Vertebral compression is a serious complication of childhood acute lymphoblastic leukemia (ALL). The prevalence and pattern of vertebral fractures, as well as their relationship to BMD and other clinical indices, have not been systematically studied. We evaluated spine health in 186 newly diagnosed children (median age, 5.3 yr; 108 boys) with ALL (precursor B cell: N = 167; T cell: N = 19) who were enrolled in a national bone health research program. Patients were assessed within 30 days of diagnosis by lateral thoraco-lumbar spine radiograph, bone age (also used for metacarpal morphometry), and BMD. Vertebral morphometry was carried out by the Genant semiquantitative method. Twenty-nine patients (16%) had a total of 75 grade 1 or higher prevalent vertebral compression fractures (53 thoracic, 71%; 22 lumbar). Grade 1 fractures as the worst grade were present in 14 children (48%), 9 patients (31%) had grade 2 fractures, and 6 children (21%) had grade 3 fractures. The distribution of spine fracture was bimodal, with most occurring in the midthoracic and thoraco-lumbar regions. Children with grade 1 or higher vertebral compression had reduced lumbar spine (LS) areal BMD Z-scores compared with those without (mean ± SD, 22.1 ± 1.5 versus 21.1 ± 1.2; p < 0.001). LS BMD Z-score, second metacarpal percent cortical area Z-score, and back pain were associated with increased odds for fracture. For every 1 SD reduction in LS BMD Z-score, the odds for fracture increased by 80% (95% CI: 10-193%); the presence of back pain had an OR of 4.7 (95% CI: 1.5-14.5). These results show that vertebral compression is an under-recognized complication of newly diagnosed ALL. Whether the fractures will resolve through bone growth during or after leukemia chemotherapy remains to be determined.
BackgroundThe current study examined associations between gender, perceived athletic competence, and enjoyment of physical education (PE) class over time in a cohort of children enrolled in grade four (ages 9 or 10) at baseline (n = 2262).MethodsWe assessed each student 5 times over a period of 2 years. We used mixed effects modeling to examine change over time in enjoyment of PE.ResultsEnjoyment of PE declined among girls but remained constant among boys. Higher levels of perceived competence were associated with higher PE enjoyment. A 3-way interaction between gender, competence, and time revealed that PE enjoyment was lowest and declined most markedly among girls with low perceived athletic competence. Among boys with low competence, enjoyment remained at a consistently low level.ConclusionsOur results indicate that lower perceived athletic competence is associated with low enjoyment of PE, and, among girls, with declining enjoyment. Findings suggest that interventions in a PE context that target perceived competence should be considered in future work.
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