Can ultrasound be used to estimate bone mineral density in children with growth problems?

Effects of 6-month customized home-based exercise on motor development, bone strength, and parental stress in children with simple congenital heart disease: a single-blinded randomized clinical trial

BACKGROUND

New "noncardiac" problems in children with congenital heart disease (CHD), such as developmental delay or long-term neurodevelopmental impairments, have attracted considerable attention in recent years. It is hypothesized that exercise might attenuate CHD-associated neurodevelopmental impairments; however, this has not been thoroughly investigated. The objective of this prospective, single-blinded, randomized controlled experiment was to evaluate the impact of customized home-based exercise for children with CHD.

METHODS

Children aged 0-5 years with echocardiography-confirmed simple CHD subtypes who were scheduled to undergo cardiac catheterization were screened for enrolment. Among 420 screened CHD children, 192 were enrolled and randomly assigned at a 1:1 ratio to receive a 6-month intervention (30 min daily customized home-based exercise program with supervision for no less than 5 days per week, combined with home-based exercise education) or control treatment (home-based education). The primary outcome was motor development (gross motor quotient (GMQ), fine motor quotient (FMQ), and total motor quotient (TMQ)). The secondary outcomes were cardiac function and structure, bone quality, physical development, parental anxiety, caregiver burden, and quality of life. Children and their families were assessed before and 1, 3, and 6 months after catheterization; 183 (95.3%) children were included in the primary analysis.

RESULTS

After 6-month treatment, the intervention group significantly increased their motor quotient, which was consistently higher than that of the control group (GMQ p < 0.0001, FMQ p = 0.02, TMQ p < 0.001). The physical developments in height, weight, and circumferences of the upper-arm, chest, and head were also significantly improved by exercise (all p < 0.017). No significant improvements in the bone strength or the cardiac structure and function were found among patients in the intervention group (all p > 0.017). For parents, higher quality of life level (total score p = 0.016) was observed in the intervention group; while effects of exercise on the anxiety (rude score p = 0.159, standard score p = 0.159) or the Zarit caregiver burden scale score (p = 0.404) were non-significant. No adverse events occurred during the study period.

CONCLUSIONS

Customized home-based exercise improved motor development in children with CHD. While the long-term effects of parent training in home-based exercise are unknown, the study results suggest positive outcomes.

TRIAL REGISTRATION

A home-based exercise program in congenital heart disease children with cardiac catheterization: a randomized controlled trial. ( http://www.chictr.org.cn/ , ChiCTR-IOR-16007762, January 14, 2016).

Determinants of bone mineral density through quantitative ultrasound screening of healthy children visiting ambulatory paediatric clinics

Objectives:

To investigate the determinants of bone mineral density through screening healthy children using a non-invasive quantitative ultrasound measurement device.

Methods:

A descriptive cross-sectional study carried out at King AbdulAziz University Hospital, Jeddah, Kingdom of Saudi Arabia. between May 2018 and January 2019 through interviewing, examining, and screening healthy children visiting general paediatric. Total sample size encompassed 450 children. The inclusion criteria were healthy children between the ages of 2 and 20 years. Exclusion criteria were previous pathological fractures, chronic medical diseases, or long-term medications. Data entry and analysis was conducted using Statistical Package for Social Sciences version 24 (IBM Corp, Armonk, NY, USA). Chi-square tests were used to determine the association between categorical variables, with calculated p<0.05 considered significant. With one-way Anova testing to study the relationship between categorical variables and continuous variables.

Results:

A significant association with bone mineral density (BMD) was found during first 2 years with height (p=0.015), vitamin D supplementation (p=0.03), and breastfeeding (p=0.025). A directly proportional relationship with BMD was found with pubertal status, physical activity, diet, sun exposure, and calcium supplement intake.

Conclusion:

This is a novel study in the investigation of the dietary, lifestyle and demographic determinants of bone mineral density in the healthy middle-eastern child otherwise unaffected by chronic medical or metabolic disease or exposed to long term medications that could have affected bone metabolism.

Use of Automated Bone Age for Critical Growth Assessment

BACKGROUND

We compared the variability of bone age (BA) rating between clinicians and an automated system in children with congenital adrenal hyperplasia (CAH).

METHOD

A total of 126 radiographs assessed by 3 clinicians blinded to patient details using Greulich and Pyle (GP) (readers 1, 2, and 3) and BoneXpert (BX).

RESULTS

Comparing BA rating with each other, the mean of the absolute differences varied from 0.42 ± 0.53 years (reader 1 and BX) to 0.57 ± 0.58 years (reader 2 and reader 3), P = .368. Comparing ratings that were consistent with all 4 methods (within 1 year of each other, 93/126, 74%) and the remaining, "outliers" (33/126, 26%), the outliers were younger (P = .003), smaller (height, P = .011, weight, P = .000), and prepubertal (P = .001).

CONCLUSION

The variability of BA rating in CAH children is similar whether performed by clinicians or an automated system. The greatest variability was in prepubertal children.

The utility of ultrasonographic bone age determination in detecting growth disturbances; a comparative study with the conventional radiographic technique

OBJECTIVE

To test whether the conventional radiographic technique in determining bone age abnormalities can be replaced by ultrasonography.

MATERIALS AND METHODS

A total of 54 Caucasian subjects up to 7 years of age with clinically suspected growth problems underwent left hand and wrist radiographic and ultrasonographic bone age estimations with the use of the Greulich-Pyle atlas. The ultrasonographic scans targeted the ossification centers in the radius and ulna distal epiphysis, carpal bones, epiphyses of the first and third metacarpals, and epiphysis of the middle phalanx, as described in previous reports. The degree of agreement between the two sets of data, as well as the accuracy of the ultrasonographic method in detecting radiographically suggested bone age abnormities, was examined.

RESULTS

The mean chronological age, radiographic bone age, and ultrasonographic bone age (all in months) were 41.96 ± 22.25, 26.68 ± 14.08, and 26.71 ± 13.50 in 28 boys and 43.62 ± 24.63, 30.12 ± 17.69, and 31.27 ± 18.06 in 26 girls, respectively. According to the Bland-Altman plot there was high agreement between the results of the two methods with only three outliers. The deviations in bone age from the chronological age taken by the two techniques had the same sign in all patients. Supposing radiography to be the method of reference, the sensitivity, specificity, positive predictive value, and negative predictive value of sonography in detecting growth abnormalities were all 100% in males and 90.9, 100, 100, and 93.8%, respectively, in females.

CONCLUSION

The conventional radiographic technique for determining bone age abnormalities could be replaced by ultrasonography.

Radial quantitative ultrasound and dual energy x-ray absorptiometry: intermethod agreement for bone status assessment in children

Aim. To validate a radial quantitative ultrasound (QUS) system with dual energy X-ray absorptiometry (DXA), a criterion technique in bone status assessment among children. Methods. Bone health was evaluated using a radial QUS system (Sunlight Omnisense 8000P) to measure the speed of sound (SOS) at one-third distal radius of the nondominant hand and DXA (Hologic QDR) was used to assess whole body bone mineral density (BMD). Results. Some 29.9% of the children were grossly misclassified according to quartiles of BMD and radial SOS. Poor agreement was observed between Z-scores of radial SOS and whole-body BMD (mean difference = 0.6 ± 0.9; 95% limits of agreement = −1.4 to 2.6). With a cut-off value of −1.0, radial SOS yielded satisfactory sensitivity (80%) and specificity (93%) for the detection of children with low BMD. Conclusion. The observed poor agreement in the present study suggests that radial QUS and DXA are not comparable and hence are not interchangeable in evaluating bone status of the children.

A Follow-up Association Study of Genetic Variants for Bone Mineral Density in a Korean Population

Bone mineral density (BMD) is one of the quantitative traits that are genetically inherited and affected by various factors. Over the past years, genome-wide association studies (GWASs) have searched for many genetic loci that influence BMD. A recent meta-analysis of 17 GWASs for BMD of the femoral neck and lumbar spine is the largest GWAS for BMD to date and offers 64 single-nucleotide polymorphisms (SNPs) in 56 associated loci. We investigated these BMD loci in a Korean population called Korea Association REsource (KARE) to identify their validity in an independent study. The KARE population contains genotypes from 8,842 individuals, and their BMD levels were measured at the distal radius (BMD-RT) and midshaft tibia (BMD-TT). Thirteen genomic loci among 56 loci were significantly associated with BMD variations, and 3 loci were involved in known biological pathways related to BMD. In order to find putative functional variants, nearby SNPs in relation to linkage equilibrium were annotated, and their possible functional effects were predicted. These findings reveal that tens of variants, not a single factor, may contribute to the genetic architecture of BMD; have an important role regardless of ethnic group; and may highlight the importance of a replication study in GWASs to validate genuine loci for BMD variation.

Bone health in children and adolescents: the available imaging techniques

Many clinical conditions affecting children can be associated with a loss of bone mass and quality, leading to an increased risk of fracture over the life. Actually, different techniques are available to assess bone density and/or bone quality, but their employment in children and adolescents requires the acknowledgement of their characteristics and reference values, as well as of age, sex and pubertal stage of the patient. In this paper, the main densitometric techniques are described, and the principal conditions potentially affecting bone health in young people are indicated, with the intention of providing a small guide to prevent fractures in people at risk.