affiliation(s)
- Halley Wasserman
- Department of Endocrinology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 7012, Cincinnati, OH 45229, USA.
| | - Jennifer M O'Donnell
- Department of Adolescent and Transitional Medicine, 3244 Burnet Avenue MLC 4000, Cincinnati, OH 45229, USA.
| | - Catherine M Gordon
- Department of Endocrinology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 7012, Cincinnati, OH 45229, USA; Department of Adolescent and Transitional Medicine, 3244 Burnet Avenue MLC 4000, Cincinnati, OH 45229, USA.
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15
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Gómez-Campos R, Andruske CL, Arruda MD, Urra Albornoz C, Cossio-Bolaños M. Proposed equations and reference values for calculating bone health in children and adolescent based on age and sex. PLoS One 2017; 12:e0181918. [PMID: 28759569 PMCID: PMC5536292 DOI: 10.1371/journal.pone.0181918] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 07/10/2017] [Indexed: 12/02/2022] Open
Abstract
Background The Dual Energy X-Ray Absorptiometry (DXA) is the gold standard for measuring BMD and bone mineral content (BMC). In general, DXA is ideal for pediatric use. However, the development of specific standards for particular geographic regions limits its use and application for certain socio-cultural contexts. Additionally, the anthropometry may be a low cost and easy to use alternative method in epidemiological contexts. The goal of our study was to develop regression equations for predicting bone health of children and adolescents based on anthropometric indicators to propose reference values based on age and sex. Methods 3020 students (1567 males and 1453 females) ranging in ages 4.0 to 18.9 were studied from the Maule Region (Chile). Anthropometric variables evaluated included: weight, standing height, sitting height, forearm length, and femur diameter. A total body scan (without the head) was conducted by means of the Dual Energy X-Ray Absorptiometry. Bone mineral density (BMD) and the bone mineral content (BMC) were also determined. Calcium consumption was controlled for by recording the intake of the three last days prior to the evaluation. Body Mass Index (BMI) was calculated, and somatic maturation was determined by using the years of peak growth rate (APHV). Results Four regression models were generated to calculate bone health: for males BMD = (R2 = 0.79) and BMC = (R2 = 0.84) and for the females BMD = (R2 = 0.76) and BMC = (R2 = 0.83). Percentiles were developed by using the LMS method (p3, p5, p15, p25, p50, p75, p85, p95 and p97). Conclusions Regression equations and reference curves were developed to assess the bone health of Chilean children and adolescents. These instruments help identify children with potential underlying problems in bone mineralization during the growth stage and biological maturation.
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Affiliation(s)
- Rossana Gómez-Campos
- Faculty of Physical Education, State University of Campinas, Campinas, Brazil
- Universidad Autonoma de Chile, Talca, Chile
| | - Cynthia Lee Andruske
- Escuela de Pedagogías en Inglés, Facultad de Ciencias de la Educación, Universidad de Talca (Campus Linares), Talca, Chile
- Research Network on Human Biological Development, Arequipa, Peru
| | - Miguel de Arruda
- Faculty of Physical Education, State University of Campinas, Campinas, Brazil
| | - Camilo Urra Albornoz
- Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomás, Talca, Chile
| | - Marco Cossio-Bolaños
- Faculty of Physical Education, State University of Campinas, Campinas, Brazil
- Department of Physical Activity Sciences, Catholic University of Maule, Talca, Chile
- Universidad Nacional de San Agustín, Arequipa, Perú
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16
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Ludwa IA, Falk B, Ward WE, Gammage KL, Klentrou P. Mechanical, biochemical, and dietary determinants of the functional model of bone development of the radius in children and adolescents. Appl Physiol Nutr Metab 2017; 42:780-787. [PMID: 28273428 DOI: 10.1139/apnm-2016-0666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study examined the degree to which various mechanical, biochemical, and dietary factors are related to nonweight bearing bone properties in 172 healthy peri-pubertal children (age, 11.7 ± 2.0 years). Dominant radial speed of sound (rSOS) was measured by transaxial quantitative ultrasound at distal radius. Potential modulating factors included somatic maturity offset (years from age of peak height velocity), grip strength, forearm lean cross-sectional area (CSA), physical activity, nutritional intake, and amino-terminal cross-linking propeptide (NTx), reflecting bone resorption. In a hierarchical regression, grip strength adjusted for CSA was the second most important predictor of rSOS after the maturity offset (β = 0.22 and β = 0.33, respectively; R2 = 0.16). When relative grip strength was added to the model the contribution of sex was no longer significant. Calcium intake was a significant predictor of rSOS only after NTx was accounted for in the model (β = 0.17, R2 = 0.21). This may suggest that calcium's effects on the muscle-bone unit may be modulated through bone resorption. In the final model, relative grip strength together with maturity offset, dietary calcium, and NTx explained up to 21% of the variance in rSOS in this cohort of children. Therefore, during the peri-pubertal stage, size-adjusted forearm muscle strength is related to radial bone strength after controlling for maturity, with calcium intake having a potential indirect association through NTx.
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Affiliation(s)
- Izabella A Ludwa
- Department of Kinesiology, Brock University, St. Catharines, ON L2S 3A1, Canada.,Department of Kinesiology, Brock University, St. Catharines, ON L2S 3A1, Canada
| | - Bareket Falk
- Department of Kinesiology, Brock University, St. Catharines, ON L2S 3A1, Canada.,Department of Kinesiology, Brock University, St. Catharines, ON L2S 3A1, Canada
| | - Wendy E Ward
- Department of Kinesiology, Brock University, St. Catharines, ON L2S 3A1, Canada.,Department of Kinesiology, Brock University, St. Catharines, ON L2S 3A1, Canada
| | - Kimberley L Gammage
- Department of Kinesiology, Brock University, St. Catharines, ON L2S 3A1, Canada.,Department of Kinesiology, Brock University, St. Catharines, ON L2S 3A1, Canada
| | - Panagiota Klentrou
- Department of Kinesiology, Brock University, St. Catharines, ON L2S 3A1, Canada.,Department of Kinesiology, Brock University, St. Catharines, ON L2S 3A1, Canada
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17
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Lekadir K, Hoogendoorn C, Armitage P, Whitby E, King D, Dimitri P, Frangi AF. Estimation of trabecular bone parameters in children from multisequence MRI using texture-based regression. Med Phys 2017; 43:3071-3079. [PMID: 27277054 DOI: 10.1118/1.4950713] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE This paper presents a statistical approach for the prediction of trabecular bone parameters from low-resolution multisequence magnetic resonance imaging (MRI) in children, thus addressing the limitations of high-resolution modalities such as HR-pQCT, including the significant exposure of young patients to radiation and the limited applicability of such modalities to peripheral bones in vivo. METHODS A statistical predictive model is constructed from a database of MRI and HR-pQCT datasets, to relate the low-resolution MRI appearance in the cancellous bone to the trabecular parameters extracted from the high-resolution images. The description of the MRI appearance is achieved between subjects by using a collection of feature descriptors, which describe the texture properties inside the cancellous bone, and which are invariant to the geometry and size of the trabecular areas. The predictive model is built by fitting to the training data a nonlinear partial least square regression between the input MRI features and the output trabecular parameters. RESULTS Detailed validation based on a sample of 96 datasets shows correlations >0.7 between the trabecular parameters predicted from low-resolution multisequence MRI based on the proposed statistical model and the values extracted from high-resolution HRp-QCT. CONCLUSIONS The obtained results indicate the promise of the proposed predictive technique for the estimation of trabecular parameters in children from multisequence MRI, thus reducing the need for high-resolution radiation-based scans for a fragile population that is under development and growth.
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Affiliation(s)
- Karim Lekadir
- Center for Computational Imaging and Simulation Technologies in Biomedicine, Universitat Pompeu Fabra, Barcelona 08018, Spain
| | - Corné Hoogendoorn
- The Academic Unit of Radiology, The University of Sheffield, Sheffield S10 2JF, United Kingdom
| | - Paul Armitage
- The Academic Unit of Reproductive and Developmental Medicine, The University of Sheffield, Sheffield S10 2SF, United Kingdom
| | - Elspeth Whitby
- The Academic Unit of Child Health, The University of Sheffield, Sheffield S10 2TH, United Kingdom
| | - David King
- The Mellanby Centre for Bone Research, The University of Sheffield, Sheffield S10 2RX, United Kingdom
| | - Paul Dimitri
- Center for Computational Imaging and Simulation Technologies in Biomedicine, The University of Sheffield, Sheffield S1 3JD, United Kingdom
| | - Alejandro F Frangi
- The Academic Unit of Radiology, The University of Sheffield, Sheffield S10 2JF, United Kingdom
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18
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Hasaneen B, Elsayed RM, Salem N, Elsharkawy A, Tharwat N, Fathy K, El-Hawary A, Aboelenin HM. Bone Mineral Status in Children with Epilepsy: Biochemical and Radiologic Markers. J Pediatr Neurosci 2017; 12:138-143. [PMID: 28904570 PMCID: PMC5588637 DOI: 10.4103/jpn.jpn_161_16] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Objective: The aim of this study is to assess bone mineral status in children with epilepsy, on different antiepileptic drugs (AEDs) regimen, using dual-energy X-ray absorptiometry (DXA) and routine biochemical bone markers. Patients and Methods: This is observational prospective controlled cohort study, conducted at Mansoura University Children Hospital, from January 2014 to June 2015. In this study, we had 152 participants with ages 3–13 years, 70 children diagnosed with epilepsy and 82 were controls. Children classified into two groups according to the duration of treatment, Group 1 children maintained on AEDs for 6–24 months, Group 2 children ≥24 months. Bone mineral density (BMD) measured by DXA and biochemical markers includes serum calcium, phosphorus, alkaline phosphatase (ALP), and parathyroid hormone (PTH). Results: In this study, we found that the serum level of calcium and phosphate were significantly low (P > 0.05) in total cases versus control. We found that the serum level of and ALP and PTH were significantly high (P > 0.05) in total cases versus control. Regarding the DXA markers, there was a significant decrease of BMD and Z-score for the total body and lumbar area in the total cases versus control (P > 0.05). Conclusion: The present study showed that all AEDs (new and old) affect bone mineral status in children receiving therapy for more than 6 months, altering both biochemical markers (serum calcium, phosphorus, ALP, and PTH) and radiologic markers (BMD assessed using DXA). Children on AEDs for a longer duration (≥2 years) showed more severe side effects on BMD. Children receiving multiple AEDs are more prone to altered bone mineral status, especially with long duration of therapy. The study also highlights the role of DXA as a safe noninvasive method to assess BMD in children on long-term AEDs.
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Affiliation(s)
- Bothina Hasaneen
- Department of Pediatric, Pediatric Neurology Unit, Mansoura University, Mansoura, Egypt
| | - Riad Moustafa Elsayed
- Department of Pediatric, Pediatric Neurology Unit, Mansoura University, Mansoura, Egypt
| | - Nanees Salem
- Department of Pediatric, Pediatric Endocrinology Unit, Mansoura University, Mansoura, Egypt
| | - Ashraf Elsharkawy
- Department of Pediatric, Pediatric Endocrinology Unit, Mansoura University, Mansoura, Egypt
| | - Noha Tharwat
- Department of Pediatric, Pediatric Neurology Unit, Mansoura University, Mansoura, Egypt
| | - Khaled Fathy
- Department of Pediatric, Pediatric Neurology Unit, Mansoura University, Mansoura, Egypt
| | - Amany El-Hawary
- Department of Pediatric, Pediatric Endocrinology Unit, Mansoura University, Mansoura, Egypt
| | - Hadil M Aboelenin
- Department of Pediatric, Pediatric Endocrinology Unit, Mansoura University, Mansoura, Egypt
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19
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Sung KH, Chung CY, Lee KM, Lee J, Chung MK, Cho BC, Moon SJ, Park MS. Correlation Between Central and Peripheral Bone Mineral Density Around the Elbow Measured by Dual-Energy X-Ray Absorptiometry in Healthy Children and Adolescents. J Clin Densitom 2017; 20:114-119. [PMID: 27210802 DOI: 10.1016/j.jocd.2016.04.007] [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: 02/25/2016] [Revised: 04/06/2016] [Accepted: 04/07/2016] [Indexed: 11/21/2022]
Abstract
This pilot study was performed to evaluate the correlation between central bone mineral density (BMD) and peripheral BMD around the elbow in children and adolescents and to compare BMD values across skeletal sites. Twenty-seven healthy volunteers between 5 and 18 yr of age were recruited for the study. Anthropometric measurements including height and weight were performed. Central BMD at the lumbar spine and left femur and peripheral BMD at the supracondylar area, medial condyle, lateral condyle, and olecranon were measured using dual-energy X-ray absorptiometry (DXA). Higher BMD levels were found in the central skeleton (lumbar spine and femur) than in peripheral sites around the elbow (p < 0.001). BMD values around the elbow ranged from 44.4% to 63.2% compared to the BMD values of the central skeleton. Among the peripheral sites around the elbow, the highest BMD was observed at the supracondylar area and olecranon, and the lowest BMD was found at the lateral condyle. Peripheral DXA measurements around the elbow were significantly correlated with central DXA measurements at the lumbar spine and femur. In conclusion, this study demonstrated that the measurements of BMD around the elbow were correlated with BMD at central sites. Given the small sample size in this pilot study, further study with a large cohort is required to use the BMD measurements around the elbow as a valid clinical tool for fracture risk assessment and population-based epidemiological studies.
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Affiliation(s)
- Ki Hyuk Sung
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Kyungki, Republic of Korea
| | - Chin Youb Chung
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Kyungki, Republic of Korea
| | - Kyoung Min Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Kyungki, Republic of Korea
| | - Jaebong Lee
- Medical Research Collaboration Center, Seoul National University Bundang Hospital, Kyungki, Republic of Korea
| | - Myung Ki Chung
- Department of Orthopaedic Surgery, Kangwon National University Hospital, Kangwon, Republic of Korea
| | - Byung Chae Cho
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Kyungki, Republic of Korea
| | - Seung Jun Moon
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Kyungki, Republic of Korea
| | - Moon Seok Park
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Kyungki, Republic of Korea.
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Gervais-André L, Vija L, Franchi-Abella S, Gonzales E, Linglart A, Adamsbaum C. Quantitative computed tomography in pediatric patients. Diagn Interv Imaging 2016; 97:499-502. [DOI: 10.1016/j.diii.2015.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 08/10/2015] [Accepted: 08/26/2015] [Indexed: 10/22/2022]
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21
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An Examination of the Effects of Leuprolide Acetate Used in the Treatment of Central Precocious Puberty on Bone Mineral Density and 25-Hydroxy Vitamin D. W INDIAN MED J 2015; 64:104-7. [PMID: 26360682 DOI: 10.7727/wimj.2014.346] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 12/11/2014] [Indexed: 11/18/2022]
Abstract
AIM Leuprolide acetate is a gonadotropin-releasing hormone (GnRH) analogue frequently used in the treatment of central precocious puberty. Research is currently taking place into its effects on endocrine systems. The aim of this study is to investigate the effect of leuprolide acetate on vitamin D and bone mineral density. METHODS Twenty-three children diagnosed with central precocious puberty and receiving leuprolide acetate therapy for at least 12 months, and a control group of 17 healthy children were enrolled. In the study group, calcium, phosphorus, alkaline phosphatase, parathormone and 25-hydroxy vitamin D levels and bone mineral density were measured. The results were compared with those of the control group. RESULTS 25-Hydroxy vitamin D levels in the study and control groups were 15.17 ± 7 mg/dL and 22.2 ± 6.1 mg/dL, respectively (p < 0.05). In terms of bone mineral density, osteopenia was determined in 13 (56.5%) patients in the study group and osteoporosis in one (4.3%), while osteopenia was identified in seven patients in the control group, with no osteoporosis being identified (p > 0.05). CONCLUSION Gonadotropin-releasing hormone agonists may have an adverse effect on bone health. They may exhibit these effects by impacting on vitamin D levels. These levels should be periodically monitored in patients receiving treatment, and vitamin D support should be given in cases where the deficiency is identified.
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Guo B, Xu Y, Gong J, Tang Y, Shang J, Xu H. Reference data and percentile curves of body composition measured with dual energy X-ray absorptiometry in healthy Chinese children and adolescents. J Bone Miner Metab 2015; 33:530-9. [PMID: 25319556 DOI: 10.1007/s00774-014-0615-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 06/26/2014] [Indexed: 11/28/2022]
Abstract
Measurements of body composition by dual-energy X-ray absorptiometry (DXA) have evident value in evaluating skeletal and muscular status in growing children and adolescents. This study aimed to generate age-related trends for body composition in Chinese children and adolescents, and to establish gender-specific reference percentile curves for the assessment of muscle-bone status. A total of 1541 Chinese children and adolescents aged from 5 to 19 years were recruited from southern China. Bone mineral content (BMC), lean mass (LM) and fat mass (FM) were measured for total body and total body less head (TBLH). After 14 years, total body LM was significantly higher in boys than girls (p < 0.001). However, total body FM was significantly higher in girls than boys in age groups 13-19 years (p < 0.01). Both LM and FM were consistent independent predictors of total body and subcranial bone mass in both sexes, even after adjustment for the well-known predictors of BMC. The results of multiple linear regression identified LM as the stronger predictor of total body and subcranial skeleton BMC while the fat mass contributed less. For all the subjects, significant positive correlations were observed between total body LM, height, total body BMC and subcranial BMC (p < 0.01). Subcranial BMC had a better correlation with LM than total body BMC. We have also presented gender-specific percentile curves for LM-for-height and BMC-for-LM which could be used to evaluate and follow various pediatric disorders with skeletal manifestations in this population.
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Affiliation(s)
- Bin Guo
- Department of Nuclear Medicine, The First Affiliated Hospital, Jinan University, No.613, West Huangpu Road, Guangzhou, 510630, China
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Risk of fracture prevention in spina bifida patients: correlation between bone mineral density, vitamin D, and electrolyte values. Childs Nerv Syst 2015; 31:1361-5. [PMID: 25930725 DOI: 10.1007/s00381-015-2726-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 04/20/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE The aim of our study was to investigate the relationship between bone mineral density (BMD), vitamin D, and electrolyte blood values in patients with spina bifida, to find a possible therapeutic regimen and an intervention to reduce the risk of fractures in this population. METHODS BMD values were measured in 49 patients (32 females, 17 males; aged 14.1 ± 3.86 years; range 5-20 years) using dual-energy X-ray absorptiometry (DEXA) and were analyzed based on sex, the level of spinal involvement, vitamin D, and electrolyte values, physical activity, body mass index (BMI), and ambulatory status [patients were divided into three subgroups: full-time wheelchair (FTWC), limited ambulator (LA), and full-time ambulator (FTA)]. These data were analyzed considering sex-, age-, and BMD-matched values and compared with those of normal population. RESULTS BMD was significantly lower in these patients compared with that in the general healthy population (Z-score: -1.2 ± 1.8); in particular, females had Z-score values significantly lower that of the males (Z-score: -2.43 ± 2.02; P < 0.0004). In FTWC subgroup, Z-score was lower than that of the other two subgroups (P < 0.009). Vitamin D values were significantly lower compared with those in the general healthy population (vitamin D spina bifida group: 14.6 ± 8.7 mg/dL; normal subjects: 35 ± 9.8 mg/dL; P < 0.001). Subjects with spina bifida showed hypophosphatemia (<3 mg/dL) because of the lower levels of vitamin D (3.1 ± 0.9 mg/dL; P < 0.001). CONCLUSIONS Spina bifida patients showed lower BMD, vitamin D, and electrolyte values than the healthy population; hence, they have an increase risk of developing pathological fractures. Vitamin D supplementation for a longer time period could reduce this risk.
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Horenstein RE, Shefelbine SJ, Mueske NM, Fisher CL, Wren TA. An approach for determining quantitative measures for bone volume and bone mass in the pediatric spina bifida population. Clin Biomech (Bristol, Avon) 2015; 30:748-54. [PMID: 26002057 PMCID: PMC4523422 DOI: 10.1016/j.clinbiomech.2015.04.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 04/16/2015] [Accepted: 04/17/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND The pediatric spina bifida population suffers from decreased mobility and recurrent fractures. This study aimed to develop a method for quantifying bone mass along the entire tibia in youth with spina bifida. This will provide information about all potential sites of bone deficiencies. METHODS Computed tomography images of the tibia for 257 children (n=80 ambulatory spina bifida, n=10 non-ambulatory spina bifida, n=167 typically developing) were analyzed. Bone area was calculated at regular intervals along the entire tibia length and then weighted by calibrated pixel intensity for density weighted bone area. Integrals of density weighted bone area were used to quantify bone mass in the proximal and distal epiphyses and diaphysis. Group differences were evaluated using analysis of variance. FINDINGS Non-ambulatory children suffer from decreased bone mass in the diaphysis and proximal and distal epiphyses compared to ambulatory and control children (P≤0.001). Ambulatory children with spina bifida showed statistically insignificant differences in bone mass in comparison to typically developing children at these sites (P>0.5). INTERPRETATION This method provides insight into tibial bone mass distribution in the pediatric spina bifida population by incorporating information along the whole length of the bone, thereby providing more information than dual-energy x-ray absorptiometry and peripheral quantitative computed tomography. This method can be applied to any population to assess bone mass distribution across the length of any long bone.
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Affiliation(s)
- Rachel E. Horenstein
- Department of Biomedical Engineering, University of Southern California, Los Angeles CA, United States
| | - Sandra J. Shefelbine
- Department of Mechanical and Industrial Engineering, Northeastern University, Boston MA, United States
| | - Nicole M. Mueske
- Children’s Orthopaedic Center, Children’s Hospital Los Angeles, Los Angeles CA, United States
| | - Carissa L. Fisher
- Children’s Orthopaedic Center, Children’s Hospital Los Angeles, Los Angeles CA, United States
| | - Tishya A.L. Wren
- Department of Biomedical Engineering, University of Southern California, Los Angeles CA, United States,Children’s Orthopaedic Center, Children’s Hospital Los Angeles, Los Angeles CA, United States
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Yaghini O, Tonekaboni SH, Amir Shahkarami SM, Ahmad Abadi F, Shariat F, Abdollah Gorji F. Bone mineral density in ambulatory children with epilepsy. Indian J Pediatr 2015; 82:225-9. [PMID: 25106841 DOI: 10.1007/s12098-014-1518-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Accepted: 06/12/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To elucidate the effects of antiepileptic drugs (AEDs) on bone health status of ambulatory epileptic children. METHODS A total of 120 epileptic children aged 2-15 y were enrolled in three groups. The first group was on therapy with carbamazepine, phenobarbital or primidone. The second was treated with valproic acid and the third group was untreated. Serum calcium, phosphorous, total alkaline phosphatase, and parathyroid hormone levels were compared between groups. Bone mineral density tests were also performed at four sites of the lumbar spine and three sites of femoral neck and results were compared between the groups. RESULTS Of all enrolled subjects, 67 patients (55.8 %) were vitamin D deficient. The three groups were not significantly different in terms of vitamin D, calcium, phosphorus, total alkaline phosphatase, and parathyroid hormone levels. While patients in first group had lower Z-score of femoral neck and lumbar spine compared to those on valproic acid, these values were also significantly different than that of the third group. CONCLUSIONS It can be concluded that both enzyme-inducing AEDs and non enzyme-inducing AEDs decrease bone mineral density (BMD). Also alkaline phosphatase (ALP) is affected in ambulatory epileptic children on enzyme-inducing AEDs. Nevertheless, valproic acid (a non-enzyme-inducing agent) does not have the mentioned side effects.
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Affiliation(s)
- Omid Yaghini
- Pediatric Neurology Unit, Department of Pediatrics, Isfahan University of Medical Sciences, Isfahan, Iran
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Szadek LL, Scharer K. Identification, prevention, and treatment of children with decreased bone mineral density. J Pediatr Nurs 2014; 29:e3-14. [PMID: 24333239 DOI: 10.1016/j.pedn.2013.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 11/05/2013] [Accepted: 11/05/2013] [Indexed: 12/23/2022]
Abstract
Osteoporosis in children is the presence of decreased bone mineral density in association with a significant fracture history. The amount of bone accretion in childhood and early adulthood is predictive of the risk of osteoporosis and fracture in later adulthood. A myriad of disorders and medications are associated with decreased bone mineral density in childhood. In addition, lifestyle factors including poor dietary habits and minimal physical activity are associated with low bone mass. Because of the limited attention given to childhood osteoporosis, this review was undertaken to examine the diagnostic criteria, etiologies, prevention of and treatment strategies for osteoporosis in children and adolescents.
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Nakavachara P, Pooliam J, Weerakulwattana L, Kiattisakthavee P, Chaichanwattanakul K, Manorompatarasarn R, Chokephaibulkit K, Viprakasit V. A normal reference of bone mineral density (BMD) measured by dual energy X-ray absorptiometry in healthy thai children and adolescents aged 5-18 years: a new reference for Southeast Asian Populations. PLoS One 2014; 9:e97218. [PMID: 24847716 PMCID: PMC4029563 DOI: 10.1371/journal.pone.0097218] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 04/16/2014] [Indexed: 11/19/2022] Open
Abstract
Ethnic-specific normative data of bone mineral density (BMD) is essential for the accurate interpretation of BMD measurement. There have been previous reports of normative BMD data for Caucasian and Asian children including Japanese, Chinese, Korean and Indian. However, the normative BMD data for Southeast Asian including Thai children and adolescents are not currently available. The goals of our study were 1) to establish normative data of BMD, bone mineral content (BMC), bone area (BA) and lean body mass (LBM) for healthy Thai children and adolescents; aged 5–18 years measured by dual energy X-ray absorptiometry (DXA, Lunar Prodigy) and 2) to evaluate the relationships between BMD vs. age, sex, puberty, weight, height, calcium intake and the age of menarche in our population. Gender and age-specific BMD (L2-4; LS and total body; TB), BMADLS (apparent BMD of the lumbar spine), BMC (L2-4 and total body), BA (L2-4 and total body) and LBM were evaluated in 367 children (174 boys and 193 girls). All parameters increased progressively with age. A rapid increase in BMD, BMC and BMADLS was observed at earlier ages in girls. Gender and Tanner stage-specific BMD normative data were also generated. The dynamic changes of BMD values from childhood to early and late puberty of Thai children appeared to be consistent with those of Caucasian and Asian populations. Using a multiple-regression, weight and Tanner stage significantly affected BMDLS, BMDTB and BMADLS in both genders. Only in girls, height was found to have significant influence on BMDTB and BMADLS. The positive correlation between BMD and several demographic parameters, except the calcium intake, was observed. In summary, we established a normal BMD reference for Thai children and adolescents and this will be of useful for clinicians and researchers to appropriately assess BMD in Thais and other Southeast Asian children.
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Affiliation(s)
- Pairunyar Nakavachara
- Division of Pediatric Endocrinology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
- * E-mail:
| | - Julaporn Pooliam
- Clinical Epidemiological Unit, Office for Research and Development, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Linda Weerakulwattana
- Division of Pediatric Endocrinology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pornpimol Kiattisakthavee
- Division of Pediatric Endocrinology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Katharee Chaichanwattanakul
- Division of Pediatric Endocrinology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Racahnee Manorompatarasarn
- Division of Pediatric Infectious Diseases, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kulkanya Chokephaibulkit
- Division of Pediatric Infectious Diseases, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Vip Viprakasit
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Crabtree NJ, Arabi A, Bachrach LK, Fewtrell M, El-Hajj Fuleihan G, Kecskemethy HH, Jaworski M, Gordon CM. Dual-energy X-ray absorptiometry interpretation and reporting in children and adolescents: the revised 2013 ISCD Pediatric Official Positions. J Clin Densitom 2014; 17:225-42. [PMID: 24690232 DOI: 10.1016/j.jocd.2014.01.003] [Citation(s) in RCA: 375] [Impact Index Per Article: 37.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 01/08/2014] [Indexed: 01/17/2023]
Abstract
The International Society for Clinical Densitometry Official Revised Positions on reporting of densitometry results in children represent current expert recommendations to assist health care providers determine which skeletal sites should be measured, which, if any, adjustments should be made, reference databases to be used, and the elements to include in a dual-energy X-ray absorptiometry report. The recommended scanning sites remain the total body less head and the posterior-anterior spine. Other sites such as the proximal femur, lateral distal femur, lateral vertebral assessment, and forearm are discussed but are only recommended for specific pediatric populations. Different methods of interpreting bone density scans in children with short stature or growth delay are presented. The use of bone mineral apparent density and height-adjusted Z-scores are recommended as suitable size adjustment techniques. The validity of appropriate reference databases and technical considerations to consider when upgrading software and hardware remain unchanged. Updated reference data sets for all contemporary bone densitometers are listed. The inclusion of relevant demographic and health information, technical details of the scan, Z-scores, and the wording "low bone mass or bone density" for Z-scores less than or equal to -2.0 standard deviation are still recommended for clinical practice. The rationale and evidence for the development of the Official Positions are provided. Changes in the grading of quality of evidence, strength of recommendation, and worldwide applicability represent a change in current evidence and/or differences in opinion of the expert panelists used to validate the position statements for the 2013 Position Development Conference.
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Affiliation(s)
- Nicola J Crabtree
- Department of Endocrinology, Birmingham Children's Hospital, Birmingham, UK.
| | - Asma Arabi
- Calcium Metabolism and Osteoporosis Program, American University of Beirut, Lebanon
| | - Laura K Bachrach
- Endocrinology, Department of Medicine, Stanford University, Palo Alto, CA, USA
| | - Mary Fewtrell
- Department of Nutritional and Surgical Science, UCL Institute of Child Health, London, UK
| | | | - Heidi H Kecskemethy
- Department of Research, Nemours/A.I. duPont Hospital for Children, Wilmington, DE, USA
| | - Maciej Jaworski
- Department of Biochemistry and Experimental Medicine, The Children's Memorial Health Institute, Warsaw, Poland
| | - Catherine M Gordon
- Division of Adolescent Medicine, Hasbro Children's Hospital and Alpert Medical School of Brown University, Providence, RI, USA
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Abstract
The incidence of inflammatory bowel disease (IBD), Crohn's disease and ulcerative colitis, in children is on the rise. Pediatric patients with IBD are especially vulnerable to the physical and psychosocial morbidities of this disorder. Unique aspects of pediatric IBD patients compared to adult patients warrants an individualized approach to management regardless of age. This review focuses on the special aspects of pediatric IBD and the implications for the diagnosis and management of this disease.
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Affiliation(s)
- Shervin Rabizadeh
- Department of Pediatrics, Pediatric Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, 8635 West 3rd Street, Suite 1165W, Los Angeles, CA 90048, USA.
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Guo B, Xu Y, Gong J, Tang Y, Xu H. Age trends of bone mineral density and percentile curves in healthy Chinese children and adolescents. J Bone Miner Metab 2013; 31:304-14. [PMID: 23361952 DOI: 10.1007/s00774-012-0401-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Accepted: 10/14/2012] [Indexed: 11/24/2022]
Abstract
The clinical utility of dual-energy X-ray absorptiometry (DXA) measurement requires appropriate normative values, designed to be diverse with respect to age, gender and ethnic background. The purpose of this study was to generate age-related trends for bone density in Chinese children and adolescents, and to establish a gender-specific reference database. A total of 1,541 Chinese children and adolescents aged from 5 to 19-years were recruited from southern China. Bone mineral density (BMD), bone mineral content (BMC), and bone area (BA) were measured for the total body (TB) and total body less head (TBLH). The height-for-age, height-for-BA, and BMC-for-BA percentile curves were developed using the least mean square method. TB BMD and TBLH BMD were highly correlated. After 18 years, TB BMD was significantly higher in boys than girls. For TB BMC and TBLH BMC, gender differences were found in age groups 12 years and 16-19 years; however, the TBLH BMD was significantly different between genders >16 years. The head region accounted for 13-52 and 16-49 % of the TB BMC in boys and girls, respectively. Furthermore, the percentages were negatively correlated with age and height. This study describes a gender-specific reference database for Chinese children and adolescents aged 5-19 years. These normative values could be used for clinical assessment in this population.
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Affiliation(s)
- Bin Guo
- Department of Nuclear Medicine, First Affiliated Hospital, Jinan University, No. 613 West Huangpu Road, Guangzhou, 510630, China
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Abstract
UNLABELLED The prevalence and morbidity associated with osteoporosis and fractures in patients with spina bifida (SB) highlight the importance of osteoporosis prevention and treatment in early childhood; however, the issue has received little attention. The method for the selection of appropriate patients for drug treatment has not been clarified. OBJECTIVE To review the literature concerning fracture risks and low bone density in paediatric patients with SB. We looked for studies describing state-of-the-art treatments and for prevention of secondary osteoporosis. METHODS Articles were identified through a search in the electronic database (PUBMED) supplemented with reviews of the reference lists of selected papers. The main outcome measures were incidence of fractures and risk factors for fracture, an association between bone mineral density (BMD) and occurrence of fracture, risk factors of low BMD, and effects of pharmacological and non-pharmacological treatments on BMD and on the incidence of fractures. We considered as a secondary outcome the occurrence of fractures in relation to the mechanism of injury. RESULTS Results indicated that patients with SB are at increased risk for fractures and low BMD. Risk factors that may predispose patients to fractures include higher levels of neurological involvement, non-ambulatory status, physical inactivity, hypercalciuria, higher body fat levels, contractures, and a previous spontaneous fracture. Limitations were observed in the number and quality of studies concerning osteoporosis prevention and treatment in paediatric patients with SB. The safety and efficiency of drugs to treat osteoporosis in adults have not been evaluated satisfactorily in children with SB.
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Affiliation(s)
- Humberto Filipe Marreiros
- Correspondence to: Humberto Filipe Marreiros, Hospital Dona Estafania, Rua Jacinta Marto, 1169-045 Lisboa, Estremadura 1500-540, Portugal.
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Sgambat K, Tuchman S, Ryan L, Wood R, Moudgil A. Low bone mineral density and nutritional vitamin D deficiency in pediatric renal transplant recipients: Assessment of risk factors and response to oral vitamin D therapy. Pediatr Transplant 2011; 15:790-7. [PMID: 21895903 DOI: 10.1111/j.1399-3046.2011.01571.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
VitD deficiency and bone disease are common after Tx. Prevalence and risk factors for low VitD and BMD and response to VitD therapy were investigated in pediatric renal Tx recipients. 25-hydroxy VitD levels of 71 Tx were compared to 54 healthy AA children. DXA of 44 Tx were compared to 47 AA controls. Of Tx, 59% were AA. Majority (59.1%) of Tx were VitD deficient (23.9%) or insufficient (35.2%). Prevalence of low VitD levels was double in AA (73.9%) vs. non-AA Tx (37.7%), (p = 0.003). Low VitD among Tx was associated with AA ethnicity (p < 0.01), winter (p < 0.05), older age (p < 0.05), males (p < 0.05) and time <6 months post Tx (p < 0.05). Tx with low VitD were treated with oral ergocalciferol or cholecalciferol (23 each); 13% treated with ergocalciferol vs. 82.6% treated with cholecalciferol achieved repletion (p < 0.0001). Of 36 Tx with whole body DXA, 19.5% had BMD (z < -1) after height adjustment. AA Tx had 3.4-fold higher risk of low BMD vs. controls (p < 0.05). Low VitD and BMD are prevalent in children after renal Tx. Better repletion of VitD is achieved with cholecalciferol.
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Affiliation(s)
- Kristen Sgambat
- Department of Nephrology, Children's National Medical Center Emergency Medicine, Children's National Medical Center, Washington, DC 20010, USA
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Markula-Patjas KP, Valta HL, Kerttula LI, Soini IH, Honkanen VEA, Toiviainen-Salo SM, Mäkitie OM. Prevalence of vertebral compression fractures and associated factors in children and adolescents with severe juvenile idiopathic arthritis. J Rheumatol 2011; 39:365-73. [PMID: 22133619 DOI: 10.3899/jrheum.110305] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Vertebral fractures occur in patients with juvenile idiopathic arthritis (JIA), but data on their frequency and causes are scarce. Our cross-sectional study evaluated prevalence of compression fractures and associated factors in a high-risk pediatric population with severe JIA. METHODS Children and adolescents with a history of treatment-resistant polyarticular-course JIA for ≥ 5 years or systemic arthritis for ≥ 3 years were recruited. Clinical examination, dietary recall, laboratory measurements, bone mineral density (BMD) measurement by dual-energy X-ray absorptiometry, and spinal radiography were performed. RESULTS Our study included 50 patients (41 girls), of whom 6 (12%) had systemic arthritis, with a median age of 14.8 years (range 7.0-18.7 yrs) and median disease duration of 10.2 years (range 3.9-16.8 years). Ninety-four percent had used systemic glucocorticoids (GC); the median total duration of GC treatment was 7.1 years (range 0-15.5 yrs). The median weight-adjusted cumulative GC dose for the preceding 3 years was 72 mg/kg (range 0-911 mg/kg). The median bone age-corrected lumbar spine and whole-body areal BMD Z-scores were -0.8 and -1.0, respectively. Twenty-two percent had vertebral fractures, mostly thoracic. Compression fractures were associated with high disease activity, high body mass index (BMI), and high recent cumulative GC dose, but not with disease duration or BMD. Thirty percent had sustained at least 1 peripheral low energy fracture. Twenty-six percent were deemed to have significantly compromised bone health. CONCLUSION Severe JIA is associated with a significant risk of vertebral compression fractures. Associated factors include high disease activity, high BMI, and high recent GC exposure. Further studies are needed to establish optimal prevention and treatment guidelines.
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Baxter-Jones ADG, Faulkner RA, Forwood MR, Mirwald RL, Bailey DA. Bone mineral accrual from 8 to 30 years of age: an estimation of peak bone mass. J Bone Miner Res 2011; 26:1729-39. [PMID: 21520276 DOI: 10.1002/jbmr.412] [Citation(s) in RCA: 405] [Impact Index Per Article: 31.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Bone area (BA) and bone mineral content (BMC) were measured from childhood to young adulthood at the total body (TB), lumbar spine (LS), total hip (TH), and femoral neck (FN). BA and BMC values were expressed as a percentage of young-adult values to determine if and when values reached a plateau. Data were aligned on biological ages [years from peak height velocity (PHV)] to control for maturity. TB BA increased significantly from -4 to +4 years from PHV, with TB BMC reaching a plateau, on average, 2 years later at +6 years from PHV (equates to 18 and 20 years of age in girls and boys, respectively). LS BA increased significantly from -4 years from PHV to +3 years from PHV, whereas LS BMC increased until +4 from PHV. FN BA increased between -4 and +1 years from PHV, with FN BMC reaching a plateau, on average, 1 year later at +2 years from PHV. In the circumpubertal years (-2 to +2 years from PHV): 39% of the young-adult BMC was accrued at the TB in both males and females; 43% and 46% was accrued in males and females at the LS and TH, respectively; 33% (males and females) was accrued at the FN. In summary, we provide strong evidence that BA plateaus 1 to 2 years earlier than BMC. Depending on the skeletal site, peak bone mass occurs by the end of the second or early in the third decade of life. The data substantiate the importance of the circumpubertal years for accruing bone mineral.
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Affiliation(s)
- Adam D G Baxter-Jones
- College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
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Bruckner AL, Bedocs LA, Keiser E, Tang JY, Doernbrack C, Arbuckle HA, Berman S, Kent K, Bachrach LK. Correlates of low bone mass in children with generalized forms of epidermolysis bullosa. J Am Acad Dermatol 2011; 65:1001-9. [PMID: 21550693 DOI: 10.1016/j.jaad.2010.08.028] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2010] [Revised: 08/25/2010] [Accepted: 08/27/2010] [Indexed: 11/29/2022]
Abstract
BACKGROUND Epidermolysis bullosa (EB) is a family of rare, heterogeneous, genetic disorders characterized by fragility of the skin and mucous membranes. Reduced bone mass and fractures have been recognized as complications of generalized forms of EB. OBJECTIVES We sought to describe the range and to estimate the prevalence of low bone mass in children with generalized EB, and to identify correlates of low bone mass in this population. METHODS This was a prospective, observational study of 24 patients with generalized EB. Each patient completed a history, physical examination, laboratory studies, bone age, and x-rays of the lumbar spine. Those aged 6 years and older underwent dual energy x-ray absorptiometry scans of the lumbar spine. Primary outcomes were areal bone mineral density (aBMD) based on chronologic age, bone age, and adjusted for height Z-score. Descriptive statistics were used to summarize results, and linear regression was used to determine factors associated with low aBMD. RESULTS Mean lumbar spine aBMD Z-scores ± SD were: -2.6 ± 1.4 for chronologic age, -1.7 ± 1.3 for bone age, and -1.0 ± 1.2 after adjusting for height Z-score. aBMD Z-scores were less than or equal to -2 in 64% for chronologic age, 50% for bone age, and 28% after adjusting for height Z-score. aBMD correlated with height Z-score, weight Z-score, extensive blistering, immobility, albumin, hemoglobin, iron, erythrocyte sedimentation rate, and c-reactive protein values. LIMITATIONS Small sample size was a limitation. CONCLUSIONS Children with severe, generalized recessive dystrophic EB have low aBMD for age. Deficits in aBMD were reduced after adjusting for delayed skeletal maturation and small body size.
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Affiliation(s)
- Anna L Bruckner
- Department of Dermatology, Stanford University School of Medicine, Stanford, CA 94305-5168, USA.
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Kocks J, Ward K, Mughal Z, Moncayo R, Adams J, Högler W. Z-score comparability of bone mineral density reference databases for children. J Clin Endocrinol Metab 2010; 95:4652-9. [PMID: 20668038 DOI: 10.1210/jc.2010-0677] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE The diversity of pediatric dual-energy x-ray absorptiometry (DXA) bone mineral density (BMD) reference databases raises questions as to whether they are interchangeable in their application. This study examined the comparability of BMD Z-scores generated from the largest available Hologic DXA databases, applied on BMD results of a large series of unselected pediatric patients. METHODS A total of 2027 BMD scans were extracted from Hologic QDR-4500A machines. Age- and sex-specific BMD Z-scores of children aged 8-17 yr, calculated from six Hologic databases, were compared for lumbar spine (LS) and total body (TB). The final dataset included 708 scans (307 of girls). RESULTS BMD Z-scores calculated from the six databases were highly correlated but differed significantly (P < 0.001) in both scan regions. Interdatabase Z-score differences (boys/girls, respectively) were up to 0.54/0.55 for LS and 1.0/0.83 for TB. These differences also varied significantly among age groups. In girls, the percentage of LS BMD Z-scores of -2 or below ("low BMD for age") varied between 15.4 and 27.9% (P < 0.012). The percentage of TB BMD Z-scores of -2 or below varied similarly in boys (P < 0.009). CONCLUSIONS Clinically relevant differences in BMD Z-scores exist between the Hologic databases, revealing a significant potential for misdiagnosis. Ideally, Z-scores should be calculated using model-, brand-, and software-specific reference curves for age, sex, and ethnic group. However, our results can be used to estimate converted values. There are other differences in children's bone mass, shape, strength, and body size that are not detected by DXA.
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Affiliation(s)
- J Kocks
- Department of Pediatrics, Medical University Innsbruck, Innsbruck, Austria
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Abstract
CONTEXT The biochemical hallmark of pseudohypoparathyroidism type 1a (PHP1a) is resistance to PTH, but based on tissue-specific imprinting of GNAS, PTH resistance may be limited to the renal cortex. Some studies have shown that bone is responsive to PTH, suggesting that PHP1a patients with chronically elevated PTH levels may have low bone mineral density (BMD). SETTING This observational study was conducted at the Institute of Clinical and Translational Research, Johns Hopkins Medical Institutions. SUBJECTS Twenty-two children and adults with PHP1a were studied. MAIN OUTCOME MEASURE The main outcome measure was BMD Z-score at the lumbar spine (LS), total hip, femoral neck, and total body using dual-energy x-ray absorptiometry, relative to height, weight, and pubertal status. RESULTS The mean (+/-SD) Z-score for height was 0.77 +/- 1.66 and 1.85 +/- 1.15 for BMI. The BMD Z-score at each of the four sites studied was as follows: LS, 0.29 +/- 1.08; total hip, 0.27 +/- 1.24; femoral neck, 0.02 +/- 1.26; and total body, 0.98 +/- 1.50. Only two subjects (9%) had BMD Z-scores less than -2, and each had additional risk factors for low BMD. BMD in total body and LS spine corrected for height-for-age Z-score was significantly greater than normal. There was no correlation between PTH level and BMD Z-score or between body mass index and BMD Z-score. CONCLUSIONS Despite secondary hyperparathyroidism, region-specific BMD is not reduced in patients with PHP1a, and total body BMD is significantly greater than normal.
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Affiliation(s)
- Dominique N Long
- Division of Pediatric Endocrinology, Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA
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Canadian Association of Radiologists technical standards for bone mineral densitometry reporting. Can Assoc Radiol J 2010; 62:166-175. [PMID: 20627445 DOI: 10.1016/j.carj.2010.04.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2010] [Revised: 04/09/2010] [Accepted: 04/09/2010] [Indexed: 11/23/2022] Open
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Hough JP, Boyd RN, Keating JL. Systematic review of interventions for low bone mineral density in children with cerebral palsy. Pediatrics 2010; 125:e670-8. [PMID: 20123765 DOI: 10.1542/peds.2009-0292] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
AIM To systematically review the efficacy of interventions to improve low bone mineral density (LBMD) in children and adolescents with cerebral palsy (CP). METHODS We performed a systematic search for published randomized, controlled trials (RCTs) and controlled clinical trials (CCTs) of children with CP (aged 0-20 years, all Gross Motor Function Classification System [GMFCS] levels) who received various medical and physical interventions for LBMD compared with no intervention or standard care. Study validity was evaluated by using the Physiotherapy Evidence Database (PEDro) scale. Standardized mean differences (SMDs) were calculated when data were sufficient. RESULTS Eight of 2034 articles met the inclusion criteria (6 RCTs, 2 CCTs). There were 3 trials of bisphosphonates, one of which (Henderson RC, Lark RK, Kecskemethy HH, Miller F, Harcke HT, Bachrach SJ. J Pediatr. 2002;141[5]:644-651) revealed a large and significant effect on BMD in 1 of 3 sites in the distal femur (SMD: 1.88 [95% confidence interval (CI): 0.52-3.24]). There were 3 trials of weight-bearing through varying approaches, one of which (Caulton JM, Ward KA, Alsop CW, Dunn G, Adams JE, Mughal MZ. Arch Dis Child. 2004;89[2]:131-135) showed a large and significant effect on the lumbar spine when increasing static standing time (SMD: 1.03 [95% CI: 0.21-1.85]). The administration of vitamin D and calcium produced a large, nonsignificant effect on BMD in the lumbar spine (Jekovec-Vrhovsek M, Kocijancic A, Prezelj J. Dev Med Child Neurol. 2000;42[6]:403-405) (SMD: 0.88 [95% CI: -0.07 to 1.84). Growth hormone combined with vitamin D and/or calcium resulted in effects comparable with vitamin D and/or calcium on BMD in the lumbar spine (Ali O, Shim M, Fowler E, et al. J Clin Endocrinol Metab. 2007;92[3]:932-937) (SMD 0 [95% CI: -1.24 to 1.24]). CONCLUSIONS Important effects on LBMD have been observed in small and diverse cohorts of children with CP. It is unclear whether small sample sizes or variable treatment responses account for nonsignificant findings. Additional large RCTs are needed of both physical and medical approaches.
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Affiliation(s)
- Janet P Hough
- BAppSc, PT, Monash Medical Centre, Victorian Paediatric Rehabilitation Service, 246 Clayton Rd, Clayton, Victoria 3168, Australia.
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42
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Baxter-Jones ADG, McKay H, Burrows M, Bachrach LK, Lloyd T, Petit M, Macdonald H, Mirwald RL, Bailey D. International longitudinal pediatric reference standards for bone mineral content. Bone 2010; 46:208-16. [PMID: 19854308 PMCID: PMC4132948 DOI: 10.1016/j.bone.2009.10.017] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2009] [Revised: 09/29/2009] [Accepted: 10/15/2009] [Indexed: 11/21/2022]
Abstract
To render a diagnosis pediatricians rely upon reference standards for bone mineral density or bone mineral content, which are based on cross-sectional data from a relatively small sample of children. These standards are unable to adequately represent growth in a diverse pediatric population. Thus, the goal of this study was to develop sex and site-specific standards for BMC using longitudinal data collected from four international sites in Canada and the United States. Data from four studies were combined; Saskatchewan Paediatric Bone Mineral Accrual Study (n=251), UBC Healthy Bones Study (n=382); Penn State Young Women's Health Study (n=112) and Stanford's Bone Mineral Accretion study (n=423). Males and females (8 to 25 years) were measured for whole body (WB), total proximal femur (PF), femoral neck (FN) and lumbar spine (LS) BMC (g). Data were analyzed using random effects models. Bland-Altman was used to investigate agreement between predicted and actual data. Age, height, weight and ethnicity independently predicted BMC accrual across sites (P<0.05). Compared to White males, Asian males had 31.8 (6.8) g less WB BMC accrual; Hispanic 75.4 (28.2) g less BMC accrual; Blacks 82.8 (26.3) g more BMC accrual with confounders of age, height and weight controlled. We report similar findings for the PF and FN. Models for females for all sites were similar with age, height and weight as independent significant predictors of BMC accrual (P<0.05). We provide a tool to calculate a child's BMC Z-score, accounting for age, size, sex and ethnicity. In conclusion, when interpreting BMC in pediatrics we recommend standards that are sex, age, size and ethnic specific.
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Affiliation(s)
| | - Heather McKay
- PhD, Department of Family Practice and Centre for Hip Health and Mobility, University of British Columbia, Vancouver Coastal Health Research Institute, BC, Canada
| | - Melonie Burrows
- PhD, Department of Orthopaedics and Centre for Hip Health and Mobility, University of British Columbia, Vancouver Coastal Health Research Institute, BC, Canada
| | | | - Tom Lloyd
- PhD, Department of Public Health Sciences, Hershey Medical Center, Hershey, PA, USA
| | - Moira Petit
- PhD, School of Kinesiology, University of Minnesota, Minneapolis, MN, USA
| | - Heather Macdonald
- PhD, Department of Mechanical & Manufacturing Engineering, University of Calgary, Calgary, AB
| | - Robert L Mirwald
- PhD, College of Kinesiology, University of Saskatchewan, SK, Canada
| | - Don Bailey
- PhD, College of Kinesiology, University of Saskatchewan, SK, Canada
- PhD, School of Human Movement Studies, University of Queensland, Australia
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Lim JS, Hwang JS, Lee JA, Kim DH, Park KD, Cheon GJ, Shin CH, Yang SW. Bone mineral density according to age, bone age, and pubertal stages in korean children and adolescents. J Clin Densitom 2010; 13:68-76. [PMID: 19942470 DOI: 10.1016/j.jocd.2009.09.006] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2009] [Revised: 09/18/2009] [Accepted: 09/18/2009] [Indexed: 01/19/2023]
Abstract
To determine whether bone age (BA)-based bone mineral density (BMD) reference values are more accurate than chronological age-based BMD values in predicting the BMD of children who have a discrepancy between their chronological age and BA; we calculated BMD reference values for 514 healthy Korean children (262 girls and 252 boys) aged 5-20yr by dual-energy X-ray absorptiometry. We found that children with BA chronological age discrepancy fitted better to the BA BMD reference curve than to the chronological age BMD reference curve. In contrast, most children without BA-chronological age discrepancy fitted well to both BA and chronological age BMD reference curves, because the 2 reference curves are very similar. In the linear regression analysis, BA-based equations for BMD had a higher R(2) value and lower standard error of estimate than chronological age-based equations. These results indicate that BA-based BMD values are more accurate in predicting BMD in children who have a discrepancy between their BA and chronological age.
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Affiliation(s)
- Jung Sub Lim
- Department of Pediatrics, Korea Cancer Center Hospital, Seoul, Republic of Korea.
| | - Jin Soon Hwang
- Department of Pediatrics, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Jun Ah Lee
- Department of Pediatrics, Korea Cancer Center Hospital, Seoul, Republic of Korea
| | - Dong Ho Kim
- Department of Pediatrics, Korea Cancer Center Hospital, Seoul, Republic of Korea
| | - Kyung Duk Park
- Department of Pediatrics, Korea Cancer Center Hospital, Seoul, Republic of Korea
| | - Gi Jeong Cheon
- Department of Nuclear Medicine, Korea Cancer Center Hospital, Seoul, Republic of Korea
| | - Choong Ho Shin
- Department of Pediatrics, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Sei Won Yang
- Department of Pediatrics, College of Medicine, Seoul National University, Seoul, Republic of Korea
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44
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Lim JS. Pediatric dual-energy X-ray absorptiometry: interpretation and clinical and research application. KOREAN JOURNAL OF PEDIATRICS 2010. [DOI: 10.3345/kjp.2010.53.3.286] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Jung Sub Lim
- Department of Pediatrics, Korean Cancer Center Hospital, Seoul, Korea
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Abstract
Life expectancy for the 400 000 adults with cerebral palsy (CP) in the USA is increasing. Although there is a perception of increased fractured rate in the adult with CP, it has not been well studied. Low bone mineral density is found in more than 50% of adults with a variety of disabilities, including CP. Dual-energy X-ray absorptiometry scanning is commonly used to assess bone mineral density, but is limited by positioning and other artifacts in adults with CP. Novel scanning regions of interest, such as the distal femur, are not yet standardized in adults. Nutritional assessment and physical activity, the basis of most fracture prevention programs, are difficult to do in the adult with CP. A better understanding of the 'muscle-bone unit' physiology and its exploitation may lead to better treatment modifications. Clinical research trials with bisphosphonates (e.g. pamidronate), estrogen, selective estrogen receptor modulators, parathyroid hormone analogs, and growth hormone need to be targeted to the adult with CP. Longitudinal studies of fracture risk factors, genetic research in bone and neuromuscular biology, and the development of treatment surrogates for physical activity are additional areas of needed expertise. This could be facilitated by an adult CP registry and the centralization of clinical research efforts.
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Affiliation(s)
- Kevin J Sheridan
- Department of Pediatrics, Gillette Children's Specialty Care, Saint Paul, MN 55101, USA.
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Cohen M, Lahat E, Bistritzer T, Livne A, Heyman E, Rachmiel M. Evidence-based review of bone strength in children and youth with cerebral palsy. J Child Neurol 2009; 24:959-67. [PMID: 19321458 DOI: 10.1177/0883073809332401] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Children with cerebral palsy have various risk factors for compromised bone health. Evidence concerning their bone fragility is gathering; however, there is no consensus regarding risk factors, indications for evaluation, follow-up, or treatment. We performed an evidence-based review targeted to address the following questions concerning children with cerebral palsy: Is bone strength impaired and what are the risk factors? Are these children at increased risk for bone fractures? What are the relations between bone mineral density and fracture risk? What methods can be used for bone health assessment? How can bone strength be improved? Currently, the most acceptable method for evaluating bone status in children is dual-energy x-ray absorptiometry. Evidence demonstrates reduced bone mass in children with cerebral palsy; yet, no clear association with fractures. Preventive methods are suggested.
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Affiliation(s)
- Michal Cohen
- Maccabi Healthcare Services, Jerusalem & Hashfela District, Israel.
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Hawli Y, Nasrallah M, El-Hajj Fuleihan G. Endocrine and musculoskeletal abnormalities in patients with Down syndrome. Nat Rev Endocrinol 2009; 5:327-34. [PMID: 19421241 DOI: 10.1038/nrendo.2009.80] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Down syndrome has a prevalence of one in 500 to one in 1,000 live births and is the most common cause of mental retardation. Most patients are treated in childhood and adolescence for mental or growth retardation. Studies that evaluate bone mass in Down syndrome are limited, and many are small case series in pediatric and adult populations who live either in the community or in residential institutions. Several environmental and hormonal factors contribute to low bone mineral density in such patients. Muscle hypotonia, low amounts of physical activity, poor calcium and vitamin D intakes, hypogonadism, growth retardation and thyroid dysfunction contribute to substantial impairments in skeletal maturation and bone-mass accrual that predispose these patients to fragility fractures. Here, we review indications and limitations of bone-mass measurements in children, summarize the endocrine and skeletal abnormalities in patients presenting with Down syndrome, and review studies that investigate therapeutic strategies for such patients.
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Affiliation(s)
- Yousra Hawli
- Division of Endocrinology and Metabolism, American University of Beirut Medical Center, Beirut, Lebanon
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Abstract
OBJECTIVES Clinical results of bone mineral density for children with inflammatory bowel disease are commonly reported using reference data for chronological age. It is known that these children, particularly those with Crohn disease, experience delayed growth and maturation. Therefore, it is more appropriate to compare clinical results with bone age rather than chronological age. MATERIALS AND METHODS Areal bone mineral density (aBMD) was measured using dual energy x-ray absorptiometry, and bone age was assessed using the Tanner-Whitehouse 3 method from a standard hand/wrist radiograph. Results were available for 44 children ages 7.99 to 16.89 years. Areal bone mineral density measurements were converted to z scores using both chronological and bone ages for each subject. RESULTS Areal bone mineral density z scores calculated using bone age, as opposed to chronological age, were significantly improved for both the total body and lumbar spine regions of interest. When subjects were grouped according to diagnosis, bone age generated z scores remained significantly improved for those with Crohn disease but not for those diagnosed with ulcerative colitis. Grouping of children with Crohn disease into younger and older ages produced significantly higher z scores using bone age compared with chronological for the older age group, but not the younger age group. CONCLUSIONS Our findings, in accordance with those presented in the literature, suggest that aBMD results in children with Crohn disease should include the consideration of bone age, rather than merely chronological age. Bone size, although not as easily available, would also be an important consideration for interpreting results in paediatric populations.
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Celiac disease: its implications for orthopaedic nursing. Orthop Nurs 2008; 27:291-4; quiz 295-6. [PMID: 18832989 DOI: 10.1097/01.nor.0000337279.63293.6d] [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] [Indexed: 11/26/2022] Open
Abstract
Celiac disease (CD), also known as gluten-sensitive enteropathy, is an inherited autoimmune disease that can lead to multisystem effects. Left undiagnosed and untreated, it has severe orthopaedic implications involving osteoporosis and unnecessary treatment of joint pain, which could be avoided. The orthopaedic nurse may have thought that CD was primarily an abdominal disorder. We need to be aware of the potential practice implications in orthopaedics by understanding the disease, its diagnosis, and treatment. Furthermore, orthopaedic nurses can contribute to current research by studying the relationships between CD and orthopaedic problems.
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Dual energy X-ray absorptiometry interpretation and reporting in children and adolescents: the 2007 ISCD Pediatric Official Positions. J Clin Densitom 2008; 11:43-58. [PMID: 18442752 DOI: 10.1016/j.jocd.2007.12.005] [Citation(s) in RCA: 269] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2007] [Accepted: 12/05/2007] [Indexed: 02/07/2023]
Abstract
The International Society for Clinical Densitometry Official Positions on reporting of densitometry results in children represent an effort to consolidate opinions to assist healthcare providers determine which skeletal sites should be assessed, which adjustments should be made in these assessments, appropriate pediatric reference databases, and elements to include in a dual energy X-ray absorptiometry (DXA) report. Skeletal sites recommended for assessment are the lumbar spine and total body less head, the latter being valuable as it provides information on soft tissue, as well as bone. Interpretation of DXA findings in children with growth or maturational delay requires special consideration; adjustments are required to prevent erroneous interpretation. Normative databases used as a reference should be based on a large sample of healthy children that characterizes the variability in bone measures relative to gender, age, and race/ethnicity, and should be specific for each manufacturer and model of densitometer and software. Pediatric DXA reports should provide relevant demographic and health information, technical details of the scan, Z-scores, and should not include T-scores. The rationale and evidence for development of the Official Positions are provided. Given the sparse data currently available in many of these areas, it is likely that these positions will change over time as new data become available.
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