Fracture after bisphosphonate treatment in children with cerebral palsy: the role of stress risers

Harcke, H. Theodore; Stevenson, Kimberly L.; Kecskemethy, Heidi H.; Bachrach, Steven J.; Grissom, Leslie E.

doi:10.1007/s00247-011-2198-9

Cited by 21 publications

(11 citation statements)

References 23 publications

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“…However, the recognition of focal undertubulation (most striking at the distal femur in this case) helps cinch the diagnosis. Recognition of these findings can be clinically important, as the abrupt change of bone mineral density at the dense bands has been implicated as a stress riser, similar to the interface between a prosthesis and native bone [8]. The potential increase in fracture risk presented by these bands may prompt a change in the duration of therapy.…”

Section: Discussionmentioning

confidence: 99%

Bisphosphonate therapy for chronic recurrent multifocal osteomyelitis

et al. 2013

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Section: Discussionmentioning

confidence: 99%

Bisphosphonate therapy for chronic recurrent multifocal osteomyelitis

et al. 2013

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“…Previous reports have shown that patients with cerebral palsy were more likely to fracture at the junction of a metaphyseal band, rather than elsewhere, following bisphosphonate treatment [22]. The presence of stress risers therefore acts as a focus for potential fractures and is readily seen in those with orthopaedic devices [28].…”

Section: Discussionmentioning

confidence: 99%

“…This area of weakness can cause failure of the material and is known as a stress riser [21]. The regions of increased bone density created by cyclical intravenous bisphosphonates result in stress risers within the bone that can be the site for subsequent fractures [22]. Stress risers can also be formed at surgical sites where osteotomy or prosthetic hardware is present.…”

Section: Introductionmentioning

confidence: 99%

Fracture during Intravenous Bisphosphonate Treatment in a Child with Osteogenesis Imperfecta: An Argument for a More Frequent, Low-Dose Treatment Regimen

et al. 2013

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Background/Aims: Intravenous bisphosphonate therapy is the mainstay of medical treatment in osteogenesis imperfecta (OI) and has been shown to increase bone mass, decrease bone pain, improve mobility, and reduce the incidence of fractures. Sclerotic metaphyseal lines parallel to the growth plate are seen on long bone radiographs following cyclical intravenous therapy. These areas create stress risers within the bone that may act as foci for subsequent fractures as exemplified in this clinical case. Methods: An 8-year-old girl with OI sustained a distal radial fracture following 3 years of treatment with 6-monthly intravenous zoledronate. Her diagnosis, response to treatment, and subsequent fracture at a sclerotic metaphyseal line is described. Results: Peripheral quantitative computer tomography was used to characterise the presence of multiple stress risers at the distal forearm. Trabecular bone mineral density fluctuated from 34 to 126% compared to neighbouring 2-mm regions. Conclusion: There remain many unanswered questions about optimal bisphosphonate treatment regimens in children with OI. The formation of stress risers following intravenous bisphosphonate treatment raises the hypothesis that a more frequent and low-dose bisphosphonate regimen would provide more uniform dosing of bone in the growing child and reduce the likelihood of fractures compared to current treatment practices.

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“…Bisphosphonates may be used to increase bone density, reducing fracture risk from 30.6 to 13 % [ 10 ]. However, after bisphosphonate therapy fractures may occur at locations where there are large differences in bone density [ 11 ]; the transition in density may produce a so-called stress concentration or stress riser, which predisposes to fracture.…”

mentioning

confidence: 99%

Neuromuscular Diseases

Miller¹,

Wilson²

2014

Pediatric Orthopedic Imaging

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This chapter addresses neuromuscular disorders of the brain/upper motor neuron (cerebral palsy) and spinal cord/lower motor neuron (myelomeningocele, spinal muscular atrophy, spinal cord injury, and poliomyelitis). It then addresses Charcot-Marie-Tooth disease, an example of a disorder affecting the peripheral nerves. Muscular diseases are then discussed, such as Duchenne muscular dystrophy, myotonic disorders, and dermatomyositis. The chapter concludes with Friedrich ataxia and complex regional pain syndrome type 1. Imaging modalities and issues for each condition are considered by anatomic region, with focus on the manifestations and sequelae of common pathophysiologic processes. Neuromuscular diseases encompass a large group of conditions affecting muscles and the nerves that control them; they can occur in utero or develop at any time from infancy through adulthood. Localizing the lesion to the brain/upper motor nerve, spinal cord/motor nerve, peripheral nerve, and muscle is essential to narrow the differential diagnosis. The type of weakness and the presence of increased muscle tone or bulk, Babinski sign, hypotonia, and delayed motor skills help determine whether the disorder is peripheral or centrally mediated. In either case, respiratory and cardiac complications, along with

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Fracture after bisphosphonate treatment in children with cerebral palsy: the role of stress risers

Cited by 21 publications

References 23 publications

Bisphosphonate therapy for chronic recurrent multifocal osteomyelitis

Bisphosphonate therapy for chronic recurrent multifocal osteomyelitis

Fracture during Intravenous Bisphosphonate Treatment in a Child with Osteogenesis Imperfecta: An Argument for a More Frequent, Low-Dose Treatment Regimen

Neuromuscular Diseases

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