1
|
Longitudinal study of bone mineral density in children with idiopathic hypercalciuria. Pediatr Nephrol 2012; 27:123-30. [PMID: 21779854 DOI: 10.1007/s00467-011-1952-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Revised: 06/08/2011] [Accepted: 06/10/2011] [Indexed: 12/18/2022]
Abstract
Children with idiopathic hypercalciuria (IH) may have a reduced bone mineral density (BMD), which could impact on bone health in adulthood. There is currently no strong evidence for a preferred treatment of such children. The aim of our study was to evaluate the BMD z-score before and after treating children and adolescents with IH with potassium citrate and thiazides. The study consisted of a historical cohort of 80 pediatric patients who were evaluated between October 1989 and November 2010. Bone scanning and densitometry measurements were made with dual-emission X-ray absorptiometry. Lumbar-spine BMD (g/cm(2)) and BMD z-score were evaluated before and after treatment. The t test and Mann-Whitney U test were used for statistical analysis. Forty-three boys and 37 girls were followed for a median time of 6.0 years. Median calcium excretion before and after treatment was 5.0 and 2.6 mg/kg/24 h, respectively. The BMD z-score changed significantly from -0.763 ± 0.954 (mean ± SD) to -0.537 ± 0.898 (p < 0.0001) before and after treatment, respectively. The BMD z-score of the patients improved with treatment, suggesting a beneficial effect and potential need for treatment. However, the lack of a control group points to the need for future studies to corroborate this outcome.
Collapse
|
2
|
Cetinkaya S, Kara C. The effect of glucocorticoid replacement therapy on bone mineral density in children with congenital adrenal hyperplasia. J Pediatr Endocrinol Metab 2011; 24:265-9. [PMID: 21823521 DOI: 10.1515/jpem.2011.189] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES 1) To evaluate the effects of glucocorticoid (GC) doses on bone mineral density (BMD) in children with congenital adrenal hyperplasia (CAH), 2) Investigate other factors influencing BMD. METHODS Twenty-six children with CAH and 11 healthy controls included in the study. All of the patients were examined with dual-energy X-ray absorptiometry (DXA) using a Hologic QDR 1000/W densitometer. The metabolic control state, age at diagnosis GC dose (mg/m2/day), pubertal status, 17 hydroxyprogesterone (17 OHP) levels, bone age (BA), and lumber BMD were evaluated in all cases. BMD (g/cm2), BMD z-score corrected to National Standards (cNS-BMD z-score), BMD z-score corrected to BA (cBABMD), bone mineral content (BMC), BMC corrected to puberty (cPBMC), and bone area (BAR) values were determined. Patients were grouped according to mean on-therapy serum 17 OHP levels as tight control (17 OHP<10 nmol/L) (n:13) and poor control (17 OHP>10 nmol/L) (n:13). All groups were compared with each other. RESULTS The age range was 2.1-15.7 years and the mean age (+/- SD) 9.3 (+/- 3.5) years. There were no significant differences between the groups in terms of GC doses, lumbar BMD values [BMD (g/cm2), BMD z-score corrected to National Standards (cNS-BMD z-score), BMD z-score corrected to BA (cBABMD), bone mineral content (BMC), BMC corrected to puberty (cPBMC), and bone area (BAR)]. However, the BMI value was higher in children with CAH than normal healthy controls. The BA of the poor control, late diagnosed groups and male patients were higher than tight control, early diagnosed group and female patients, respectively. BMC and BA were lower than the control group in tight control with early diagnosed patients. The cBABMD z-score was lower in males with poor control than males with tight control. There were no similar results in female patients. CONCLUSIONS Although GC treatment seems not to influence BMD in CAH patients in our study, further studies are needed to additionally evaluate daily calcium (Ca) intake, polymorphism of vitamin D receptor, ethnic factors (strict Islamic dress, etc.), socioeconomic status, and 24-h urinary free cortisol level.
Collapse
Affiliation(s)
- Semra Cetinkaya
- Dr. Sami Ulus Obstetrics and Gynecology, Children's Health and Disease Training and Research Hospital, Ankara, Turkey.
| | | |
Collapse
|
3
|
Chew NS, Doran PP, Powderly WG. Osteopenia and osteoporosis in HIV: pathogenesis and treatment. Curr Opin HIV AIDS 2009; 2:318-23. [PMID: 19372906 DOI: 10.1097/coh.0b013e3281a3c092] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW Since the introduction of potent antiretroviral therapy, the emphasis in managing HIV patients has changed from treatment and prevention of opportunistic infections to dealing with toxicities of long-term antiretroviral therapy such as bone demineralization. To date, the pathogenic mechanisms underlying the initiation and progression of osteoporosis in HIV patients remain to be elucidated. This review focuses on recent advances in our understanding of the role of both HIV and antiretroviral therapy in driving bone disease and presents an update on current treatment options and new therapeutic agents targeting novel sites. RECENT FINDINGS Recent studies explored the role of HIV and individual antiretroviral therapy drugs in modifying the phenotype of bone cells. Studies have demonstrated effects on cell differentiation, maturation and function in response to both HIV and its treatment - effects mediated via direct alterations in both cell signaling and gene and protein expression. SUMMARY Evidence from clinical and cell biological investigations has demonstrated the importance of both HIV and antiretroviral therapy in the emergence of osteoporotic bone disease. Continued efforts aimed at deciphering the molecular basis of metabolic bone disease in HIV patients are necessary to ensure optimal treatment of current patients and to create novel therapeutic interventions.
Collapse
Affiliation(s)
- Nicholas S Chew
- UCD School of Medicine and Medical Sciences, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | | | | |
Collapse
|
4
|
Deng FY, Liu YZ, Li LM, Jiang C, Wu S, Chen Y, Jiang H, Yang F, Xiong JX, Xiao P, Xiao SM, Tan LJ, Sun X, Zhu XZ, Liu MY, Lei SF, Chen XD, Xie JY, Xiao GG, Liang SP, Deng HW. Proteomic analysis of circulating monocytes in Chinese premenopausal females with extremely discordant bone mineral density. Proteomics 2008; 8:4259-72. [PMID: 18924182 PMCID: PMC2760933 DOI: 10.1002/pmic.200700480] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Osteoporosis (OP) is a major public health problem, mainly characterized by low bone mineral density (BMD). Circulating monocytes (CMCs) may serve as progenitors of osteoclasts and produce a wide variety of factors important to bone metabolism. However, the specific action mechanism of CMCs in the pathogenesis of OP is far from clear. We performed a comparative protein expression profiling study of CMCs in Chinese premenopausal females with extremely discordant BMD, identified a total of 38 differentially expressed proteins, and confirmed with Western blotting five proteins: ras suppressor protein1 (RSU1), gelsolin (GSN), manganese-containing superoxide dismutase (SOD2), glutathione peroxidase 1(GPX1), and prolyl 4-hydroxylase beta subunit (P4HB). These proteins might affect CMCs' trans-endothelium, differentiation, and/or downstream osteoclast functions, thus contribute to differential osteoclastogenesis and finally lead to BMD variation. The findings promote our understanding of the role of CMCs in BMD determination, and provide an insight into the pathogenesis of human OP.
Collapse
Affiliation(s)
- Fei-Yan Deng
- Laboratory of Molecular and Statistical Genetics, College of Life Sciences, Hunan Normal University, Changsha, Hunan, P. R. China, Departments of Orthopedics Surgery and Basic Medical Sciences, University of Missouri, Kansas City, MO, USA
| | - Yao-Zhong Liu
- Departments of Orthopedics Surgery and Basic Medical Sciences, University of Missouri, Kansas City, MO, USA
| | - Li-Ming Li
- Laboratory of Molecular and Statistical Genetics, College of Life Sciences, Hunan Normal University, Changsha, Hunan, P. R. China
| | - Chen Jiang
- Laboratory of Molecular and Statistical Genetics, College of Life Sciences, Hunan Normal University, Changsha, Hunan, P. R. China
| | - Shan Wu
- Laboratory of Molecular and Statistical Genetics, College of Life Sciences, Hunan Normal University, Changsha, Hunan, P. R. China
| | - Yuan Chen
- Laboratory of Molecular and Statistical Genetics, College of Life Sciences, Hunan Normal University, Changsha, Hunan, P. R. China
| | - Hui Jiang
- Laboratory of Molecular and Statistical Genetics, College of Life Sciences, Hunan Normal University, Changsha, Hunan, P. R. China
| | - Fang Yang
- Laboratory of Molecular and Statistical Genetics, College of Life Sciences, Hunan Normal University, Changsha, Hunan, P. R. China
| | - Ji-Xian Xiong
- Key Laboratory of Protein Chemistry and Developmental Biology of Ministry of Education, College of Life Sciences, Hunan Normal University, Changsha, Hunan, P. R. China
| | - Peng Xiao
- Osteoporosis Research Center, Creighton University Medical Center, Omaha, NE, USA
| | - Su-Mei Xiao
- Laboratory of Molecular and Statistical Genetics, College of Life Sciences, Hunan Normal University, Changsha, Hunan, P. R. China
| | - Li-Jun Tan
- Laboratory of Molecular and Statistical Genetics, College of Life Sciences, Hunan Normal University, Changsha, Hunan, P. R. China
| | - Xiao Sun
- Laboratory of Molecular and Statistical Genetics, College of Life Sciences, Hunan Normal University, Changsha, Hunan, P. R. China
| | - Xue-Zhen Zhu
- Laboratory of Molecular and Statistical Genetics, College of Life Sciences, Hunan Normal University, Changsha, Hunan, P. R. China
| | - Man-Yuan Liu
- Laboratory of Molecular and Statistical Genetics, College of Life Sciences, Hunan Normal University, Changsha, Hunan, P. R. China
| | - Shu-Feng Lei
- Laboratory of Molecular and Statistical Genetics, College of Life Sciences, Hunan Normal University, Changsha, Hunan, P. R. China
| | - Xiang-Ding Chen
- Laboratory of Molecular and Statistical Genetics, College of Life Sciences, Hunan Normal University, Changsha, Hunan, P. R. China
| | - Jing-Yun Xie
- Key Laboratory of Protein Chemistry and Developmental Biology of Ministry of Education, College of Life Sciences, Hunan Normal University, Changsha, Hunan, P. R. China
| | - Gary G. Xiao
- Laboratory of Molecular and Statistical Genetics, College of Life Sciences, Hunan Normal University, Changsha, Hunan, P. R. China, Key Laboratory of Protein Chemistry and Developmental Biology of Ministry of Education, College of Life Sciences, Hunan Normal University, Changsha, Hunan, P. R. China, Osteoporosis Research Center, Creighton University Medical Center, Omaha, NE, USA
| | - Song-Ping Liang
- Key Laboratory of Protein Chemistry and Developmental Biology of Ministry of Education, College of Life Sciences, Hunan Normal University, Changsha, Hunan, P. R. China
| | - Hong-Wen Deng
- Laboratory of Molecular and Statistical Genetics, College of Life Sciences, Hunan Normal University, Changsha, Hunan, P. R. China, Departments of Orthopedics Surgery and Basic Medical Sciences, University of Missouri, Kansas City, MO, USA
| |
Collapse
|
5
|
Rosso R, Vignolo M, Parodi A, Di Biagio A, Sormani MP, Bassetti M, Aicardi G, Bassetti D. Bone quality in perinatally HIV-infected children: role of age, sex, growth, HIV infection, and antiretroviral therapy. AIDS Res Hum Retroviruses 2005; 21:927-32. [PMID: 16386108 DOI: 10.1089/aid.2005.21.927] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Appropriate supportive care and identification of long-term sequels of therapy are of paramount importance in HIV-infected pediatric patients. As low bone mineral quality (BMQ) in patients can be considered a marker of possible degeneration in osteopenia and osteoporosis in adulthood, we evaluated bone features in a pediatric population. Forty-four patients (23 females, 21 males; aged 3-17 years) were compared with a control population (1227 healthy children: 568 females, 641 males; aged 3-18 years). Seven patients were CDC stage C, 18 B, and 18 A. All patients were vertically infected; four were naive to any antiretroviral treatment, seven were taking two NRTIs, and 32 were on HAART. BMQ was assessed by a quantitative ultrasound (QUS) technique. It measures the amplitude-dependent speed of sound (AD-SoS, m/sec) and the bone transmission time (BTT, microsec). QUS values were significantly lower in cases than in controls, even after adjustment for age and body size (AD-SoS: 1924.7 +/- 64.9 and BTT: 0.97 +/- 0.3 in controls; AD-SoS: 1879.7 +/- 57.2 and BTT: 0.80 +/- 0.32 in cases; p < or = 0.001). The associations of AD-SoS and BTT with gender, type of therapy, and CDC stages were not significant. AD-SoS and BTT were significantly associated with age (r = 0.59, p < 0.0001), skeletal age SDS (r = 0.46, p = 0.002), height (r = 0.66, p < 0.0001), and therapy duration (r = 0.31, p = 0.04). Both AD-SoS and BTT values in patients fell below mean values of controls. Follow-up of bone mineral density is important in patients to prevent long-term problems of skeletal status.
Collapse
Affiliation(s)
- R Rosso
- Department of Infectious Diseases, University of Genoa, School of Medicine, San Martino Hospital, 16132 Genoa, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
6
|
Hamerman D. Bone health across the generations: a primer for health providers concerned with osteoporosis prevention. Maturitas 2005; 50:1-7. [PMID: 15590208 DOI: 10.1016/j.maturitas.2004.08.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2004] [Revised: 07/26/2004] [Accepted: 08/12/2004] [Indexed: 11/17/2022]
Abstract
Osteoporosis represents a major public health problem by virtue of later life association with fragility fractures which may indeed be the first sign of this "silent epidemic". While as prevalent as cardiovascular and other age-related chronic diseases, efforts at osteoporosis prevention have been less successful due to limited commitment among the public to take steps to maintain their "bone health", and fragmentation of osteoporosis management among different health specialties, indeed with many reports of deficient physician knowledge of the subject. This paper presents a survey of the factors that contribute to bone loss or accrual in women across the generations, including adolescence, the reproductive years, the menopause inception, and the decades thereafter. Health providers in a variety of disciplines aware of and inquiring about the spectrum of bone changes in their patients over the generations may intervene effectively in a more timely manner to limit future fracture occurrence.
Collapse
Affiliation(s)
- David Hamerman
- Department of Medicine and Resnick Gerontology Center, Albert Einstein College of Medicine and Montefiore Medical Center, USA.
| |
Collapse
|
7
|
Alvarez R, García R, Luis J, López J, Gutiérrez A, González M, del Río L, Aguilera F, Vázquez R. [Bone mineral density in children with osteogenesis imperfecta]. REVISTA ESPANOLA DE MEDICINA NUCLEAR 2003; 22:224-8. [PMID: 12846946 DOI: 10.1016/s0212-6982(03)72190-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECT Osteogenesis imperfecta is the term used for a group of disorders of collagen synthesis which cause increased bone fragility. The aim of our study was to evaluate the BMD in patients with OI. MATERIAL AND METHODS We used dual-energy x ray absorptiometry, Hologic QDR 4500W (DEXA), to compare the bone mineral density (BMD) of 8 patients aged from 3 years to 20 years who had osteogenesis imperfecta with an age and sex matched control group. RESULTS DEXA detected highly significant differences in BMD respecting control group. The mean BMD in the patients with osteogenesis imperfecta was 62.6 % of normal in lumbar spine (p < 0.01) and 63.01 % of normal in the femoral neck (p < 0.01) using Wilcoxon test. CONCLUSION DEXA is an objective, reproductible and sensitive method of measurement of BMD in children. It may help to stablish the diagnosis, to asses prognosis and possibly to monitor the response to different types of treatment.
Collapse
Affiliation(s)
- R Alvarez
- U.D. Medicina Nuclear. Hospital Universitario Virgen del Rocío. Sevilla. Spain.
| | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Lima EM, Goodman WG, Kuizon BD, Gales B, Emerick A, Goldin J, Salusky IB. Bone density measurements in pediatric patients with renal osteodystrophy. Pediatr Nephrol 2003; 18:554-9. [PMID: 12712376 DOI: 10.1007/s00467-002-1041-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2001] [Revised: 12/21/2001] [Accepted: 10/15/2002] [Indexed: 10/25/2022]
Abstract
Peripheral quantitative computed tomography (pQCT) can selectively measure the densities of cortical and trabecular bone, but there is limited information about its use in patients with renal osteodystrophy. Thus pQCT (Norland XCT-2000, Stratec, Pforzheim, Germany) was performed at the ultradistal radius in 21 patients aged 16+/-3.6 (SD) years on continuous cycling peritoneal dialysis. Trabecular bone density (TBD) was higher in patients, 206+/-16 mg/cm(3), than in controls, 182.7+/-24.8 mg/cm(3) ( P<0.0001), whereas cortical bone density (CBD) was lower in patients, 946.5+/-147.5 mg/cm(3), than in controls, 1,153+/-25.4 mg/cm(3) ( P<0.001). TBD was inversely correlated with age ( r=-0.59, P=0.05), height ( r=-0.59, P<0.01), and weight ( r=-0.51, P<0.05). In contrast, CBD was positively correlated with age ( r=0.53, P<0.05), height ( r=0.56, P<0.05), and weight ( r=0.53, P<0.05). CBD was inversely related to serum alkaline phosphatase ( r=-0.71, P<0.001) and parathyroid hormone levels ( r=-0.50, P<0.05). In patients with adynamic bone, TBD was less, 192+/-9 mg/cm(3), than in those with high-turnover lesions, 215+/-13 mg/cm(3), P<0.001. CBD, however, was lower in patients with high-turnover lesions, 900+/-151 mg/cm(3), than in those with low turnover, 1,022+/-111 mg/cm(3), P<0.05. Compared with controls, in patients with high-turnover lesions, CBD was lower ( P<0.0001) and TBD higher ( P<0.0001). These findings suggest that pQCT may be an additional tool in the assessment of renal osteodystrophy.
Collapse
Affiliation(s)
- Eleonora M Lima
- Division of Pediatric Nephrology, Department of Pediatrics, UCLA School of Medicine, Los Angeles, California 90095, USA
| | | | | | | | | | | | | |
Collapse
|
9
|
Penido MGMG, Lima EM, Marino VSP, Tupinambá ALF, França A, Souto MFO. Bone alterations in children with idiopathic hypercalciuria at the time of diagnosis. Pediatr Nephrol 2003; 18:133-9. [PMID: 12579402 DOI: 10.1007/s00467-002-1036-6] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2002] [Revised: 08/26/2002] [Accepted: 10/02/2002] [Indexed: 12/17/2022]
Abstract
Some children with idiopathic hypercalciuria (IH) develop bone alterations at some stage of the disease. The aims of this study were to evaluate bone mass in 88 children with IH (G1) at the time of diagnosis and to compare the findings with data for a control group of 29 normal children (G2). Kidney and bone metabolism markers were measured in both groups, and bone densitometry was performed. Serum alkaline phosphatase, intact parathyroid hormone, urinary calcium and uric acid were significantly higher in G1, whereas urinary volume and urinary citrate excretion were lower. The following densitometric parameters were significantly lower in G1: (1) lumbar spine (L(2)-L(4)) bone mineral density (BMD), bone mineral content (BMC), BMC corrected for height and for width of the vertebra, volumetric BMD (BMDvol), and Z score; (2) whole-body BMD; (3) femoral neck BMD. Lumbar spine BMDvol was reduced (osteopenia) in 35% of the patients compared with G2. N telopeptide, a urinary marker of bone resorption, was significantly higher in G1 than in G2, and was negatively correlated with lumbar spine BMD and BMDvol. Children with urinary lithiasis or idiopathic hyperuricosuria associated with IH showed no significant differences in bone metabolism compared with children without these associations. We conclude that (1) there is an altered bone metabolism in IH, with osteopenia already present at diagnosis in 35% of the patients; (2) N telopeptide is one of the most useful markers of bone alterations in IH, especially at an early stage of the disease; (3) investigation of bone metabolism is necessary in IH to prevent future serious consequences such as osteoporosis and bone fractures.
Collapse
|
10
|
Gleeson HK, Darzy K, Shalet SM. Late endocrine, metabolic and skeletal sequelae following treatment of childhood cancer. Best Pract Res Clin Endocrinol Metab 2002; 16:335-48. [PMID: 12064896 DOI: 10.1053/beem.2002.0201] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
With an ever increasing adult population of childhood cancer survivors there is a need to focus on the late effects of cancer therapy. It is essential that, after discharge from the paediatric oncologists, the patients are not lost from the health system but are under continued surveillance with access to the appropriate physicians. Endocrine and metabolic consequences may affect a patient's life both soon after cancer treatment and also for many years in the future. In this review we consider the following potential problems: growth hormone deficiency and replacement in adulthood, cardiovascular risk factors, osteopaenia, thyroid and parathyroid dysfunction.
Collapse
Affiliation(s)
- Helena K Gleeson
- Department of Endocrinology, Christie Hospital, Wilmslow Road, Manchester, Withington, M20 4BX, UK
| | | | | |
Collapse
|
11
|
Lequin MH, Hop WC, van Rijn RR, Bukkems MC, Verhaak LL, Robben SG, Van Kuijk C. Comparison between quantitative calcaneal and tibial ultrasound in a Dutch Caucasian pediatric and adolescent population. J Clin Densitom 2001; 4:137-46. [PMID: 11477307 DOI: 10.1385/jcd:4:2:137] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2000] [Revised: 10/15/2000] [Accepted: 11/03/2000] [Indexed: 11/11/2022]
Abstract
In the field of bone densitometry, attention has recently been focused on the pediatric population. Quantitative ultrasound (QUS) as bone assessment technique has many advantages for children in comparison with bone assessment techniques that use ionizing radiation. In this pilot study, we investigated the use of calcaneal and tibial QUS systems in a healthy Caucasian pediatric population. We studied 120 healthy Caucasian Dutch children between ages 7 and 19 yr: 53 boys (mean age of 12.5 yr, range 4.5-18) and 67 girls (mean age of 13.5 yr; range 7.1-19). We recruited children from a large population who previously had participated in a bone assessment study performed at our hospital. Two operators performed calcaneal QUS of the right calcaneus and tibial QUS of the right tibia. The correlation between calcaneal and tibial ultrasound was modest but significant (r = 0.29; p < 0.01). Using the calcaneal device, we found in girls a weak positive correlation between skeletal age and speed of sound (SOS) (r = 0.38), broadband ultrasound attenuation (r = 0.57), and quantitative ultrasound index (r = 0.46), all with a value of p < 0.01. For boys all parameters failed to reach significance. Using the tibial device, we found a good correlation between skeletal age and SOS in girls (r = 0.76) and modest correlation in boys (r = 0.50), both with a value of p < 0.01. This is one of the first studies to present a comparison between two ultrasound techniques in children. At present we feel that, in light of the poor correlation with skeletal age, calcaneal ultrasound has yet to prove its efficacy in children. Tibial ultrasound seems to be a good bone assessment technique in children.
Collapse
Affiliation(s)
- M H Lequin
- Department of Radiology, University Children's Hospital Sophia Rotterdam, Dr. Molewaterplein 60, 3015 GJ Rotterdam, The Netherlands.
| | | | | | | | | | | | | |
Collapse
|
12
|
Carrascosa A, Gussinyé M, Terradas P, Yeste D, Audí L, Vicens-Calvet E. Spontaneous, but not induced, puberty permits adequate bone mass acquisition in adolescent Turner syndrome patients. J Bone Miner Res 2000; 15:2005-10. [PMID: 11028454 DOI: 10.1359/jbmr.2000.15.10.2005] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Lumbar L2-L4 bone mineral density (BMD) values were measured in 37 adolescent and young adult Turner syndrome patients. Nine had developed spontaneous puberty and had had regular menses since menarche (12.55 years +/- 1.17 years) to the time of BMD evaluation (14.96 years +/- 1.26 years). In the other 28, puberty was induced with increasing doses of oral ethinyl estradiol (2.5-10.0 microg/day, for 2 years) and later administration of estrogen/gestagen therapy up to the time of BMD evaluation. In 18, the adolescent group, menarche appeared at 14.68 years +/- 0.63 years and BMD was evaluated at 17.77 years +/- 0.70 years, and in the other 10, the young adult group, menarche appeared at 14.47 years +/- 0.53 years and BMD was evaluated at 20.90 years +/- 0.68 year. BMD values were in the normal range in those who had developed spontaneous puberty (Z score values, -0.24 +/- 0.22) and in the osteopenia range in those in whom puberty was induced (Z score values, -2.09 +/- 0.79 and -2.18 +/- 0.32 for the adolescent and young adult groups, respectively) p < 0.0001. Height Z score values were similar in all three groups (-3.45 +/- 0.77, -3.15 +/- 0.83, and -3.08 +/- 0.33, respectively). No significant differences in calcium intake or physical activity were found among groups. Neither the karyotype distribution nor growth hormone (GH) therapy (five in the spontaneous puberty and six in the induced puberty groups had been treated for a 3.5- to 4.4-year period) explained the differences in BMD values. Because the main difference between groups was the availability of estrogens to bone tissue from infancy to menarche and of estrogens/gestagens from then on up to the time of BMD evaluation, our results suggest that normal gonadal function from infancy to adulthood may be required for adequate bone mass peaking. Early detection of osteopenia and improvement in general measures for adequate bone mass peaking (calcium intake and physical activity) should be considered mandatory in the health care of these patients.
Collapse
Affiliation(s)
- A Carrascosa
- Children's Hospital Vall d'Hebron, Autonomous University, Barcelona, Spain
| | | | | | | | | | | |
Collapse
|
13
|
Harbour ME, Gregory JW, Jenkins HR, Evans BA. Proliferative response of different human osteoblast-like cell models to proinflammatory cytokines. Pediatr Res 2000; 48:163-8. [PMID: 10926290 DOI: 10.1203/00006450-200008000-00008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Children with inflammatory bowel disease are known to be at risk of osteopenia. The cause of this osteopenia is likely to be multifactorial, but the inflammatory process with its characteristic overproduction of cytokines has been implicated. To investigate this possible contribution of the disease activity to the development of osteopenia, we performed in vitro assays of the proliferation of osteoblast-like cells of differing origins in response to the inflammatory cytokines tumor necrosis factor-alpha and IL-1/beta. Osteoblast-like cells derived from pediatric bone explants, adherent stromal cells derived from bone marrow (osteoprogenitors), MG-63 osteosarcoma cells, and SV-40 virally transformed osteoprogenitor cells (HCC1) were studied. Tumor necrosis factor-alpha stimulated the proliferation of cells in primary cultures (i.e. from explants and marrow samples) in a linear, dose-dependent manner. In contrast, inhibition of proliferation was observed with the established cell lines (MG-63 and HCC1). IL-1beta stimulated proliferation of all cells apart from the immortalized human bone marrow cell line, HCC1, in which case potent inhibition was observed. We conclude that proinflammatory cytokines are potent regulators of osteoblast-like cell proliferation, and that the responses are specific to cell type. The opposite results obtained with established cell lines compared with the primary cultures suggest that careful consideration should be given to choosing the most suitable cell line for in vitro studies relating to in vivo mechanisms predisposing to osteopenia.
Collapse
Affiliation(s)
- M E Harbour
- Department of Child Health, University of Wales College of Medicine, Heath Park, Cardiff, United Kingdom
| | | | | | | |
Collapse
|
14
|
Battin J, Barthe N, Barat P. [Contribution of osteo-densitometry in Turner syndrome and in somatotropin deficiencies]. Arch Pediatr 2000; 4:95s-101s. [PMID: 9246313 DOI: 10.1016/s0929-693x(97)86471-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- J Battin
- Clinique de pédiatrie et génétique médicale, hôpital des Enfants-CHU Pellegrin, Bordeaux, France
| | | | | |
Collapse
|
15
|
Zacharin M. Use of androgens and oestrogens in adolescents--a review of hormone replacement treatment. J Pediatr Endocrinol Metab 2000; 13:3-11. [PMID: 10689632 DOI: 10.1515/jpem.2000.13.1.3] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- M Zacharin
- Department of Endocrinology and Diabetes, Royal Children's Hospital, Parkville, Victoria, Australia
| |
Collapse
|
16
|
Marco Hernández M, Méndez Fernández M, Ruiz Ramírez J. Variaciones de la densidad y de la concentración mineral ósea entre distintas comunidades. An Pediatr (Barc) 2000. [DOI: 10.1016/s1695-4033(00)77351-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
17
|
Arikoski P, Komulainen J, Riikonen P, Jurvelin JS, Voutilainen R, Kröger H. Reduced bone density at completion of chemotherapy for a malignancy. Arch Dis Child 1999; 80:143-8. [PMID: 10325729 PMCID: PMC1717834 DOI: 10.1136/adc.80.2.143] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Osteoporosis and pathological fractures occur occasionally in children with malignancies. This study was performed to determine the degree of osteopenia in children with a malignancy at completion of chemotherapy. METHODS Lumbar spine (L2-L4) bone mineral density (BMD; g/cm2) and femoral neck BMD were measured by dual energy x ray absorptiometry in 22 children with acute lymphoblastic leukaemia (ALL), and in 26 children with other malignancies. Apparent volumetric density was calculated to minimise the effect of bone size on BMD. Results were compared with those of 113 healthy controls and expressed as age and sex standardised mean Z scores. RESULTS Patients with ALL had significantly reduced lumbar volumetric (-0.77) and femoral areal and volumetric BMDs (-1.02 and -0.98, respectively). In patients with other malignancies, femoral areal and apparent volumetric BMDs were significantly decreased (-0.70 and -0.78, respectively). CONCLUSIONS The results demonstrate that children with a malignancy are at risk of developing osteopenia. A follow up of BMD after the completion of chemotherapy should facilitate the identification of patients who might be left with impaired development of peak bone mass, and who require specific interventions to prevent any further decrease in their skeletal mass and to preserve their BMD.
Collapse
Affiliation(s)
- P Arikoski
- Department of Pediatrics, Kuopio University Hospital, Finland.
| | | | | | | | | | | |
Collapse
|
18
|
Arikoski P, Komulainen J, Voutilainen R, Riikonen P, Parviainen M, Tapanainen P, Knip M, Kröger H. Reduced bone mineral density in long-term survivors of childhood acute lymphoblastic leukemia. J Pediatr Hematol Oncol 1998; 20:234-40. [PMID: 9628435 DOI: 10.1097/00043426-199805000-00009] [Citation(s) in RCA: 108] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE Osteoporosis and pathologic fractures are occasionally found in patients with childhood acute lymphoblastic leukemia (ALL). This study was performed to determine the degree of possible osteopenia in long-term survivors of childhood ALL. PATIENTS AND METHODS Lumbar spine (L2-L4) and femoral neck bone mineral densities (BMDs) (g/cm2) were measured in 29 survivors (aged 12 to 30 years, median 17) of childhood ALL 2 to 20 (median 8) years after discontinuation of chemotherapy. These results were compared with those from 273 healthy controls and expressed as a percentage of the age- and sex-matched control values (mean +/- standard deviation). RESULTS Lumbar and femoral BMDs were significantly reduced in survivors of childhood ALL. Particularly, male gender (lumbar: 91.7 +/- 10.4%, p = 0.008; femoral: 91.9 +/- 11.3%, p = 0.005) and a history of cranial irradiation (lumbar: 93.0 +/- 8.9%, p = 0.005; femoral: 94.4 +/- 13.3%, p = 0.03) were associated with low lumbar and femoral BMDs. CONCLUSIONS The detected deficit in bone density in survivors of childhood ALL may predispose these patients to osteoporotic fractures later in adulthood. A follow-up of BMD in survivors of childhood ALL should facilitate the identification of patients who would require specific therapeutic interventions to prevent further decrease of their skeletal mass and preserve their BMD.
Collapse
Affiliation(s)
- P Arikoski
- Department of Pediatrics, Kuopio University Hospital, Finland
| | | | | | | | | | | | | | | |
Collapse
|
19
|
Gussinyé M, Carrascosa A, Potau N, Enrubia M, Vicens-Calvet E, Ibáñez L, Yeste D. Bone mineral density in prepubertal and in adolescent and young adult patients with the salt-wasting form of congenital adrenal hyperplasia. Pediatrics 1997; 100:671-4. [PMID: 9310523 DOI: 10.1542/peds.100.4.671] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To evaluate bone mineral density (BMD) in prepubertal and in adolescent and young adult patients with the salt-wasting form of congenital adrenal hyperplasia (CAH). DESIGN A relationship between bone mineral content and risk for osteoporotic fractures has been observed in adulthood. Infancy, childhood, and adolescence are critical periods for skeletal mineralization; thus, chronic diseases may impair bone mass peaking, particularly if children and adolescents are overexposed to glucocorticoids, as may occur in patients with CAH. Lumbar L2-L4 BMD values were measured by dual x-ray absorptiometry and compared with those of 471 age- and sex-matched controls. PATIENTS Thirty-three patients with the salt-wasting form of CAH were studied. Sixteen (10 girls and 6 boys; age range, 1.5 to 8.3 years) were prepubertal and 17 (13 women and 4 men; age range, 17.1 to 28.2 years) were adolescent and young adults who had reached final height and had presented normal pubertal development and normal gonadal function thereafter. The average doses of hydrocortisone (mg/m body surface/day) received from diagnosis in the neonatal period to BMD evaluation were 21.2 +/- 2.2 and 22.3 +/- 2.6, respectively. RESULTS Mean BMD Z score values were 0.16 +/- 1.01 in prepubertal patients and 0.06 +/- 1.02 in adolescent and young adult patients with no statistically significant differences with age- and sex-matched controls. Mean height Z score values were -0.03 +/- 1.13 in prepubertal patients and -1.13 +/- 0.62 in adolescent and young adult patients with significant differences between the latter and their respective age- and sex-matched controls. CONCLUSION Long-term glucocorticoid therapy does not impair bone mass peaking in CAH patients with normal gonadal function, even though their adult height values are low.
Collapse
Affiliation(s)
- M Gussinyé
- Department of Pediatrics, Children's Hospital Vall d' Hebron, Autonomous University, Barcelona, Spain
| | | | | | | | | | | | | |
Collapse
|
20
|
Leger J, Ruiz JC, Guibourdenche J, Kindermans C, Garabedian M, Czernichow P. Bone mineral density and metabolism in children with congenital hypothyroidism after prolonged L-thyroxine therapy. Acta Paediatr 1997; 86:704-10. [PMID: 9240877 DOI: 10.1111/j.1651-2227.1997.tb08572.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The effect of long-term L-thyroxine (LT4) replacement therapy on bone mineral density and on biochemical markers of bone turnover were studied in children with congenital hypothyroidism (CH). Forty-four children and adolescents (mean age 8.5 +/- 3.5 years) with primary CH who began LT4 replacement therapy within the first month of life were studied. Bone mineral density (BMD) of the lumbar vertebrae and the upper femoral bone was measured by dual energy X-ray absorptiometry. Serum osteocalcin (OC) and bone alkaline phosphatase were measured as markers of bone formation and urinary deoxypyridinoline was taken as a marker of bone resorption. Bone mineral densities of CH children were not different from those in age-matched controls. The biochemical markers of bone turnover were normal except for the serum OC levels which were found to be higher than in controls and positively correlated with the free thyroid hormone levels (for FT4 r = 0.42, p = 0.02). Eight CH children demonstrated low BMD values (below -1 SDS) at -2 +/- 0.7 SDS for the lumbar spine and -1.6 +/- 0.5 SDS for the femoral site. These eight children showed lower mean weight (p < 0.05) and their dietary calcium intake tended to be less (p <0.06) than that seen in the normal BMD group. In conclusion, our results show that LT4 replacement therapy for 8 years is not detrimental to the skeletal mineralization of CH children. As in a healthy population, weight and current intake of calcium seem to be major determinants of bone density. Dietary recommendations, especially when calcium intake is below the recommended dietary allowance, may have to be reconsidered.
Collapse
Affiliation(s)
- J Leger
- Paediatric Endocrinology and Diabetes Unit, Hôpital Robert Debré, Paris, France
| | | | | | | | | | | |
Collapse
|
21
|
Lewis RL, Dickerson JW, Davies GJ. Lifestyle and injuries of professional ballet dancers: reflections in retirement. JOURNAL OF THE ROYAL SOCIETY OF HEALTH 1997; 117:23-31. [PMID: 9050289 DOI: 10.1177/146642409711700107] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- R L Lewis
- Nutrition Research Centre, South Bank University, London
| | | | | |
Collapse
|