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Young SL, Gallo LA, Brookes DSK, Hayes N, Maloney M, Liddle K, James A, Moritz KM, Reid N. Altered bone and body composition in children and adolescents with confirmed prenatal alcohol exposure. Bone 2022; 164:116510. [PMID: 35931325 DOI: 10.1016/j.bone.2022.116510] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 07/08/2022] [Accepted: 07/29/2022] [Indexed: 11/21/2022]
Abstract
Prenatal alcohol exposure can contribute to long term adverse health outcomes. Development of the skeletal system begins at the early embryonic stage and continues into early adulthood but the effect of prenatal alcohol exposure on skeletal growth is relatively unexplored in a clinical population. Here, we performed dual X-ray absorptiometry to examine bone, fat, and muscle accrual in children and adolescents diagnosed with, or at risk of, fetal alcohol spectrum disorders (FASDs). Children (aged 4-9 years) with FASD or at risk of FASD (n = 10) had similar growth to age matched controls (n = 27). By adolescence (aged ≥10 years), those with FASDs (n = 13) were shorter and had lower areal bone mineral density and lean tissue mass than typically developing peers (n = 29). Overall, adolescents diagnosed with FASDs had greater odds of impairments to bone and body composition. These findings highlight the importance of early FASD diagnosis and appropriate post-diagnostic medical follow-up to enable timely, effective interventions to optimize bone and body composition during paediatric growth.
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Affiliation(s)
- Sophia L Young
- School of Biomedical Sciences, Faculty of Medicine, University of Queensland, St Lucia, Australia; Child Health Research Centre, Centre for Children's Health Research, South Brisbane, Australia
| | - Linda A Gallo
- School of Biomedical Sciences, Faculty of Medicine, University of Queensland, St Lucia, Australia
| | - Denise S K Brookes
- Institute of Health and Biomedical Innovation, Centre for Children's Health Research, South Brisbane, Australia
| | - Nicole Hayes
- Child Health Research Centre, Centre for Children's Health Research, South Brisbane, Australia
| | - Maree Maloney
- School of Health and Rehabilitation Sciences, University of Queensland, St Lucia, Australia
| | - Karen Liddle
- Queensland Children's Hospital, Queensland Health, South Brisbane, Australia
| | - Amanda James
- Queensland Children's Hospital, Queensland Health, South Brisbane, Australia
| | - Karen M Moritz
- School of Biomedical Sciences, Faculty of Medicine, University of Queensland, St Lucia, Australia; Child Health Research Centre, Centre for Children's Health Research, South Brisbane, Australia
| | - Natasha Reid
- Child Health Research Centre, Centre for Children's Health Research, South Brisbane, Australia.
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2
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Barr RD, Inglis D, Athale U, Farncombe T, Gordon CL. The Influence of Body Composition on Bone Health in Long-term Survivors of Acute Lymphoblastic Leukemia in Childhood and Adolescence: Analyses by Dual-energy Radiograph Absorptiometry and Peripheral Quantitative Computed Tomography. J Pediatr Hematol Oncol 2022; 44:423-431. [PMID: 35482464 DOI: 10.1097/mph.0000000000002470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 03/12/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND The normal interrelationship of body composition with bone health is less clear in the context of disease. Survivors of acute lymphoblastic leukemia (ALL) exhibit sarcopenic obesity and osteopenia. The impact of body composition on bone health in such survivors was examined. SUBJECTS AND METHODS Survivors of ALL (N=74), >10 years from diagnosis, underwent dual-energy radiograph absorptiometry and peripheral quantitative computed tomography. RESULTS Whole-body bone mineral content (WB BMC) Z scores were greater in males than females, but WB BMC indices (WB BMC/height 2 ) were comparable (0.74±0.125 and 0.72±0.069, respectively). WB BMC index (I) and fat-free mass index correlated significantly with trabecular bone mineral density, only in males. Fat mass index and appendicular lean mass index showed no such correlations. WB BMCI and fat-free mass index also correlated, again predominantly in males, with measures of strength in both trabecular and cortical bone. WB BMCI also correlated strongly with trabecular number, thickness, and hole size, also only in males. CONCLUSIONS The results point to the need for enhancing muscle mass, measured by appendicular lean mass index, while reducing fat mass and maintaining good bone mineralization in long-term survivors of ALL to ensure the integrity of healthy bones.
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Affiliation(s)
| | - Dean Inglis
- Canadian Longitudinal Study on Aging, Department of Health Research Methods, Evidence, and Impact, McMaster University
| | | | - Troy Farncombe
- Department of Nuclear Medicine, Hamilton Health Sciences Corporation, Hamilton, ON, Canada
| | - Christopher L Gordon
- Department of Nuclear Medicine, Hamilton Health Sciences Corporation, Hamilton, ON, Canada
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3
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Deodati A, Manco M, Mariani M, Bocchini S, Högler W, Cappa M, Fintini D. Bone density and body composition in small for gestational age children with adequate catch up growth: A preliminary retrospective case control study. Bone 2021; 153:116114. [PMID: 34273633 DOI: 10.1016/j.bone.2021.116114] [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: 02/17/2021] [Revised: 07/08/2021] [Accepted: 07/11/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Fetal growth patterns and birth weight (BW) have been associated with bone mineral density (BMD) and content (BMC) throughout infancy and childhood up to early adulthood. We hypothesized that in small for gestational age (SGA) children, compensatory infant catch-up growth to normal height centiles counteracts the adverse consequences of low BW on bone accrual. AIM To evaluate BMD and BMC of SGA children born at term who experienced a normal catch-up growth as compared to children born appropriate for gestational age (AGA). PATIENTS We recruited 53 SGA (26 females) and 60 AGA children (27 females), aged 6 to 18 years, matched for sex and body mass index (BMI). Fat mass (FM); Free fat mass (FFM); Lumbar spine and Total body less head (TBLH) BMD; BMC and BMD standard deviation scores corrected for body size (BMAD, BMAD z-score and TBLH BMD/Height) and TBLH BMC for FFM (TBLHBMC/FFM) were derived from Dual Energy X-ray absorptiometry (DXA) scans. RESULTS SGA and AGA children did not differ in any auxological, body composition and bone parameters appropriately adjusted for height and FFM. BMI, FM and, remarkably, FFM were significantly correlated with bone mass parameters in both groups while no correlation was found between FM and FFM with the BW SDS in the univariate analysis. CONCLUSION Our preliminary data demonstrate that SGA children born at term who recover from their growth deficiency through catch-up growth achieve bone mass and body composition not different from children born AGA.
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Affiliation(s)
- Annalisa Deodati
- Endocrinology Unit, Paediatric University Hospital Department, "Bambino Gesù" Children's Hospital, IRCCS, Rome, Italy
| | - Melania Manco
- Research Area for Multifactorial Diseases and Complex Phenotypes, "Bambino Gesù" Children's Hospital, IRCCS, Rome, Italy
| | - Michela Mariani
- Endocrinology Unit, Paediatric University Hospital Department, "Bambino Gesù" Children's Hospital, IRCCS, Rome, Italy
| | - Sarah Bocchini
- Endocrinology Unit, Paediatric University Hospital Department, "Bambino Gesù" Children's Hospital, IRCCS, Rome, Italy
| | - Wolfgang Högler
- Department of Paediatrics and Adolescent Medicine, Johannes Kepler University Linz, Linz, Austria
| | - Marco Cappa
- Endocrinology Unit, Paediatric University Hospital Department, "Bambino Gesù" Children's Hospital, IRCCS, Rome, Italy
| | - Danilo Fintini
- Endocrinology Unit, Paediatric University Hospital Department, "Bambino Gesù" Children's Hospital, IRCCS, Rome, Italy.
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4
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Léger J, Fjellestad-Paulsen A, Bargiacchi A, Pages J, Chevenne D, Alison M, Alberti C, Guilmin-Crepon S. One Year of GH Treatment for Growth Failure in Children With Anorexia Nervosa: A Randomized Placebo-Controlled Trial. J Clin Endocrinol Metab 2021; 106:e2535-e2546. [PMID: 33772303 DOI: 10.1210/clinem/dgab203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Children with anorexia nervosa (AN) are at risk of adult height deficit due to prolonged low height velocity (HV). OBJECTIVE To investigate the effects of human growth hormone (GH) injections on HV in children with AN and severe growth impairment. DESIGN AND PARTICIPANTS In this prospective, randomized, double-blind, single-center, proof-of-concept trial, children with AN and low HV (≤2 cm/year) for at least 18 months, and a bone age ≤12 years for girls and ≤14 years for boys, were randomized to receive daily subcutaneous injections of human GH (0.050 mg/kg/day) or placebo for 12 months. MAIN OUTCOME MEASURES Change in HV after 12 months. RESULTS In total, 8 patients were assigned to the GH group and 6 to the placebo group. Patients had a median (25th-75th percentile) HV of 1.0 (0.5;1.5) cm/year. The effect of GH treatment increased strongly after 6 months, with a height gain after 12 months of 9.65 (8.0;11.6) cm for the GH group vs 3.85 (1.7;7.3) cm for the placebo group, with an absolute median (2.5th-97.5th percentile) difference between the groups of 5.8 (-1.85;9.68) cm after bootstrapping. The percentage of patients with a HV > 5 cm/year during the study period was higher in the GH group than in the placebo group (100% vs 50%, P = 0.05). Adverse events occurred in similar numbers in the 2 groups, were mild or nonfatal, and did not lead to treatment being stopped. CONCLUSION GH administration to improve HV is a potentially valid option for increasing HV in children with AN and prolonged severe growth failure.
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Affiliation(s)
- Juliane Léger
- Assistance Publique-Hôpitaux de Paris, Robert Debré University Hospital, Endocrinology-Diabetology Department, Reference Center for Growth and Development Endocrine Diseases, Paris, France
- Université de Paris; NeuroDiderot, Institut National de la Santé et de la Recherche Médicale (INSERM) UMR 1141, Paris, France
| | - Anne Fjellestad-Paulsen
- Assistance Publique-Hôpitaux de Paris, Robert Debré University Hospital, Endocrinology-Diabetology Department, Reference Center for Growth and Development Endocrine Diseases, Paris, France
| | - Anne Bargiacchi
- Assistance Publique-Hôpitaux de Paris, Robert Debré University Hospital, Child and Adolescent Psychiatry Department, Reference Center for Growth and Development Endocrine Diseases, Paris, France
| | - Justine Pages
- Assistance Publique-Hôpitaux de Paris, Robert Debré University Hospital, Clinical Epidemiology Unit, Paris, France
| | - Didier Chevenne
- Assistance Publique-Hôpitaux de Paris, Biochemistry Unit, Robert Debré University Hospital, Paris, France
| | - Marianne Alison
- Assistance Publique-Hôpitaux de Paris, Robert Debré University Hospital, Pediatric Radiology Department, Paris, France
| | - Corinne Alberti
- Assistance Publique-Hôpitaux de Paris, Robert Debré University Hospital, Clinical Epidemiology Unit, Paris, France
- Inserm, CIC-EC 1426, Paris, France
| | - Sophie Guilmin-Crepon
- Assistance Publique-Hôpitaux de Paris, Robert Debré University Hospital, Clinical Epidemiology Unit, Paris, France
- Inserm, CIC-EC 1426, Paris, France
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Clarke J, Peyre H, Alison M, Bargiacchi A, Stordeur C, Boizeau P, Mamou G, Crépon SG, Alberti C, Léger J, Delorme R. Abnormal bone mineral density and content in girls with early-onset anorexia nervosa. J Eat Disord 2021; 9:9. [PMID: 33423687 PMCID: PMC7798269 DOI: 10.1186/s40337-020-00365-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 12/22/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Early-onset anorexia nervosa (EO-AN) represents a significant clinical burden to paediatric and mental health services. The impact of EO-AN on bone mineral abnormalities has not been thoroughly investigated due to inadequate control for pubertal status. In this study, we investigated bone mineral abnormalities in girls with EO-AN regardless of pubertal development stage. METHOD We conducted a cross-sectional study of 67 girls with EO-AN (median age = 12.4 [10.9-13.7 years]) after a median duration of disease of 1.3 [0.6-2.0] years, and 67 healthy age-, sex-, pubertal status- matched control subjects. We compared relevant bone mineral parameters between groups: the total body bone mineral density [TB-BMD], the lumbar spine BMD [LS-BMD], the total body bone mineral content [TB-BMC] and the ratio of the TB-BMC to lean body mass [TB-BMC/LBM]. RESULTS TB-BMD, TB-BMC, LS-BMD and TB-BMC/LBM were all significantly lower in patients with AN compared to controls. In the EO-AN group, older age, later pubertal stages and higher lean body mass were associated with higher TB-BMC, TB-BMD, and LS-BMD values. DISCUSSION Girls with EO-AN displayed deficits in bone mineral content and density after adjustment for pubertal maturation. Age, higher pubertal stage and lean body mass were identified as determinants of bone maturation in the clinical population of patients with EO-AN. Bone health should be promoted in patients, specifically in those with an onset of disorder before 14 years old and with a delayed puberty.
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Affiliation(s)
- Julia Clarke
- Child and Adolescent Psychiatry Department, Assistance Publique-Hôpitaux de Paris, Robert Debré University Hospital, Paris, France. .,Université de Paris, Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Paris, France.
| | - Hugo Peyre
- Child and Adolescent Psychiatry Department, Assistance Publique-Hôpitaux de Paris, Robert Debré University Hospital, Paris, France.,Université de Paris, INSERM UMR 1141, Paris, France
| | - Marianne Alison
- Radiology Department, Assistance Publique-Hôpitaux de Paris, Robert Debré University Hospital, Pediatric, Paris, France
| | - Anne Bargiacchi
- Child and Adolescent Psychiatry Department, Assistance Publique-Hôpitaux de Paris, Robert Debré University Hospital, Paris, France
| | - Coline Stordeur
- Child and Adolescent Psychiatry Department, Assistance Publique-Hôpitaux de Paris, Robert Debré University Hospital, Paris, France
| | - Priscilla Boizeau
- Unit of Clinical Epidemiology, Assistance Publique-Hôpitaux de Paris, Robert Debré University Hospital, Paris, France
| | - Grégor Mamou
- Child and Adolescent Psychiatry Department, Assistance Publique-Hôpitaux de Paris, Robert Debré University Hospital, Paris, France
| | - Sophie Guilmin Crépon
- Radiology Department, Assistance Publique-Hôpitaux de Paris, Robert Debré University Hospital, Pediatric, Paris, France.,Department of Pediatric Endocrinology and Diabetology & Reference centre for Growth and Development Endocrine diseases, Assistance Publique-Hôpitaux de Paris, Robert Debré University Hospital, Paris, France.,INSERM UMR-S 1123 ECEVE and CIC-EC 1426, Paris, France
| | | | - Juliane Léger
- Université de Paris, INSERM UMR 1141, Paris, France.,Department of Pediatric Endocrinology and Diabetology & Reference centre for Growth and Development Endocrine diseases, Assistance Publique-Hôpitaux de Paris, Robert Debré University Hospital, Paris, France
| | - Richard Delorme
- Child and Adolescent Psychiatry Department, Assistance Publique-Hôpitaux de Paris, Robert Debré University Hospital, Paris, France
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6
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Pellegrino F, Zatelli MC, Bondanelli M, Carnevale A, Cittanti C, Fortini M, Gamberini MR, Giganti M, Ambrosio MR. Dual-energy X-ray absorptiometry pitfalls in Thalassemia Major. Endocrine 2019; 65:469-482. [PMID: 31300960 DOI: 10.1007/s12020-019-02003-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 07/01/2019] [Indexed: 01/19/2023]
Abstract
BACKGROUND Low mineral mass and reduced bone strength with increased fracture risk are the main causes of morbidity in Thalassemia Major (TM). The pathogenesis is multifactorial and includes ineffective erythropoiesis with medullary expansion, multiple endocrine dysfunctions, direct iron bone deposition, deferoxamine-induced bone dysplasia, and reduced physical activity associated with disease complications. Dual-energy X-ray absorptiometry (DXA) is the "gold standard" for bone mineral density (BMD) assessment and for bone strength and quality evaluation. This method identifies patients at greater risk of fragility fractures, guiding treatment and monitoring response to therapy. In TM, DXA shows limitations concerning BMD calculation accuracy and fracture risk prediction. One of the main challenges in the assessment of bone health in patients with TM is the accurate interpretation of densitometric results. PURPOSE This review investigates the major pitfalls in DXA implementation and interpretation in TM. METHODS Available literature has been assessed. CONCLUSIONS DXA shows limitations in assessing bone mineral "status" in TM, especially in the paediatric population, due to the peculiar characteristics of bone architecture and deformities associated with the disease. A radiological technique adjustment in this population is mandatory.
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Affiliation(s)
- Fabio Pellegrino
- Department of Morphology, Surgery and Experimental Medicine, Section of Radiology, University of Ferrara, Ferrara, Italy
| | - Maria Chiara Zatelli
- Department of Medical Sciences, Section of Endocrinology and Internal Medicine, University of Ferrara, Ferrara, Italy
| | - Marta Bondanelli
- Department of Medical Sciences, Section of Endocrinology and Internal Medicine, University of Ferrara, Ferrara, Italy
| | - Aldo Carnevale
- Department of Morphology, Surgery and Experimental Medicine, Section of Radiology, University of Ferrara, Ferrara, Italy
| | - Corrado Cittanti
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Monica Fortini
- Unit of Thalassaemia and Haemoglobinopathies Day Hospital, Regional HUB Centre, Department of Medicine, Azienda Ospedaliero Universitaria S. Anna, Cona - Ferrara, Italy
| | - Maria Rita Gamberini
- Unit of Thalassaemia and Haemoglobinopathies Day Hospital, Regional HUB Centre, Department of Medicine, Azienda Ospedaliero Universitaria S. Anna, Cona - Ferrara, Italy
| | - Melchiore Giganti
- Department of Morphology, Surgery and Experimental Medicine, Section of Radiology, University of Ferrara, Ferrara, Italy
| | - Maria Rosaria Ambrosio
- Department of Medical Sciences, Section of Endocrinology and Internal Medicine, University of Ferrara, Ferrara, Italy.
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7
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Pham-Short A, Donaghue KC, Ambler G, Briody J, Garnett S, Munns CF, Craig ME. Abnormal Cortical and Trabecular Bone in Youth With Type 1 Diabetes and Celiac Disease. Diabetes Care 2019; 42:1489-1495. [PMID: 31167891 DOI: 10.2337/dc18-2376] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 05/14/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This study compared bone health in youth with type 1 diabetes and celiac disease (CD) versus type 1 diabetes alone. RESEARCH DESIGN AND METHODS This was a case-control study of 42 youth with coexisting type 1 diabetes and CD and 40 with type 1 diabetes matched for age, sex, diabetes duration, and HbA1c. Bone mineral density (BMD), bone mineral content (BMC), and BMC-to-lean tissue mass (LTM) ratio were measured using DXA and reported as z-scores for height. Total, trabecular, and cortical bone and muscle parameters were measured using peripheral quantitative computed tomography (pQCT) and reported as z-scores for age. RESULTS Mean age at assessment was 14.3 ± 3.1 years; diabetes duration, 8.0 ± 3.5 years; HbA1c, 8.2 ± 1.5% (66 ± 5 mmol/mol); and 25-hydroxy vitamin D, 71 ± 21 nmol/L. Comparing youth with coexisting CD versus type 1 diabetes alone, DXA showed lower BMC-to-LTM ratio (0.37 ± 1.12 vs. 0.73 ± 2.23, P = 0.007) but no difference in total BMD. Youth with coexisting CD also had lower BMC-to-LTM ratio versus the general population (P = 0.04). Radial pQCT showed lower total BMC (-0.92 ± 1.40 vs. -0.26 ± 1.23, P = 0.03) despite similar bone and muscle cross-sectional area. In multivariable linear regression, lower BMC was associated with higher insulin dose (P = 0.03) but not HbA1c. CONCLUSIONS Youth with both type 1 diabetes and CD have lower BMC relative to LTM and lower BMC, indicating abnormal trabecular and cortical bone development despite similar bone and muscle size. These findings suggest that the two conditions confer a lower bone turnover state. We recommend further examination of bone health in this population; future research should examine early interventions to improve bone health.
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Affiliation(s)
- Anna Pham-Short
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,Children's Hospital Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Kim C Donaghue
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,Children's Hospital Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Geoffrey Ambler
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,Children's Hospital Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Julie Briody
- Children's Hospital Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Nuclear Medicine, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Sarah Garnett
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,Children's Hospital Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Craig F Munns
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,Children's Hospital Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Maria E Craig
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, New South Wales, Australia .,Children's Hospital Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia.,School of Women's and Child's Health, University of New South Wales, Sydney, New South Wales, Australia
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8
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Neelis E, Kouwenhoven S, Olieman J, Tabbers M, Jonkers C, Wells J, Fewtrell M, Wijnen R, Rings E, de Koning B, Hulst J. Body Composition Using Air Displacement Plethysmography in Children With Intestinal Failure Receiving Long-Term Home Parenteral Nutrition. JPEN J Parenter Enteral Nutr 2019; 44:318-326. [PMID: 30900272 DOI: 10.1002/jpen.1527] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 02/17/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Children with intestinal failure (IF) are at risk of growth failure, but little information about body composition is available. Our aim was to assess body composition using air displacement plethysmography (ADP) and relate it to clinical and growth parameters. METHODS In this prospective descriptive observational 2-center cohort study, children aged 2-18 years receiving home parenteral nutrition (PN) for ≥6 months underwent ADP measurement. Fat mass index (FMI) and fat-free mass index (FFMI) standard deviation scores (SDSs) were calculated to normalize for small body size. RESULTS Twenty-one out of 22 children, median age 7.4 years, underwent successful ADP measurement after a median PN duration of 5.5 years. They were significantly lighter (median weight for age SDS -0.71, P = 0.004) and shorter (median height for age SDS -1.55, P < 0.001) than the normal population mean; 52% were growing below target height range. They had low FFMI (median SDS -1.53, P < 0.001) and high FMI (median SDS 0.80, P = 0.002). Weight for height and body mass index (BMI) were significantly associated with FFMI and BMI with FMI, but children with the same weight and height showed different body composition. In 13 patients with 1-year follow-up, growth and body composition did not change significantly. CONCLUSION Children with IF receiving long-term PN show lower FFM and higher FM than healthy children. Additionally, children with similar routine growth parameters showed different body composition. Further studies should evaluate the effect of a patient-tailored approach including physical activity and nutrition advice based on body composition.
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Affiliation(s)
- Esther Neelis
- Department of Pediatric Gastroenterology, Erasmus Medical Center - Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Stefanie Kouwenhoven
- Department of Pediatrics, Amsterdam UMC, Vrije Universiteit Amsterdam, Emma Children's Hospital, Amsterdam, the Netherlands
| | - Joanne Olieman
- Department of Pediatric Surgery, Erasmus Medical Center - Sophia Children's Hospital, Rotterdam, the Netherlands.,Department of Dietetics, Erasmus Medical Center - Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Merit Tabbers
- Department of Pediatric Gastroenterology, Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Amsterdam, the Netherlands
| | - Cora Jonkers
- Department of Dietetics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Jonathan Wells
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Mary Fewtrell
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - René Wijnen
- Department of Pediatric Surgery, Erasmus Medical Center - Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Edmond Rings
- Department of Pediatric Gastroenterology, Erasmus Medical Center - Sophia Children's Hospital, Rotterdam, the Netherlands.,Department of Pediatric Gastroenterology, Leiden University Medical Center - Willem Alexander Children's Hospital, Leiden, the Netherlands
| | - Barbara de Koning
- Department of Pediatric Gastroenterology, Erasmus Medical Center - Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Jessie Hulst
- Department of Pediatric Gastroenterology, Erasmus Medical Center - Sophia Children's Hospital, Rotterdam, the Netherlands
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9
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Mumford J, Kohn M, Briody J, Miskovic-Wheatley J, Madden S, Clarke S, Biggin A, Schindeler A, Munns C. Long-term Outcomes of Adolescent Anorexia Nervosa on Bone. J Adolesc Health 2019; 64:305-310. [PMID: 30819332 DOI: 10.1016/j.jadohealth.2018.07.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 07/25/2018] [Accepted: 07/25/2018] [Indexed: 01/08/2023]
Abstract
PURPOSE Anorexia nervosa (AN) is a chronic and life-threatening eating disorder that can have a considerable negative impact on the growing skeleton. We hypothesized that the long-term impact on bone health may persist even after normalization of body weight. METHODS 41 females (mean age 21.2 ± 2.9 years) with a history of adolescent-onset AN attended a follow-up bone health assessment at 5 years (T5, n = 28) or 10 years (T10, n = 13) after their first AN-related hospital admission. Assessment included dual-energy x-ray absorptiometry measurements of the total body, lumbar spine, and proximal femur, peripheral quantitative computed tomography at the radius and tibia, anthropometric measurements, serum biochemistry, fracture history, and a patient questionnaire. RESULTS A recovery in body weight and BMI was seen for both the T5 and T10 cohorts (BMI at intake 16.6, BMI at T5-T10 21.2-21.3). Dual-energy x-ray absorptiometry body composition indicated a recovery of fat mass and lean tissue mass. Total BMD was unaffected, but reductions were seen at the femoral neck and arms. Peripheral quantitative computed tomography showed reduced trabecular and cortical bone in the radius, and cortical thinning in the tibia. AN patients showed a statistically significant reduction in measures of radiographic bone health at follow up, although not to a degree that necessitated clinical intervention. Serum insulin-like growth factor 1 was also positively correlated with total BMD and BMC measures. While fracture risk was not increased, a subset of participants (8%) showed multiple (>4) fractures. CONCLUSION A longitudinal study of adolescent AN showed persisting negative effects on bone health.
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Affiliation(s)
- Jessica Mumford
- Eating Disorder Service, Sydney Children's Hospital Network, Westmead, New South Wales, Australia; School of Rural Medicine, University of New England, Armidale, New South Wales, Australia
| | - Michael Kohn
- Eating Disorder Service, Sydney Children's Hospital Network, Westmead, New South Wales, Australia; Adolescent and Young Adult Medicine, Westmead Hospital, Westmead, New South Wales, Australia
| | - Julie Briody
- Nuclear Medicine, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Jane Miskovic-Wheatley
- Eating Disorder Service, Sydney Children's Hospital Network, Westmead, New South Wales, Australia
| | - Sloane Madden
- Eating Disorder Service, Sydney Children's Hospital Network, Westmead, New South Wales, Australia
| | - Simon Clarke
- Adolescent and Young Adult Medicine, Westmead Hospital, Westmead, New South Wales, Australia; The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Andrew Biggin
- Department of Endocrinology, The Children's Hospital at Westmead, Westmead, New South Wales, Australia; Children's Hospital Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Aaron Schindeler
- Orthopaedic Research Unit, The Children's Hospital at Westmead, Westmead, New South Wales, Australia; Discipline of Paediatrics & Child Health, University of Sydney, Sydney, New South Wales, Australia
| | - Craig Munns
- Department of Endocrinology, The Children's Hospital at Westmead, Westmead, New South Wales, Australia; Discipline of Paediatrics & Child Health, University of Sydney, Sydney, New South Wales, Australia.
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10
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Fiscaletti M, Coorey CP, Biggin A, Briody J, Little DG, Schindeler A, Munns CF. Diagnosis of Recurrent Fracture in a Pediatric Cohort. Calcif Tissue Int 2018; 103:529-539. [PMID: 29943187 DOI: 10.1007/s00223-018-0449-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 06/20/2018] [Indexed: 01/08/2023]
Abstract
Significant fracture history in children is defined as having at least one vertebral fracture, at least 2 fractures by age 10, or at least 3 fractures by age 19. Between September 2011 and December 2014, clinical data were collected on children with a significant fracture history that attended a major Australian children's hospital. Fifty-six patients were identified as having 305 fractures in total, including 44 vertebral fractures. 18% of patients (10/56) were diagnosed with osteogenesis imperfecta (OI) by a bone health expert, molecular testing or both, and they sustained 23% of all fractures (71/305). Analysis of serum bone biochemistry showed all median values to be within a normal range and no clinically significant differences between patients with and without OI. The DXA and pQCT derived bone mineral density (BMD) and bone mineral content (BMC) Z scores were reduced overall. DXA derived total body and lumbar spine areal BMD-for-age and BMC-for-age Z scores were significantly lower in children who had vertebral fractures or who were later diagnosed with OI. Similarly, pQCT performed on radii and tibiae showed Z scores significantly less than zero. pQCT-derived limb muscle cross sectional area Z scores were significantly lower in the OI subgroup. In conclusion, this study describes the bone phenotype of children referred to a tertiary hospital clinic for recurrent fractures and highlights a subset of children with previously undiagnosed OI, but a larger cohort without classic OI. Thus it can be clinically challenging to differentiate between children with OI type 1 (mild phenotype) and non-OI children without bone densitometry and genetic testing. We conclude that recurrent fractures in children should prompt a comprehensive bone and systemic health assessment to eliminate an underlying pathology.
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Affiliation(s)
- M Fiscaletti
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, NSW, Australia.
- Department of Endocrinology & Diabetes, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW, 2145, Australia.
| | - C P Coorey
- Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - A Biggin
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, NSW, Australia
- Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - J Briody
- Department of Nuclear Medicine, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - D G Little
- Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
- Department of Orthopaedics, The Children's Hospital at Westmead, Sydney, NSW, Australia
- Orthopaedic Research & Biotechnology Unit, The Children's Hospital at Westmead, Westmead, Australia
| | - A Schindeler
- Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
- Orthopaedic Research & Biotechnology Unit, The Children's Hospital at Westmead, Westmead, Australia
| | - C F Munns
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, NSW, Australia
- Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
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11
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Growth, Body Composition, and Micronutrient Abnormalities During and After Weaning Off Home Parenteral Nutrition. J Pediatr Gastroenterol Nutr 2018; 67:e95-e100. [PMID: 30028828 DOI: 10.1097/mpg.0000000000002090] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES The aim of the study is to assess growth, body composition, and micronutrient abnormalities in children with intestinal failure (IF) over time, both during and after weaning off parenteral nutrition (PN). METHODS Retrospective study in children on home PN between 2001 and 2015. Weight-for-age (WFA) and height-for-age (HFA) SD scores (SDS) were calculated, as well as fat mass (FM) and fat-free mass (FFM) SDS obtained by dual energy x-ray absorptiometry. The course of growth parameters and body composition was analyzed with linear-mixed models. All micronutrient measurements during the study period were obtained. RESULTS Fifty-two patients were included with a median follow-up of 3.4 years. Seventy-one percent weaned off after a median PN duration of 0.9 years. One year after the start of PN, 28 patients were still PN-dependent with median WFA-SDS of -0.66 and median HFA-SDS of -0.96, both significantly lower than zero. Catch-up growth was achieved during PN, but HFA-SDS decreased after weaning (P = 0.0001). At a median age of 6.2 years, median %FM SDS was 0.30 and FFM SDS was -1.21, the latter significantly lower than zero. Frequent micronutrient abnormalities during PN were vitamin A (90%), zinc (87%), and iron (76%) and after weaning vitamin A (94%), E (61%), and 25-OH vitamin D (59%). CONCLUSIONS Children with IF demonstrate abnormal growth and body composition and frequent micronutrient abnormalities. Longitudinal evaluation showed that catch-up growth occurs during PN, but height SDS decreases after weaning. This underlines the need for close monitoring, also after reaching enteral autonomy.
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12
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Di Iorgi N, Maruca K, Patti G, Mora S. Update on bone density measurements and their interpretation in children and adolescents. Best Pract Res Clin Endocrinol Metab 2018; 32:477-498. [PMID: 30086870 DOI: 10.1016/j.beem.2018.06.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Following the increased awareness about the central role of the pediatric age in building bone for life, clinicians face more than ever the necessity of assessing bone health in pediatric subjects at risk for early bone mass derangements or in healthy children, in order to optimize their bone mass accrual and prevent osteoporosis. Although the diagnosis of osteoporosis is not made solely upon bone mineral density measurements during growth, such determination can be very useful in the follow-up of pediatric patients with primary and secondary osteoporosis. The ideal instrument would give information on the mineral content and density of the bone, and on its architecture. It should be able to perform the measurements on the skeletal sites where fractures are more frequent, and it should be minimally invasive, accurate, precise and rapid. Unfortunately, none of the techniques currently utilized fulfills all requirements. In the present review, we focus on the pediatric use of dual-energy X-ray absorptiometry (DXA), quantitative computed tomography (QCT), peripheral QCT (pQCT), and magnetic resonance imaging (MRI), highlighting advantages and limits for their use and providing indications for bone densitometry interpretation and of vertebral fractures diagnosis in pediatric subjects.
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Affiliation(s)
- Natascia Di Iorgi
- Department of Pediatrics, Istituto Giannina Gaslini, University of Genova, Genova, Italy.
| | - Katia Maruca
- Pediatric Bone Densitormetry Service and Laboratory of Pediatric Endocrinology, IRCCS San Raffaele Institute, Milano, Italy
| | - Giuseppa Patti
- Department of Pediatrics, Istituto Giannina Gaslini, University of Genova, Genova, Italy
| | - Stefano Mora
- Pediatric Bone Densitormetry Service and Laboratory of Pediatric Endocrinology, IRCCS San Raffaele Institute, Milano, Italy.
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13
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Khadilkar AV, Sanwalka N, Mughal MZ, Chiplonkar S, Khadilkar V. Indian girls have higher bone mineral content per unit of lean body than boys through puberty. J Bone Miner Metab 2018; 36:364-371. [PMID: 28580516 DOI: 10.1007/s00774-017-0843-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 04/24/2017] [Indexed: 10/19/2022]
Abstract
Our aim is to describe changes in the muscle-bone unit assessed as a ratio of bone mineral content (BMC) to lean body mass (LBM) through puberty at total body and various skeletal sites in Indian boys and girls. A cross-sectional study was conducted (888 children, 480 boys, aged 5-17 years) in Pune, India. Pubertal staging was assessed. BMC, LBM and fat percentage at the arms, legs, android, gynoid and total body (less the head) were assessed by dual energy X-ray absorptiometry. The amount of BMC per unit LBM (BMC/LBM) was computed. Changes in mean BMC/LBM at 5 Tanner (pubertal) stages after adjustment for age and fat percentage were calculated. In boys, adjusted BMC/LBM was significantly higher with successive Tanner stages [legs (TS-II vs TS-I), android (TS-III vs TS-II, TS-IV vs TS-III) and gynoid region (TS-III vs TS-II and TS-II vs TS-I) (p < 0.05)]. In girls, adjusted BMC/LBM was significantly higher with successive Tanner stages at total body, legs and gynoid (TS-III vs TS-II; TS-II vs TS-I; TS-V vs TS-IV), arms (TS-I to TS-V) and android regions (TS-V vs TS-IV) (p < 0.05). Boys had significantly higher adjusted BMC/LBM than girls at earlier Tanner stages (TS-I to TS-III), whereas girls had significantly higher adjusted BMC/LBM than boys at later Tanner stages (TS-IV, TS-V) (p < 0.05). Indian boys and girls showed higher total and regional body, and age- and fat percentage-adjusted BMC/LBM with successive pubertal stages. Girls had higher BMC/LBM than boys which may possibly act as a reservoir for later demands of pregnancy and lactation.
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Affiliation(s)
- Anuradha V Khadilkar
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Block 5, Lower Ground Floor, 32, Sassoon Road, Pune, 411001, Maharashtra, India.
| | | | - M Zulf Mughal
- Royal Manchester Children's Hospital, Manchester, UK
| | - Shashi Chiplonkar
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Block 5, Lower Ground Floor, 32, Sassoon Road, Pune, 411001, Maharashtra, India
| | - Vaman Khadilkar
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Block 5, Lower Ground Floor, 32, Sassoon Road, Pune, 411001, Maharashtra, India
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14
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Lewiecki EM, Bilezikian JP, Carey JJ, Dell RM, Gordon CM, Harris ST, McClung MR, Miller PD, Rosenblatt M. Proceedings of the 2017 Santa Fe Bone Symposium: Insights and Emerging Concepts in the Management of Osteoporosis. J Clin Densitom 2018; 21:3-21. [PMID: 29229501 DOI: 10.1016/j.jocd.2017.10.041] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 10/31/2017] [Indexed: 11/28/2022]
Abstract
The 18th Annual Santa Fe Bone Symposium was held on August 4-5, 2017, in Santa Fe, New Mexico, USA. The symposium convenes health-care providers and clinical researchers to present and discuss clinical applications of recent advances in research of skeletal diseases. The program includes lectures, oral presentations by endocrinology fellows, case-based panel discussions, and breakout sessions on topics of interest, with emphasis on participation and interaction of all participants. Topics included the evaluation and treatment of adult survivors with pediatric bone diseases, risk assessment and management of atypical femur fractures, nonpharmacologic strategies in the care of osteoporosis, and skeletal effects of parathyroid hormone with opportunities for therapeutic intervention. Management of skeletal complications of rheumatic diseases was discussed. Insights into sequential and combined use of antiresorptive agents were presented. Individualization of patient treatment decisions when clinical practice guidelines may not be applicable was covered. Challenges and opportunities with osteoporosis drug development were discussed. There was an update on progress of Bone Health TeleECHO (Bone Health Extension for Community Healthcare Outcomes), a teleconferencing strategy for sharing knowledge and expanding capacity to deliver best-practice skeletal health care.
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Affiliation(s)
- E Michael Lewiecki
- New Mexico Clinical Research & Osteoporosis Center, Albuquerque, NM, USA.
| | - John P Bilezikian
- Columbia University College of Physicians and Surgeons, New York, NY, USA
| | | | | | - Catherine M Gordon
- Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Steven T Harris
- University of California San Francisco, San Francisco, CA, USA
| | | | - Paul D Miller
- University of Colorado Health Sciences Center, Denver, CO, USA
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15
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Poinsot P, Geoffroy P, Braillon P, Denis A, Loras-Duclaux I, Marotte S, Boutroy S, Bacchetta J, Touzet S, Lachaux A, Peretti N. Longitudinal Bone Mineralization Assessment in Children Treated With Long-Term Parenteral Nutrition for Severe Intestinal Failure. JPEN J Parenter Enteral Nutr 2017; 42:613-622. [PMID: 28355492 DOI: 10.1177/0148607117701399] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 03/01/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Metabolic bone disease is common in children receiving home parenteral nutrition (HPN) for intestinal failure (IF). Long-term evolution of bone mass in pediatric IF is poorly documented. The aims of this study were (1) to determine the prevalence of low bone mass (LBM) in children receiving HPN for IF, (2) to evaluate the evolution of total bone mineral content (TBMC) during HPN with dual-energy x-ray absorptiometry (DXA), and (3) to identify related factors. METHODS All children referred in our HPN center from 2004 to 2014 were eligible. Inclusion criteria were HPN dependence due to noninflammatory IF, at least 2 TBMC assessments, and HPN duration of at least 2 years at last DXA. TBMC was expressed in z score for ideal weight for height (WFH). LBM was defined by a TBMC WFH z score ≤-2 standard deviations (SD). RESULTS A total of 175 DXAs for 31 children were performed, mean of 5.6 ± 2.9 assessments per child. The median time between first and last DXA recorded was 6.2 years (0.7-16.6). At the first DXA, 14 children (45%) had a LBM. TBMC increased by +0.1 ± 0.04 SD per year of HPN (P = .012). The risk of LBM decreased with an odds ratio of 0.9 per year of HPN (95% confidence interval, 0.92-0.99; P = .018). Lean mass z score and calcium parenteral intakes were related to the TBMC improvement. CONCLUSION LBM is common in pediatric IF, but bone status could improve during HPN in these children.
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Affiliation(s)
- Pierre Poinsot
- Hepatology, Gastroenterology and Pediatric Nutrition Unit, Femme Mere Enfant Hospital, Hospices Civils de Lyon, University Claude Bernard Lyon 1, Lyon, France
| | - Perrine Geoffroy
- Hepatology, Gastroenterology and Pediatric Nutrition Unit, Femme Mere Enfant Hospital, Hospices Civils de Lyon, University Claude Bernard Lyon 1, Lyon, France
| | - Pierre Braillon
- Radiology Department, Hopital Femme Mere Enfant, Hospices Civils de Lyon, Lyon, France
| | - Angelique Denis
- Medical Information and Research Analysis Department, Hospices Civils de Lyon, Lyon, France
| | - Irene Loras-Duclaux
- Hepatology, Gastroenterology and Pediatric Nutrition Unit, Femme Mere Enfant Hospital, Hospices Civils de Lyon, University Claude Bernard Lyon 1, Lyon, France
| | - Stéphanie Marotte
- Hepatology, Gastroenterology and Pediatric Nutrition Unit, Femme Mere Enfant Hospital, Hospices Civils de Lyon, University Claude Bernard Lyon 1, Lyon, France
| | - Stéphanie Boutroy
- INSERM U1033, Lyos, Pathophysiology, Hospices Civils de Lyon, Lyon, France
| | - Justine Bacchetta
- INSERM U1033, Lyos, Pathophysiology, Hospices Civils de Lyon, Lyon, France.,Pediatric Nephrology, Rheumatology, Dermatology Unit, Femme Mere Enfant Hospital, Hospices Civils de Lyon, University Claude Bernard Lyon 1, Lyon, France
| | - Sandrine Touzet
- Medical Information and Research Analysis Department, Hospices Civils de Lyon, Lyon, France
| | - Alain Lachaux
- Hepatology, Gastroenterology and Pediatric Nutrition Unit, Femme Mere Enfant Hospital, Hospices Civils de Lyon, University Claude Bernard Lyon 1, Lyon, France
| | - Noel Peretti
- Hepatology, Gastroenterology and Pediatric Nutrition Unit, Femme Mere Enfant Hospital, Hospices Civils de Lyon, University Claude Bernard Lyon 1, Lyon, France.,INSERM U1060, CarMeN laboratory, Hospices Civils de Lyon, F-69003 Lyon, France
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16
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Cabrera-Salcedo C, Mizuno T, Tyzinski L, Andrew M, Vinks AA, Frystyk J, Wasserman H, Gordon CM, Hwa V, Backeljauw P, Dauber A. Pharmacokinetics of IGF-1 in PAPP-A2-Deficient Patients, Growth Response, and Effects on Glucose and Bone Density. J Clin Endocrinol Metab 2017; 102:4568-4577. [PMID: 29029190 PMCID: PMC5718699 DOI: 10.1210/jc.2017-01411] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 09/19/2017] [Indexed: 11/19/2022]
Abstract
CONTEXT The pregnancy-associated plasma protein A2 (PAPP-A2) cleaves insulinlike growth factor binding proteins 3 and 5, releasing free insulinlike growth factor 1 (IGF-1). Homozygous mutations in PAPP-A2 result in growth failure with elevated total but low free IGF-1. OBJECTIVE To determine the 24-hour pharmacokinetic (PK) profile of free and total IGF-1 after a dose of recombinant human insulinlike growth factor 1 (rhIGF-1). We describe the growth response and effects on glucose metabolism and bone mineral density (BMD) after 1 year of rhIGF-1 therapy. DESIGN AND PATIENTS Three affected siblings, their heterozygous parents, and two healthy controls participated. The subjects received a dose of rhIGF-1, followed by serial blood samples collected over 24 hours. The two younger siblings were started on rhIGF-1 treatment. An oral glucose tolerance test and dual-energy X-ray absorptiometry scans were obtained at baseline and after 1 year of treatment. RESULTS Subcutaneous administration of rhIGF-1 increased the concentration of free and total IGF-1 in patients with PAPP-A2 deficiency. The PK profile was comparable in all participants. At baseline, all three subjects demonstrated insulin resistance and below-average BMD. Treatment with rhIGF-1 is ongoing in the youngest patient but was discontinued in his brother because of the development of pseudotumor cerebri. The treated patient had an increase in height velocity from 3.0 to 6.2 cm/y, resolution of insulin resistance, and an increase in total body BMD. CONCLUSIONS rhIGF-1 at standard dosages resulted in similar PK characteristics in patients with PAPP-A2 deficiency, heterozygous relatives, and healthy controls. The youngest affected patient experienced a modest growth response to therapy with rhIGF-1, as well as beneficial effects on glucose metabolism and bone mass.
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Affiliation(s)
- Catalina Cabrera-Salcedo
- Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio 45229
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio 45267
| | - Tomoyuki Mizuno
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio 45267
- Clinical Pharmacology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio 45229
| | - Leah Tyzinski
- Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio 45229
| | - Melissa Andrew
- Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio 45229
| | - Alexander A. Vinks
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio 45267
- Clinical Pharmacology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio 45229
| | - Jan Frystyk
- Department of Clinical Medicine, Faculty of Health, Aarhus University Hospital, DK-8000 Aarhus, Denmark
| | - Halley Wasserman
- Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio 45229
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio 45267
| | - Catherine M. Gordon
- Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio 45229
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio 45267
| | - Vivian Hwa
- Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio 45229
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio 45267
| | - Philippe Backeljauw
- Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio 45229
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio 45267
| | - Andrew Dauber
- Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio 45229
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio 45267
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17
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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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18
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Ward LM, Ma J, Rauch F, Benchimol EI, Hay J, Leonard MB, Matzinger MA, Shenouda N, Lentle B, Cosgrove H, Scharke M, Konji VN, Mack DR. Musculoskeletal health in newly diagnosed children with Crohn's disease. Osteoporos Int 2017; 28:3169-3177. [PMID: 28791436 DOI: 10.1007/s00198-017-4159-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 07/11/2017] [Indexed: 12/15/2022]
Abstract
UNLABELLED We evaluated the impact of Crohn's disease on muscle and bone strength, mass, density, and geometry in children with newly diagnosed CD and found profound muscle and bone deficits; nevertheless, the prevalence of vertebral fractures at this time point was low. INTRODUCTION Crohn's disease (CD) is an inflammatory condition of the gastrointestinal tract that can affect the musculoskeletal system. The objective of this study was to determine the prevalence of vertebral fractures and the impact of CD on muscle and bone mass, strength, density, and geometry in children with newly diagnosed CD. METHODS Seventy-three children (26 girls) aged 7.0 to 17.7 years were examined within 35 days following CD diagnosis by lateral spine radiograph for vertebral fractures and by jumping mechanography for muscle strength. Bone and muscle mass, density, and geometry were assessed by dual-energy x-ray absorptiometry and peripheral quantitative computed tomography (pQCT). RESULTS Disease activity was moderate to severe in 66 (90%) patients. Mean height (Z-score -0.3, standard deviation (SD) 1.1, p = 0.02), weight (Z-score -0.8, SD 1.3, p < 0.01), body mass index (Z-score -1.0, SD 1.3, p < 0.01), lumbar spine areal bone mineral density (BMD; Z-score -1.1, SD 1.0, p < 0.01), total body bone mineral content (Z-score -1.5, SD 1.0, p < 0.01), and total body lean mass (Z-score -2.5, SD 1.1, p < 0.01) were all low for age and gender. pQCT showed reduced trabecular volumetric BMD at the tibial metaphysis, expansion of the bone marrow cavity and thin cortices at the diaphysis, and low calf muscle cross-sectional area. Jumping mechanography demonstrated low muscle power. Only one patient had a vertebral fracture. CONCLUSIONS Children with newly diagnosed CD have profound muscle and bone deficits; nevertheless, the prevalence of vertebral fractures at this time point was low.
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Affiliation(s)
- L M Ward
- Pediatric Bone Health Clinical Research Program, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.
- Department of Pediatrics, University of Ottawa, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada.
| | - J Ma
- Pediatric Bone Health Clinical Research Program, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada
| | - F Rauch
- Shriners Hospital for Children, Department of Pediatrics, McGill University, Montreal, QC, Canada
| | - E I Benchimol
- Department of Pediatrics, University of Ottawa, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada
- Children's Hospital of Eastern Ontario Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - J Hay
- Department of Health Sciences, Brock University, St. Catharines, ON, Canada
| | - M B Leonard
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA
| | - M A Matzinger
- Department of Medical Imaging, Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, ON, Canada
| | - N Shenouda
- Department of Medical Imaging, Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, ON, Canada
| | - B Lentle
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - H Cosgrove
- Pediatric Bone Health Clinical Research Program, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - M Scharke
- Pediatric Bone Health Clinical Research Program, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - V N Konji
- Pediatric Bone Health Clinical Research Program, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - D R Mack
- Department of Pediatrics, University of Ottawa, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada
- Children's Hospital of Eastern Ontario Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
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Thornton D, Gordon CM. Restrictive Eating Disorders and Skeletal Health in Adolescent Girls and Young Women. Calcif Tissue Int 2017; 100:449-460. [PMID: 27339670 PMCID: PMC9767748 DOI: 10.1007/s00223-016-0164-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 06/10/2016] [Indexed: 12/19/2022]
Abstract
This article reviews the effects of restrictive eating disorders on bone health. The relationship between eating disorders and amenorrhea is discussed in detail. The pathologic impact of malnutrition on bone is explored by examining the results of studies using various available imaging techniques. The multiple hormonal alterations seen in adolescents and young women with anorexia nervosa are reviewed, as well as how these alterations may influence bone turnover, density, structure, and strength. The diagnostic clinical evaluation for adolescents and young women with these disorders is also outlined. Available treatment options, including those that hold promise for efficacy, as well as those we deemed to be ineffective, are considered from both the clinical and mechanistic standpoints. Finally, future research opportunities are offered, including intriguing work in the area of fat and bone interactions.
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Affiliation(s)
- Darcey Thornton
- Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Ave MLC 4000, Cincinnati, OH, 45229, USA
| | - Catherine M Gordon
- Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Ave MLC 4000, Cincinnati, OH, 45229, USA.
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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20
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Harbaugh CM, Zhang P, Henderson B, Derstine BA, Holcombe SA, Wang SC, Kohoyda-Inglis C, Ehrlich PF. Personalized medicine: Enhancing our understanding of pediatric growth with analytic morphomics. J Pediatr Surg 2017; 52:837-842. [PMID: 28189451 DOI: 10.1016/j.jpedsurg.2017.01.030] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 01/23/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND/PURPOSE Analytic morphomics is being used to identify 3-D biologic measures with superior clinical utility and risk stratification over traditional factors such as age, height, and weight. The purpose of this study is to define age and gender specific Pediatric Reference Analytic Morphomics Population (PRAMP™) growth charts. METHODS This retrospective study population contains 2591 individual CT scans of a normative reference population of males and females (1-20years old). Growth curves were constructed at the 5th, 25th, 50th, 75th, and 95th quantiles for morphomic variables, including psoas muscle area, trabecular bone density, and visceral fat area by age and gender. RESULTS Total psoas muscle area increases over time until late adolescence. Trabecular bone density remains stable until adolescence, decreases during adolescence, and increases in young adulthood. Visceral fat area increases over time with greater variation between the 5th and 95th percentile with increasing age. CONCLUSIONS The PRAMP™ data have been used to construct age- and sex-specific reference growth curves. This may be used to better define "abnormal" in efforts to create unique risk-categorization algorithms specific to particular clinical and global health investigations. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Calista M Harbaugh
- Section of Pediatric Surgery, Department of Surgery, The University of Michigan Medical School and The C.S. Mott Children's Hospital, Ann Arbor, MI, United States; Morphomic Analysis Group, The University of Michigan Medical School, Ann Arbor, MI, United States.
| | - Peng Zhang
- Morphomic Analysis Group, The University of Michigan Medical School, Ann Arbor, MI, United States
| | - Brianna Henderson
- Section of Pediatric Surgery, Department of Surgery, The University of Michigan Medical School and The C.S. Mott Children's Hospital, Ann Arbor, MI, United States; Morphomic Analysis Group, The University of Michigan Medical School, Ann Arbor, MI, United States
| | - Brian A Derstine
- Morphomic Analysis Group, The University of Michigan Medical School, Ann Arbor, MI, United States
| | - Sven A Holcombe
- Morphomic Analysis Group, The University of Michigan Medical School, Ann Arbor, MI, United States
| | - Stewart C Wang
- Section of Trauma Burn Surgery, Department of Surgery, The University of Michigan Medical School, Ann Arbor, MI, United States; Morphomic Analysis Group, The University of Michigan Medical School, Ann Arbor, MI, United States
| | - Carla Kohoyda-Inglis
- Morphomic Analysis Group, The University of Michigan Medical School, Ann Arbor, MI, United States
| | - Peter F Ehrlich
- Section of Pediatric Surgery, Department of Surgery, The University of Michigan Medical School and The C.S. Mott Children's Hospital, Ann Arbor, MI, United States; Morphomic Analysis Group, The University of Michigan Medical School, Ann Arbor, MI, United States
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21
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Pezzuti IL, Kakehasi AM, Filgueiras MT, de Guimarães JA, de Lacerda IAC, Silva IN. Imaging methods for bone mass evaluation during childhood and adolescence: an update. J Pediatr Endocrinol Metab 2017; 30:485-497. [PMID: 28328530 DOI: 10.1515/jpem-2016-0252] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 01/31/2017] [Indexed: 11/15/2022]
Abstract
The objective of the work was to prepare an update on imaging methods for bone evaluation during childhood and adolescence. The text was based on original and review articles on imaging methods for clinical evaluation of bone mass in children and adolescents up to 20 years old. They were selected from BIREME and PUBMED by means of the following keywords: bone density; osteoporosis/diagnosis; densitometry; tomography; ultrasonography; magnetic resonance imaging; and radiogrammetry and published in Portuguese or English, in the last 10 years (2006-2016). The article was organized into topics with the description of peculiarities, advantages and disadvantages of each imaging method and their possible clinical applicability. Despite the emergence of new technologies, dual energy X-ray absorptiometry (DXA) remains the gold standard method for low bone mass diagnosis in all age groups. However, interpretation is complex in children and adolescents and demands skilled people. Quantitative computed tomography (QCT) [central QCT, peripheral QCT (pQCT) and high resolution-pQCT (HR-pQCT)] and magnetic resonance imaging (MRI) evaluate real bone density, but are not yet available for routine use. Quantitative bone ultrasound (QUS) shows good perspectives for its use in primary prevention actions. Automated radiogrammetry shows promise as a method able to flag individuals who might benefit from a complete bone assessment, but the clinical value of the measures still needs to be established.
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Affiliation(s)
- Isabela Leite Pezzuti
- Department of Pediatrics, Division of Pediatric Endocrinology, Faculdade de Medicina/Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG) Av. Alfredo Balena 190, s/267 30130-100, Belo Horizonte, MG
| | - Adriana Maria Kakehasi
- Department of Locomotor System, Faculdade de Medicina/Hospital das Clínicas niversidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG
| | - Maria Tereza Filgueiras
- Pediatric Imaging, Faculdade de Medicina/Hospital das Clínicas Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG
| | - Juliana Albano de Guimarães
- Research initiation student, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG
| | | | - Ivani Novato Silva
- Department of Pediatrics, Head of Division of Pediatric Endocrinology, Faculdade de Medicina/Hospital das Clínicas Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG
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22
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Crabtree NJ, Shaw NJ, Bishop NJ, Adams JE, Mughal MZ, Arundel P, Fewtrell MS, Ahmed SF, Treadgold LA, Högler W, Bebbington NA, Ward KA. Amalgamated Reference Data for Size-Adjusted Bone Densitometry Measurements in 3598 Children and Young Adults-the ALPHABET Study. J Bone Miner Res 2017; 32:172-180. [PMID: 27490028 PMCID: PMC5453244 DOI: 10.1002/jbmr.2935] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 07/28/2016] [Accepted: 08/02/2016] [Indexed: 01/24/2023]
Abstract
The increasing use of dual-energy X-ray absorptiometry (DXA) in children has led to the need for robust reference data for interpretation of scans in daily clinical practice. Such data need to be representative of the population being studied and be "future-proofed" to software and hardware upgrades. The aim was to combine all available pediatric DXA reference data from seven UK centers to create reference curves adjusted for age, sex, ethnicity, and body size to enable clinical application, using in vivo cross-calibration and making data back and forward compatible. Seven UK sites collected data on GE Lunar or Hologic Scanners between 1996 and 2012. Males and females aged 4 to 20 years were recruited (n = 3598). The split by ethnic group was white 2887; South Asian 385; black Afro-Caribbean 286; and mixed heritage 40. Scans of the total body and lumbar spine (L1 to L4 ) were obtained. The European Spine Phantom was used to cross-calibrate the 7 centers and 11 scanners. Reference curves were produced for L1 to L4 bone mineral apparent density (BMAD) and total body less head (TBLH) and L1 to L4 areal bone mineral density (aBMD) for GE Lunar Prodigy and iDXA (sex- and ethnic-specific) and for Hologic (sex-specific). Regression equations for TBLH BMC were produced using stepwise linear regression. Scans of 100 children were randomly selected to test backward and forward compatibility of software versions, up to version 15.0 for GE Lunar and Apex 4.1 for Hologic. For the first time, sex- and ethnic-specific reference curves for lumbar spine BMAD, aBMD, and TBLH aBMD are provided for both GE Lunar and Hologic scanners. These curves will facilitate interpretation of DXA data in children using methods recommended in ISCD guidelines. The databases have been created to allow future updates and analysis when more definitive evidence for the best method of fracture prediction in children is agreed. © 2016 American Society for Bone and Mineral Research.
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Affiliation(s)
- Nicola J Crabtree
- Department of Endocrinology and Diabetes, Birmingham Children's Hospital, Birmingham, UK
| | - Nicholas J Shaw
- Department of Endocrinology and Diabetes, Birmingham Children's Hospital, Birmingham, UK
| | - Nicholas J Bishop
- Academic Unit of Child Health, University of Sheffield, Sheffield, UK
| | - Judith E Adams
- Radiology and Manchester Academic Health Science Centre, Manchester Royal Infirmary, Central Manchester University Hospitals NHS Foundation Trust and University of Manchester, Manchester, UK
| | - M Zulf Mughal
- Department of Endocrinology, Central Manchester University Hospitals NHS Foundation Trust and University of Manchester, Manchester, UK
| | - Paul Arundel
- Academic Unit of Child Health, University of Sheffield, Sheffield, UK
| | - Mary S Fewtrell
- Childhood Nutrition Research Centre, University College London, Institute of Child Health, London, UK
| | - S Faisal Ahmed
- Developmental Endocrinology Research Group, School of Medicine, University of Glasgow, Royal Hospital for Sick Children, Glasgow, UK
| | - Laura A Treadgold
- Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Wolfgang Högler
- Department of Endocrinology and Diabetes, Birmingham Children's Hospital, Birmingham, UK
| | - Natalie A Bebbington
- Department of Endocrinology and Diabetes, Birmingham Children's Hospital, Birmingham, UK
| | - Kate A Ward
- Nutrition and Bone Health, MRC Human Nutrition Research, Cambridge, UK.,MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
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Abstract
BACKGROUND Young individuals with Crohn disease (CD) are at risk of poor bone mineral density (BMD) and reduced lean tissue mass (LTM). The importance of LTM for maintaining skeletal health, in both incident and established CD, is evidenced. We used dual-energy x-ray absorptiometry assessment to identify areal BMD and LTM in individuals with CD. METHODS In 57 patients with CD (15F; 12.99-14.16 years) anthropometric, disease activity, bone age assessment, and total body dual-energy x-ray absorptiometry measurements were acquired. A 4-step algorithm was used to assess simultaneous bone and body composition data: areal BMD and height z scores, and LTM for height and bone mineral content (BMC) for LTM z scores were calculated. Low z score cut-off values were defined as ≤1 standard deviations below the population means. RESULTS The CD cohort showed: low areal BMD z scores (P = 0.00); and low LTM for height (P = 0.00) according to defined cut-off values. BMC appeared to be adapting for the lower amount of LTM. Correcting for bone age eliminated the low areal BMD z scores. As expected, LTM for height and BMC for LTM z scores remained unchanged. CONCLUSIONS We present a useful clinical algorithm to show significant LTM for height deficits, regardless of chronological or bone age, in this CD cohort. BMC seemed to adapt to the reduced LTM, indicating clinically "normal" areal BMD for age when considered for height. The ongoing deficits in LTM may, however, create chronic long-term consequences for bone health. Improving LTM should be a focus of clinical treatment in individuals with CD.
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Medina-Gomez C, Heppe DHM, Yin JL, Trajanoska K, Uitterlinden AG, Beck TJ, Jaddoe VWV, Rivadeneira F. Bone Mass and Strength in School-Age Children Exhibit Sexual Dimorphism Related to Differences in Lean Mass: The Generation R Study. J Bone Miner Res 2016; 31:1099-106. [PMID: 26599073 DOI: 10.1002/jbmr.2755] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 11/20/2015] [Accepted: 11/21/2015] [Indexed: 11/12/2022]
Abstract
Bone strength, a key determinant of fracture risk, has been shown to display clear sexual dimorphism after puberty. We sought to determine whether sex differences in bone mass and hip bone geometry as an index of strength exist in school-age prepubertal children and the degree to which the differences are independent of body size and lean mass. We studied 3514 children whose whole-body and hip scans were measured using the same densitometer (GE-Lunar iDXA) at a mean age of 6.2 years. Hip dual-energy X-ray absorptiometry (DXA) scans underwent hip structural analyses (HSA) with derivation of bone strength indices. Sex differences in these parameters were assessed by regression models adjusted for age, height, ethnicity, weight, and lean mass fraction (LMF). Whole-body bone mineral density (BMD) and bone mineral content (BMC) levels were 1.3% and 4.3% higher in girls after adjustment by LMF. Independent of LMF, boys had 1.5% shorter femurs, 1.9% and 2.2% narrower shaft and femoral neck with 1.6% to 3.4% thicker cortices than girls. Consequent with this geometry configuration, girls observed 6.6% higher stresses in the medial femoral neck than boys. When considering LMF, the sexual differences on the derived bone strength indices were attenuated, suggesting that differences in muscle loads may reflect an innate disadvantage in bone strength in girls, as consequence of their lower muscular acquisition. In summary, we show that bone sexual dimorphism is already present at 6 years of age, with boys having stronger bones than girls, the relation of which is influenced by body composition and likely attributable to differential adaptation to mechanical loading. Our results support the view that early life interventions (ie, increased physical activity) targeted during the pre- and peripubertal stages may be of high importance, particularly in girls, because before puberty onset, muscle mass is strongly associated with bone density and geometry in children. © 2015 American Society for Bone and Mineral Research.
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Affiliation(s)
- Carolina Medina-Gomez
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.,The Generation R Study Group, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Denise H M Heppe
- The Generation R Study Group, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Pediatrics, Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jia-Lian Yin
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.,The Generation R Study Group, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Katerina Trajanoska
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - André G Uitterlinden
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.,The Generation R Study Group, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Thomas J Beck
- Beck Radiological Innovations Inc., Baltimore, MD, USA.,Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Vincent W V Jaddoe
- The Generation R Study Group, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Pediatrics, Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Fernando Rivadeneira
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.,The Generation R Study Group, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
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25
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Lifshitz F, Hecht JP, Bermúdez EF, Gamba CA, Reinoso JM, Casavalle PL, Friedman SM, Rodriguez PN. Body composition analysis by dual-energy X-ray absorptiometry in young preschool children. Eur J Clin Nutr 2016; 70:1203-1209. [DOI: 10.1038/ejcn.2016.38] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 02/03/2016] [Accepted: 02/09/2016] [Indexed: 02/06/2023]
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Weaver CM, Gordon CM, Janz KF, Kalkwarf HJ, Lappe JM, Lewis R, O'Karma M, Wallace TC, Zemel BS. The National Osteoporosis Foundation's position statement on peak bone mass development and lifestyle factors: a systematic review and implementation recommendations. Osteoporos Int 2016; 27:1281-1386. [PMID: 26856587 PMCID: PMC4791473 DOI: 10.1007/s00198-015-3440-3] [Citation(s) in RCA: 722] [Impact Index Per Article: 90.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 11/10/2015] [Indexed: 12/21/2022]
Abstract
Lifestyle choices influence 20-40 % of adult peak bone mass. Therefore, optimization of lifestyle factors known to influence peak bone mass and strength is an important strategy aimed at reducing risk of osteoporosis or low bone mass later in life. The National Osteoporosis Foundation has issued this scientific statement to provide evidence-based guidance and a national implementation strategy for the purpose of helping individuals achieve maximal peak bone mass early in life. In this scientific statement, we (1) report the results of an evidence-based review of the literature since 2000 on factors that influence achieving the full genetic potential for skeletal mass; (2) recommend lifestyle choices that promote maximal bone health throughout the lifespan; (3) outline a research agenda to address current gaps; and (4) identify implementation strategies. We conducted a systematic review of the role of individual nutrients, food patterns, special issues, contraceptives, and physical activity on bone mass and strength development in youth. An evidence grading system was applied to describe the strength of available evidence on these individual modifiable lifestyle factors that may (or may not) influence the development of peak bone mass (Table 1). A summary of the grades for each of these factors is given below. We describe the underpinning biology of these relationships as well as other factors for which a systematic review approach was not possible. Articles published since 2000, all of which followed the report by Heaney et al. [1] published in that year, were considered for this scientific statement. This current review is a systematic update of the previous review conducted by the National Osteoporosis Foundation [1]. [Table: see text] Considering the evidence-based literature review, we recommend lifestyle choices that promote maximal bone health from childhood through young to late adolescence and outline a research agenda to address current gaps in knowledge. The best evidence (grade A) is available for positive effects of calcium intake and physical activity, especially during the late childhood and peripubertal years-a critical period for bone accretion. Good evidence is also available for a role of vitamin D and dairy consumption and a detriment of DMPA injections. However, more rigorous trial data on many other lifestyle choices are needed and this need is outlined in our research agenda. Implementation strategies for lifestyle modifications to promote development of peak bone mass and strength within one's genetic potential require a multisectored (i.e., family, schools, healthcare systems) approach.
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Affiliation(s)
- C M Weaver
- Department of Nutritional Sciences, Women's Global Health Institute, Purdue University, 700 W. State Street, West Lafayette, IN, 47907, USA
| | - C M Gordon
- Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital, 3333 Burnet Avenue, MLC 4000, Cincinnati, OH, 45229, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, 3230 Eden Ave, Cincinnati, OH, 45267, USA
| | - K F Janz
- Departments of Health and Human Physiology and Epidemiology, University of Iowa, 130 E FH, Iowa City, IA, 52242, USA
| | - H J Kalkwarf
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 7035, Cincinnati, OH, 45229, USA
| | - J M Lappe
- Schools of Nursing and Medicine, Creighton University, 601 N. 30th Street, Omaha, NE, 68131, USA
| | - R Lewis
- Department of Foods and Nutrition, University of Georgia, Dawson Hall, Athens, GA, 30602, USA
| | - M O'Karma
- The Children's Hospital of Philadelphia Research Institute, 3535 Market Street, Room 1560, Philadelphia, PA, 19104, USA
| | - T C Wallace
- Department of Nutrition and Food Studies, George Mason University, MS 1 F8, 10340 Democracy Lane, Fairfax, VA, 22030, USA.
- National Osteoporosis Foundation, 1150 17th Street NW, Suite 850, Washington, DC, 20036, USA.
- National Osteoporosis Foundation, 251 18th Street South, Suite 630, Arlington, VA, 22202, USA.
| | - B S Zemel
- University of Pennsylvania Perelman School of Medicine, 3535 Market Street, Room 1560, Philadelphia, PA, 19104, USA
- Division of Gastroenterology, Hepatology, and Nutrition, The Children's Hospital of Philadelphia, 3535 Market Street, Room 1560, Philadelphia, PA, 19104, USA
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Bai W, Binkley TL, Wallace JW, Carver TW, Specker BL. Peripheral quantitative computed tomography (pQCT) bone measurements in children with cystic fibrosis. Pediatr Pulmonol 2016; 51:28-33. [PMID: 26551628 DOI: 10.1002/ppul.23323] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 07/06/2015] [Accepted: 07/29/2015] [Indexed: 11/09/2022]
Abstract
BACKGROUND Individuals with cystic fibrosis (CF) have low bone density and increased fracture risk. METHODS Cross-sectional study investigating whole body bone mineral content (WBBMC), bone geometry and strength in 12 children with CF compared to 23 age- and sex-matched controls with and without adjusting for age, height, and body composition. RESULTS CF group had lower WBBMC than controls (P = 0.007) with larger differences at older ages (age-by-group, P = 0.08). CF group had decreased height (P = 0.006), a trend of lower lean mass per height (P = 0.08), and no difference in relationship between WBBMC and lean mass compared to controls (P = 0.65). Periosteal and endosteal circumferences were smaller in CF (each, P = 0.02). Positive relationships of cortical area and bone strength with age were attenuated with CF (group-by-age; each, P < 0.01). CONCLUSION Children with CF have similar WBBMC relative to lean mass as controls. Cortical bone area and bone strength were less in CF group compared to controls, with greater differences in older children.
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Affiliation(s)
- Wei Bai
- EA Martin Program in Human Nutrition, SWC Box 506, South Dakota State University, South Dakota
| | - Teresa L Binkley
- EA Martin Program in Human Nutrition, SWC Box 506, South Dakota State University, South Dakota
| | - James W Wallace
- Sanford Children's Specialty Clinic, 1600 W. 22nd Street, Sioux Falls, South Dakota
| | - Terrence W Carver
- Children's Mercy Hospitals and Clinics, 2401 Gillham Road, Kansas City, Missouri
| | - Bonny L Specker
- EA Martin Program in Human Nutrition, SWC Box 506, South Dakota State University, South Dakota
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Saraff V, Högler W. ENDOCRINOLOGY AND ADOLESCENCE: Osteoporosis in children: diagnosis and management. Eur J Endocrinol 2015; 173:R185-97. [PMID: 26041077 DOI: 10.1530/eje-14-0865] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 06/03/2015] [Indexed: 01/21/2023]
Abstract
Osteoporosis in children can be primary or secondary due to chronic disease. Awareness among paediatricians is vital to identify patients at risk of developing osteoporosis. Previous fractures and backaches are clinical predictors, and low cortical thickness and low bone density are radiological predictors of fractures. Osteogenesis Imperfecta (OI) is a rare disease and should be managed in tertiary paediatric units with the necessary multidisciplinary expertise. Modern OI management focuses on functional outcomes rather than just improving bone mineral density. While therapy for OI has improved tremendously over the last few decades, this chronic genetic condition has some unpreventable, poorly treatable and disabling complications. In children at risk of secondary osteoporosis, a high degree of suspicion needs to be exercised. In affected children, further weakening of bone should be avoided by minimising exposure to osteotoxic medication and optimising nutrition including calcium and vitamin D. Early intervention is paramount. However, it is important to identify patient groups in whom spontaneous vertebral reshaping and resolution of symptoms occur to avoid unnecessary treatment. Bisphosphonate therapy remains the pharmacological treatment of choice in both primary and secondary osteoporosis in children, despite limited evidence for its use in the latter. The duration and intensity of treatment remain a concern for long-term safety. Various new potent antiresorptive agents are being studied, but more urgently required are studies using anabolic medications that stimulate bone formation. More research is required to bridge the gaps in the evidence for management of paediatric osteoporosis.
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Affiliation(s)
- Vrinda Saraff
- Department of Endocrinology and DiabetesBirmingham Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, UK
| | - Wolfgang Högler
- Department of Endocrinology and DiabetesBirmingham Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, UK
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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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Short DF, Gilsanz V, Kalkwarf HJ, Lappe JM, Oberfield S, Shepherd JA, Winer KK, Zemel BS, Hangartner TN. Anthropometric models of bone mineral content and areal bone mineral density based on the bone mineral density in childhood study. Osteoporos Int 2015; 26:1099-108. [PMID: 25311106 PMCID: PMC4768717 DOI: 10.1007/s00198-014-2916-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 09/24/2014] [Indexed: 10/24/2022]
Abstract
UNLABELLED New models describing anthropometrically adjusted normal values of bone mineral density and content in children have been created for the various measurement sites. The inclusion of multiple explanatory variables in the models provides the opportunity to calculate Z-scores that are adjusted with respect to the relevant anthropometric parameters. INTRODUCTION Previous descriptions of children's bone mineral measurements by age have focused on segmenting diverse populations by race and sex without adjusting for anthropometric variables or have included the effects of a single anthropometric variable. METHODS We applied multivariate semi-metric smoothing to the various pediatric bone-measurement sites using data from the Bone Mineral Density in Childhood Study to evaluate which of sex, race, age, height, weight, percent body fat, and sexual maturity explain variations in the population's bone mineral values. By balancing high adjusted R(2) values with clinical needs, two models are examined. RESULTS At the spine, whole body, whole body sub head, total hip, hip neck, and forearm sites, models were created using sex, race, age, height, and weight as well as an additional set of models containing these anthropometric variables and percent body fat. For bone mineral density, weight is more important than percent body fat, which is more important than height. For bone mineral content, the order varied by site with body fat being the weakest component. Including more anthropometrics in the model reduces the overlap of the critical groups, identified as those individuals with a Z-score below -2, from the standard sex, race, and age model. CONCLUSIONS If body fat is not available, the simpler model including height and weight should be used. The inclusion of multiple explanatory variables in the models provides the opportunity to calculate Z-scores that are adjusted with respect to the relevant anthropometric parameters.
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Affiliation(s)
- D F Short
- Wright State University, Dayton, OH, USA,
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Cystic fibrosis-related bone disease explored using a four step algorithm. J Cyst Fibros 2014; 14:127-34. [PMID: 25169790 DOI: 10.1016/j.jcf.2014.07.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 06/24/2014] [Accepted: 07/24/2014] [Indexed: 11/21/2022]
Abstract
BACKGROUND A suboptimal bone accrual in young individuals with cystic fibrosis (CF) may be related to the development of a premature CF-related bone disease. Dual energy X-ray absorptiometry (DXA) is the mainstream measure of bone health; however, the influence of body size and lean tissue mass (LTM) on bone data is poorly interpreted. METHODS Total body dual-energy X-ray absorptiometry (DXA) measurements of bone mineral content (BMC) and LTM in 53 individuals with CF (7.00-17.99years) were compared to 53 sex-matched controls. BMC, height, and LTM in relation to height and BMC Z-scores were calculated and used in a 4-step algorithm. RESULTS Pubertal females with CF had less total body BMC for age (p=0.02); pre-pubertal males (p=0.05) and pubertal females with CF (p=0.03) were shorter; and pubertal females with CF showed less total body BMC for LTM (p=0.01). CONCLUSIONS The algorithm showed the following: (1) prior to puberty lowered total body BMC was primarily due to short stature, (2) LTM was appropriate for body size, and (3) pubertal females with CF had significantly less total body BMC for their LTM. Longer controlled trials are needed to clinically interpret CF-related bone disease using DXA derived data that considers patient size and body composition.
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Abstract
PURPOSE OF REVIEW Abnormalities in bone health are increasingly recognized in the pediatric population. Although the methodologies for assessing bone mineral density were originally developed for adults, great strides have been made in recent years, improving their applicability to children. Understanding these technologies, their interpretation, utility, and limitations is critical when assessing a child or adolescent with a suspected abnormality in bone mineral density. RECENT FINDINGS Improved normative databases that address some of the confounding variables in the growing and maturing child have solidified dual-energy X-ray absorptiometry as the preferred method for the assessment of bone mineral density in children. Consensus statements by expert panels now provide specific guidance to clinicians seeking to evaluate children with fractures or at risk for fractures. Although still primarily a research tool, continued development of quantitative computed tomography applications in pediatrics suggests there may be a complementary role for clinical use in the future. SUMMARY In the child or adolescent with a significant fracture history or a potential for fractures because of an underlying cause, clinicians now have guidelines and normative data to better focus their evaluation. Likewise, researchers can use this information to improve clinical trial design and interpretation of results.
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Ooi HL, Briody J, Biggin A, Cowell CT, Munns CF. Intravenous zoledronic Acid given every 6 months in childhood osteoporosis. Horm Res Paediatr 2014; 80:179-84. [PMID: 24052046 DOI: 10.1159/000354303] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 07/05/2013] [Indexed: 11/19/2022] Open
Abstract
AIM To evaluate the safety and efficacy of 12 months of zoledronic acid (ZA) administered every 6 months to children with osteoporosis. METHODS Retrospective cohort study of 27 patients (16 male, 11 female) treated with ZA (0.05 mg/kg/dose) every 6 months for 1 year. 20 were immobile, 4 steroid-induced osteoporosis, 2 idiopathic osteoporosis and 1 neurofibromatosis type 1. 16 had long bone fractures and 12 had vertebral wedging at baseline. Mineral homeostasis, bone mineral density (BMD) and vertebral morphometry were evaluated at baseline and 12 months. Results were compared to published data on 3-monthly ZA treatment. RESULTS Median age at ZA start was 10.5 years (range 6.2-13.3). Following the first infusion, 2 developed asymptomatic hypocalcemic, 14 developed temperature > 38°C, 13 aches/pain and 6 nausea. At 12 months, there was reduction in bone turnover and improvement in BMD and vertebral shape. No patient fractured after starting ZA. Growth was normal. Outcomes were similar to 3-monthly ZA. CONCLUSION ZA administered 6-monthly was associated with acute phase reaction to the first dose and improvement in BMD, reduction in bone turnover and improved vertebral shape at 12 months.
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Affiliation(s)
- Hooi Leng Ooi
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, N.S.W., Australia
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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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Kalkwarf HJ, Abrams SA, DiMeglio LA, Koo WWK, Specker BL, Weiler H. Bone densitometry in infants and young children: the 2013 ISCD Pediatric Official Positions. J Clin Densitom 2014; 17:243-57. [PMID: 24674638 DOI: 10.1016/j.jocd.2014.01.002] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 01/08/2014] [Indexed: 11/19/2022]
Abstract
Infants and children <5 yr were not included in the 2007 International Society for Clinical Densitometry Official Positions regarding Skeletal Health Assessment of Children and Adolescents. To advance clinical care of very young children, the International Society for Clinical Densitometry 2013 Position Development Conference reviewed the literature addressing appropriate methods and skeletal sites for clinical dual-energy X-ray absorptiometry (DXA) measurements in infants and young children and how results should be reported. DXA whole-body bone mineral content and bone mineral density for children ≥3 yr and DXA lumbar spine measurements for infants and young children 0-5 yr were identified as feasible and reproducible. There was insufficient information regarding methodology, reproducibility, and reference data to recommended forearm and femur measurements at this time. Appropriate methods to account for growth delay when interpreting DXA results for children <5 yr are currently unknown. Reference data for children 0-5 yr at multiple skeletal sites are insufficient and are needed to enable interpretation of DXA measurements. Given the current scarcity of evidence in many areas, it is likely that these positions will change over time as new data become available.
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Affiliation(s)
- Heidi J Kalkwarf
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
| | - Steven A Abrams
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Linda A DiMeglio
- Department of Pediatrics, Section of Pediatric Endocrinology and Diabetology, Indiana University, Indianapolis, IN, USA
| | - Winston W K Koo
- Department of Pediatrics, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Bonny L Specker
- Ethel Austin Martin Program in Human Nutrition, South Dakota State University, Brookings, SD, USA
| | - Hope Weiler
- School of Dietetics and Human Nutrition, McGill University, Montreal, QC, Canada
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Xu Y, Guo B, Gong J, Xu H, Bai Z. The correlation between calcaneus stiffness index calculated by QUS and total body BMD assessed by DXA in Chinese children and adolescents. J Bone Miner Metab 2014; 32:159-66. [PMID: 23695447 DOI: 10.1007/s00774-013-0474-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 04/14/2013] [Indexed: 12/31/2022]
Abstract
Few studies have shown comparison data between calcaneus stiffness index (SI) calculated by quantitative ultrasound (QUS) and bone mineral density (BMD) measured by dual-energy X-ray absorptiometry (DXA) in the Chinese population. This study was aimed to examine the correlations between calcaneus SI calculated by QUS and total body BMD and bone mineral content (BMC) measured by DXA in Chinese children and adolescents. We measured the total body BMD and BMC using Lunar Prodigy (GE Healthcare), and speed of sound (SOS), broadband ultrasound attenuation (BUA), and a calculated SI of the left os calcis using Lunar Achilles Express (GE Healthcare) in 392 healthy Chinese schoolchildren and adolescents aged 5-19 years. The short-term precision for DXA was 0.5 % for total body BMD. The precision for QUS was 1.8 % for SI, 2.9 % for BUA, and 0.4 % for SOS. Pearson's correlation coefficients (r) were calculated to assess the possible correlations between the total body BMC by DXA and SI calculated by QUS. There were significantly positive correlations between SI of the left os calcis and total body BMD (r = 0.693, p < 0.001, n = 392) and BMC (r = 0.690, p < 0.001, n = 392). For all the subjects, significant positive correlations were observed between the calcaneal SI and the age, weight, height, BMI, total body BMD, total body BMC, total body lean mass, and total body fat mass, with r ranging from 0.310 (total body fat mass) to 0.693 (total body BMD) (p < 0.001, n = 392). In conclusion, QUS bone densitometry is a useful measuring method showing the physiological bone development in childhood and adolescence.
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Affiliation(s)
- Yi Xu
- Department of Clinical Medicine, Medical College, Jinan University, No. 601 West Huangpu Road, Guangzhou, 510632, China
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Pichler J, Hanslik A, Dietrich Huber W, Aufricht C, Bidmon-Fliegenschnee B. Paediatric patients with inflammatory bowel disease who received infliximab experienced improved growth and bone health. Acta Paediatr 2014; 103:e69-75. [PMID: 24237381 DOI: 10.1111/apa.12448] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 09/30/2013] [Indexed: 12/16/2022]
Abstract
AIM Children with inflammatory bowel disease (IBD) have a high prevalence of growth retardation and low bone mineral density (BMD). This retrospective study investigated whether the start of infliximab treatment (IFX) was associated with improvement of growth and bone health. METHODS Anthropometry, BMD and bone markers were measured 1 year before and after the start of IFX treatment in 33 patients (51% males), with a median age of 13.5 years at baseline. Outcomes were growth with treatment and indicators of improved bone health. RESULTS Twenty-one children (64%) experienced a positive catch-up growth after IFX. Height standard deviation scores (SDS) were significantly higher in children in remission. Treatment with IFX was associated with a statistically significant increase in 25-hydroxycholecalciferol (25-OHD, p = 0.01). IFX had no influence on BMD. Children with low BMD < -2 had significantly higher inflammation scores, lower body mass index, weight, height SDS and 25-ODH after IFX. CONCLUSION After treatment with IFX, children with IBD improved significantly in weight, with the majority achieving positive catch-up growth. Bone mass tended to remain static with time of treatment with IFX, despite a significant increase in 25-OHD. Improved nutritional status positively predicts improved bone mineralisation.
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Affiliation(s)
- Judith Pichler
- Department of Paediatrics and Adolescent Medicine; Medical University of Vienna; Vienna Austria
| | - Andreas Hanslik
- Department of Paediatrics and Adolescent Medicine; Medical University of Vienna; Vienna Austria
| | - Wolf Dietrich Huber
- Department of Paediatrics and Adolescent Medicine; Medical University of Vienna; Vienna Austria
| | - Christoph Aufricht
- Department of Paediatrics and Adolescent Medicine; Medical University of Vienna; Vienna Austria
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Kelly DA, Bucuvalas JC, Alonso EM, Karpen SJ, Allen U, Green M, Farmer D, Shemesh E, McDonald RA. Long-term medical management of the pediatric patient after liver transplantation: 2013 practice guideline by the American Association for the Study of Liver Diseases and the American Society of Transplantation. Liver Transpl 2013; 19:798-825. [PMID: 23836431 DOI: 10.1002/lt.23697] [Citation(s) in RCA: 118] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 06/15/2013] [Indexed: 12/15/2022]
Affiliation(s)
- Deirdre A Kelly
- Liver Unit, Birmingham Children's Hospital, National Health Service Trust, Birmingham, United Kingdom.
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Crabtree NJ, Högler W, Cooper MS, Shaw NJ. Diagnostic evaluation of bone densitometric size adjustment techniques in children with and without low trauma fractures. Osteoporos Int 2013; 24:2015-24. [PMID: 23361874 DOI: 10.1007/s00198-012-2263-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Accepted: 12/13/2012] [Indexed: 11/30/2022]
Abstract
UNLABELLED Several established methods are used to size adjust dual-energy X-ray absorptiometry (DXA) measurements in children. However, there is no consensus as to which method is most diagnostically accurate. All size-adjusted bone mineral density (BMD) values were more diagnostically accurate than non-size-adjusted values. The greatest odds ratio was estimated volumetric BMD for vertebral fracture. INTRODUCTION The size dependence of areal bone density (BMDa) complicates the use of DXA in children with abnormal stature. Despite several size adjustment techniques being proposed, there is no consensus as to the most appropriate size adjustment technique for estimating fracture risk in children. The aim of this study was to establish whether size adjustment techniques improve the diagnostic ability of DXA in a cohort of children with chronic diseases. METHODS DXA measurements were performed on 450 children, 181 of whom had sustained at least one low trauma fracture. Lumbar spine (L2-L4) and total body less head (TBLH) Z-scores were calculated using different size adjustment techniques, namely BMDa and volumetric BMD for age (bone mineral apparent density (BMAD)); bone mineral content (BMC) and bone area for height; BMC for bone area; BMC for lean mass (adjusted for height); and BMC for bone and body size. RESULTS Unadjusted L2-L4 and TBLH BMDa were most sensitive but least specific at distinguishing children with fracture. All size adjustments reduced sensitivity but increased post-test probabilities, from a pre-test probability of 40 % to between 58 and 77 %. The greatest odds ratio for fracture was L2-L4 BMAD for a vertebral fracture and TBLH for lean body mass (LBM) (adjusted for height) for a long bone fracture with diagnostic odds ratios of 9.3 (5.8-14.9) and 6.5 (4.1-10.2), respectively. CONCLUSION All size adjustment techniques improved the predictive ability of DXA. The most accurate method for assessing vertebral fracture was BMAD for age. The most accurate method for assessing long bone fracture was TBLH for LBM adjusted for height.
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Affiliation(s)
- N J Crabtree
- Department of Nuclear Medicine, Queen Elizabeth Hospital, Birmingham, UK.
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Pichler J, Chomtho S, Fewtrell M, Macdonald S, Hill SM. Growth and bone health in pediatric intestinal failure patients receiving long-term parenteral nutrition. Am J Clin Nutr 2013; 97:1260-9. [PMID: 23576042 DOI: 10.3945/ajcn.112.057935] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Children with chronic intestinal failure (IF) treated with long-term parenteral nutrition (PN) may present with low bone mineral density (BMD). The cause may reflect small body size or suboptimal bone mineralization. OBJECTIVE We assessed growth and bone health in children with severe IF. DESIGN Height, weight, and fracture history were recorded. The lumbar spine bone mass was measured in 45 consecutive patients (24 male subjects) aged 5-17 y receiving PN for a median of 5 y. BMD and bone mineral apparent density (BMAD) [ie, adjusted-for-height SD scores (SDSs)] were calculated. RESULTS Diagnoses were short bowel syndrome in 12 patients (27%), intestinal enteropathy in 20 patients (44%), and motility disorder in 13 patients (29%). Mean (±SD) weight, height, and body mass index SDSs were -0.8 ± 1.3, -1.80 ± 1.5, and 0.4 ± 1.3, respectively. The height SDS was less than -2 in 23 children (50%). Patients with enteropathy or intestinal mucosal inflammation (associated with dysmotility or short bowel) were significantly shorter than patients without enteropathy (P = 0.007). The BMD SDS was -1.7 ± 1.6, and the BMAD SDS was -1.4 ± 1.5, independent of primary diagnosis or mucosal inflammation. Nineteen patients (42%) had low BMD (SDS less than -2.0), and 14 patients (31%) had low BMAD. In 25 patients studied at 1-2-y intervals, the BMD SDS fell significantly with time, whereas BMAD declined less, which suggested that a poor bone mineral accretion reflected poor growth. A total of 11 of 37 patients (24%) had nonpathologic fractures (P = 0.3 compared with the general population). CONCLUSIONS Approximately 50% of children were short, and one-third of children had low BMD and BMAD. Children with enteropathy or intestinal mucosal inflammation are at greatest risk of growth failure. Close nutritional monitoring and bespoke PN should maximize the potential for growth and bone mass.
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Affiliation(s)
- Judith Pichler
- Department of Paediatric and Adolescent Medicine, Medical University of Vienna, Vienna, Austria.
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Rana M, Munns CF, Selvadurai H, Briody J, Craig ME. The impact of dysglycaemia on bone mineral accrual in young people with cystic fibrosis. Clin Endocrinol (Oxf) 2013; 78:36-42. [PMID: 22757766 DOI: 10.1111/j.1365-2265.2012.04484.x] [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: 03/05/2012] [Revised: 04/10/2012] [Accepted: 06/24/2012] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The effect of dysglycaemia on bone mineral density (BMD) has not been studied in young people with CF. We examined factors associated with BMD in a tertiary paediatric CF clinic. DESIGN Retrospective, clinic-based study at The Children's Hospital at Westmead, Sydney. PATIENTS Young people with CF aged ≤ 18 years. MEASUREMENTS Bone mineral density was measured by dual-energy X-ray absorptiometry; main outcome measures were total body (TB), lumbar spine (LS) and femoral neck (FN) BMD and bone mineral content (BMC), and LS volumetric BMD (vBMD), reported as z scores for height. Dysglycaemia, based on oral glucose tolerance test, was defined as CF-related diabetes (CFRD) or impaired glucose tolerance (IGT). RESULTS Overall, 14 of 81 (17%) had CFRD, 6 (7%) IGT and 61 (76%) normal glucose tolerance (NGT). Mean age was 14.9 ± 2.4 years and mean height z score -0.68 ± 1.39. Osteopenic (z score ≤-2) TB, LS or FN BMD was present in 30 of 81 (37%), BMC in 42 (52%) and vBMD in 10 (5%). Across the three groups, there were differences in LS vBMD (CFRD, -0.67 ± 0.76; IGT, -0.52 ± 0.76; NGT, -0.05 ± 1.39; P = 0.04), LS BMD (P < 0.01), LS BMC (P = 0.01) and TB BMD (P = 0.01). In multivariate linear regression, LS BMC was associated with dysglycaemia (β = 0.56; 95% CI, 0.00-1.13; P = 0.05) and approached significance for FEV(1) (β = 0.01; 95% CI, 0.00-0.02; P = 0.06). CONCLUSIONS Dysglycaemia is associated with reduced bone mass accrual in youth with CF, in addition to recognized factors such as abnormal lung function, poor nutritional status and disease severity. Bone health assessment is essential in youth with CF.
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Affiliation(s)
- Malay Rana
- Institute of Endocrinology and Diabetes, Sydney Children's Hospital Network, Westmead, Australia
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Gahlot M, Khadgawat R, Ramot R, Eunice M, Ammini AC, Gupta N, Kalaivani M. The effect of growth hormone deficiency on size-corrected bone mineral measures in pre-pubertal children. Osteoporos Int 2012; 23:2211-7. [PMID: 22071483 DOI: 10.1007/s00198-011-1825-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Accepted: 10/12/2011] [Indexed: 11/25/2022]
Abstract
UNLABELLED Growth hormone deficiency (GHD) in children has been frequently perceived to be a cause of low bone mass accrual. The confounding effects of poor growth limit the interpretation of prior studies of bone health in GHD. We studied size-corrected bone mineral measures in 30 pre-pubertal GHD children and 75 healthy controls. Our study shows that size-corrected whole-body bone mineral content of GHD children were comparable with controls. INTRODUCTION The purpose of this study is to evaluate the effects of GHD on size-corrected bone measures at the lumbar spine (LS) and the whole body (WB). METHODS LS bone area (BA), LS bone mineral content (BMC), WB BA, WB BMC, and lean body mass (LBM) were measured in 30 pre-pubertal GHD children and 75 controls by dual-energy X-ray absorptiometry. Multiple linear regressions were used to calculate size-corrected (Sc) LS BA(Sc), LS BMC(Sc), WB BA(Sc), and WB BMC(Sc) from control subjects using height and age as independent variables. Furthermore, the relationship between muscle and bone was studied by first assessing LBM for height (LBM(Ht)) and then determining WB BMC for LBM (WB BMC(LBM)). All values were converted to Z-scores and compared with the control. RESULTS At diagnosis, WB BMC(Sc) Z-score of GHD children was not significantly different from controls. However, mean Z-scores of LS BA(Sc) (-0.89 ± 0.84, p < 0.0001), LS BMC(Sc) (-0.70 ± 1.1, p < 0.001), WB BA(Sc) (-0.65 ± 1.0, p < 0.006), and LBM(Ht) (-0.66 ± 1.7, p < 0.01) were significantly reduced, and WB BMC(Lbm) (0.78 ± 1.5, p < 0.003) was significantly higher in GHD children than controls. CONCLUSION Size-corrected WB BMC of GHD children were comparable with controls, and bones were normally adapted for muscle mass. Determinants of bone strength which may primarily be affected by GHD are muscle mass, bone size, and geometry rather than bone mass.
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Affiliation(s)
- M Gahlot
- Department of Dietetics and Nutrition, All India Institute of Medical Sciences, New Delhi, India
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Morse NL. Benefits of docosahexaenoic acid, folic acid, vitamin D and iodine on foetal and infant brain development and function following maternal supplementation during pregnancy and lactation. Nutrients 2012; 4:799-840. [PMID: 22852064 PMCID: PMC3407995 DOI: 10.3390/nu4070799] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Revised: 07/09/2012] [Accepted: 07/12/2012] [Indexed: 11/17/2022] Open
Abstract
UNLABELLED Scientific literature is increasingly reporting on dietary deficiencies in many populations of some nutrients critical for foetal and infant brain development and function. PURPOSE To highlight the potential benefits of maternal supplementation with docosahexaenoic acid (DHA) and other important complimentary nutrients, including vitamin D, folic acid and iodine during pregnancy and/or breast feeding for foetal and/or infant brain development and/or function. METHODS English language systematic reviews, meta-analyses, randomised controlled trials, cohort studies, cross-sectional and case-control studies were obtained through searches on MEDLINE and the Cochrane Register of Controlled Trials from January 2000 through to February 2012 and reference lists of retrieved articles. Reports were selected if they included benefits and harms of maternal supplementation of DHA, vitamin D, folic acid or iodine supplementation during pregnancy and/or lactation. RESULTS Maternal DHA intake during pregnancy and/or lactation can prolong high risk pregnancies, increase birth weight, head circumference and birth length, and can enhance visual acuity, hand and eye co-ordination, attention, problem solving and information processing. Vitamin D helps maintain pregnancy and promotes normal skeletal and brain development. Folic acid is necessary for normal foetal spine, brain and skull development. Iodine is essential for thyroid hormone production necessary for normal brain and nervous system development during gestation that impacts childhood function. CONCLUSION Maternal supplementation within recommended safe intakes in populations with dietary deficiencies may prevent many brain and central nervous system malfunctions and even enhance brain development and function in their offspring.
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Affiliation(s)
- Nancy L Morse
- Efamol Ltd., 14 Mole Business Park, Leatherhead KT22 7BA, UK.
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Ooi HL, Briody J, McQuade M, Munns CF. Zoledronic acid improves bone mineral density in pediatric spinal cord injury. J Bone Miner Res 2012; 27:1536-40. [PMID: 22437628 DOI: 10.1002/jbmr.1598] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Spinal cord injury (SCI) is associated with rapid and sustained bone loss and increase risk of fracture. Disuse is the primary cause for bone loss, although neural and hormonal changes may also contribute via different mechanisms. Bisphosphonates are used widely to treat osteoporosis in adults and are used increasingly for primary and secondary osteoporosis in children. Current data are insufficient to recommend routine use of bisphosphonates for fracture prevention in adult patients post-SCI and there are no available data in pediatric SCI. We report a 12-year-old boy with non-traumatic SCI who was treated with six monthly zoledronic acid (0.05 mg/kg/dose) for 18 months. The patient (AA) was diagnosed with transverse myelitis at 8.1 years of age, resulting in ventilator-dependent incomplete C3 tetraplegia. Following a fragility fracture to the surgical neck of the right humerus at 9.5 years of age, he was started on zoledronic acid. Bone turnover decreased and bone densitometry data (dual-energy X-ray absorptiometry [DXA] and peripheral quantitative computed tomography [pQCT]) showed improvement in metaphyseal and diaphyseal bone mineral content (BMC), volumetric bone mineral density (vBMD), and size, after 18 months of treatment. In the growing skeleton post-SCI, zoledronic acid potentially increases vertebral and long-bone strength by preserving trabecular bone (increased BMC and vBMD) and increasing cortical vBMD and cross-sectional area (CSA).
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Affiliation(s)
- Hooi Leng Ooi
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia.
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Podfigurna-Stopa A, Pludowski P, Jaworski M, Lorenc R, Genazzani AR, Meczekalski B. Skeletal status and body composition in young women with functional hypothalamic amenorrhea. Gynecol Endocrinol 2012; 28:299-304. [PMID: 21957879 DOI: 10.3109/09513590.2011.613972] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
CONTEXT Functional hypothalamic amenorrhea (FHA) related to hypoestrogenism and hormonal status may influence skeletal homeostasis and body composition. The study aimed to evaluate hormones concentrations, body composition and bone strength in FHA cases. PATIENTS AND METHODS Total body scans using DXA method (DPX-L, GE Lunar) were performed in a group of 27 women aged 21.8 years ± 3.9 with FHA related to weight loss. References of healthy control subjects were used to calculate Z-scores (age and gender matched), SD-scores (height and gender matched), and SDs-scores (weight and gender matched). Whole skeleton bone mineral content (TBBMC, g) and density (TBBMD, g/cm(2)), lumbar spine (L2-L4) bone mineral density (SBMD; g/cm(2)), lean body mass (LBM, g) and fat mass (FM, g) were investigated. Relative bone strength index was calculated as the TBBMC/LBM ratio. Serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, testosterone, and prolactin (PRL) concentrations were assayed to characterize hormonal profile of FHA cases. RESULTS Hormonal evaluation in patients with FHA revealed significantly decreased serum concentrations of gonadotropins and estradiol. Serum LH concentrations were 1.47 ± 0.89 mIU/ml, FSH 4.44 ± 1.94 mIU/ml. Estradiol concentrations in serum were 27.08 ± 13.10 pg/ml. As evidenced by Z-scores, FHA cases had decreased SBMD, TBBMD and TBBMC Z-scores of -1.23 ± 0.90 (p < 0.0001), -0.72 ± 0.86 (p < 0.001), and -0.90 ± 1.40 (p < 0.01), respectively. Reduced FM, LBM and FM/LBM ratio Z-scores of -1.80 ± 2.28 (p < 0.001), -0.59 ± 1.49 (p < 0.05) and -0.74 ± 1.55 (p < 0.05), but not TBBMC/LBM Z-score of -0.54 ± 2.14 (ns) were noted in FHA cases compared with healthy control cases. TBBMC, TBBMD, TBBMC/LBM when BH- or BW-matched were normal as evidenced by SD-scores and SDs-scores. SBMD remained reduced when BH-matched (SD-score = -0.40 ± 0.86; p < 0.05) whereas FM and FM/LBM were lower than expected in healthy, both compared to BH- and BW-dependent references. The length of amenorrhea in months negatively correlated with SBMD Z-score (R = -0.39, p < 0.05), and SD-scores for SBMD (R = -0.48), TBBMD (R = -0.43), TBBMC (R = -0.46) (all p < 0.05) and positively with SDs-scores for FM (R = 0.44, p < 0.05). CONCLUSION Patients with FHA were characterized by lower concentrations of serum FSH, LH and estradiol concentrations. Moreover, FHA cases had decreased FM and an imbalanced relationship between BW, FM, and LBM. Despite reduced BMD and BMC, bone strength was not significantly affected by FHA.
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Endocrine and bone metabolic complications in chronic liver disease and after liver transplantation in children. J Pediatr Gastroenterol Nutr 2012; 54:313-21. [PMID: 22064631 DOI: 10.1097/mpg.0b013e31823e9412] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
With improved survival of orthotopic liver transplantation (OLT) in children, prevention and treatment of pre- and posttransplant complications have become a major focus of care. End-stage liver failure can cause endocrine complications such as growth failure and hepatic osteodystrophy, and, like other chronic illnesses, also pubertal delay, relative adrenal insufficiency, and the sick euthyroid syndrome. Drug-induced diabetes mellitus post-OLT affects approximately 10% of children. Growth failure is found in 60% of children assessed for OLT. Despite optimisation of nutrition, rarely can further stunting of growth before OLT be prevented. Catch-up growth is usually observed after steroid weaning from 18 months post-OLT. Whether growth hormone treatment would benefit the 20% of children who fail to catch up in height requires testing in randomised controlled trials. Hepatic osteodystrophy in children comprises vitamin D deficiency rickets, low bone mass, and fractures caused by malnutrition and malabsorption. Vitamin D deficiency requires aggressive treatment with ergocalciferol (D2) or cholecalciferol (D3). The active vitamin D metabolites alphacalcidol or calcitriol increase gut calcium absorption but do not replace vitamin D stores. Prevalence of fractures is increased both before OLT (10%-28% of children) and after OLT (12%-38%). Most fractures are vertebral, are associated with low spine bone mineral density, and frequently occur asymptomatically, but they may also cause chronic pain. Fracture prediction in these children is limited. OLT in children is also associated with a greater risk of developing avascular bone necrosis (4%) and scoliosis (13%-38%). This article reviews the literature on endocrine and skeletal complications of liver disease and presents preventive screening recommendations and therapeutic strategies.
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Bone mineral density of adolescent female tennis players and nontennis players. J Osteoporos 2012; 2012:423910. [PMID: 22811951 PMCID: PMC3395175 DOI: 10.1155/2012/423910] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Revised: 05/02/2012] [Accepted: 05/09/2012] [Indexed: 12/19/2022] Open
Abstract
The purpose of this study was to determine differences in bone mineral density (BMD) among adolescent female tennis players (TPs) and nontennis players (NTPs) and to assess body composition as a predictor variable of BMD. Nineteen female TPs and 19 female NTPs, ages 14 to 18 years, participated in this study. Lumbar spine, total hip, femoral neck, forearms BMD, and body composition were assessed using dual-energy X-ray absorptiometry (DXA). Lumbar spine and total hip BMD measurements for TP were greater than NTP. However, these differences were not statistically significant (P = 0.37 and 0.12, resp.). TP had significantly greater femoral neck BMD than NTPs (P = 0.02). This difference might play an important role in preventing osteoporosis and decreasing the risk of fractures at the hip later in life.
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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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Simm PJ, Johannesen J, Briody J, McQuade M, Hsu B, Bridge C, Little DG, Cowell CT, Munns CF. Zoledronic acid improves bone mineral density, reduces bone turnover and improves skeletal architecture over 2 years of treatment in children with secondary osteoporosis. Bone 2011; 49:939-43. [PMID: 21820091 DOI: 10.1016/j.bone.2011.07.031] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Revised: 06/16/2011] [Accepted: 07/19/2011] [Indexed: 11/18/2022]
Abstract
There are limited data on the use of bisphosphonate therapy for secondary osteoporoses in childhood, and no previous reports of the use of zoledronic acid in this group. We report 20 children with a variety of underlying primary diagnoses with associated secondary osteoporosis, who were treated with 3 monthly zoledronic acid for 2 years (annualised dose 0.1mg/kg/year). There was a significant improvement in lumbar spine (by 1.88 SD±1.24 over first 12 months, p<0.001) and total bone mineral density as assessed by dual energy absorptiometry (DXA) scans, with a similar increase in bone mineral content for lean tissue mass (mean increase 1.34 SD in first 12 months, p<0.001). Bone turnover was reduced with a suppression of both osteocalcin and alkaline phosphatase in the first 12 months of treatment. Skeletal architecture was improved, with increased second metacarpal cortical thickness from 2.44mm to 2.72mm (p<0.001) and improved vertebral morphometry, with 7 patients who had vertebral wedging at baseline showing improved anterior (p=0.017) and middle (p=0.001) vertebral height ratios. Aside from well reported transient side effects with the first dose, there were no adverse effects reported. No adverse effects on anthropometric parameters were seen over the course of the study. Despite all patients having sustained fragility fractures prior to treatment, no fractures were reported during the study period. Further evidence is required to confirm efficacy, with long term follow up required to assess the impact of treatment on fracture risk.
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Affiliation(s)
- Peter J Simm
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia.
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