Fractures in children and adolescents with spina bifida - experience of a Portuguese tertiary care hospital

Marreiros, Humberto; Monteiro, Luísa; Loff, Clara; Calado, Eulália

doi:10.1186/1743-8454-6-s2-s34

Cited by 6 publications

(11 citation statements)

References 17 publications

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“…In the literature review, the search focusing on fracture: Spina bifida [MeSH] OR Myelomeningocele [MeSH] AND Fracture [MeSH] yielded 128 articles. Of these, 21 met the inclusion criteria [6,7,9,10,[12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28]. Although not yielded by the search criteria, two additional articles on this topic were identified and included [5,11].…”

Section: Resultsmentioning

confidence: 99%

“…Risk factors for the occurrence of fractures in SB include high levels of neurological involvement [6,7,9,10,18], patients in wheelchairs [6,7,13,28], the presence of hypercalciuria [15], the presence of contractures [18], and high body fat content and body mass index (BMI) values [15]. An association between secondary inactivity due to cast immobilization and/or operative orthopaedic procedures and the occurrence of fractures was detected [6][7][8][9][10][11][12]19,20,40]. The occurrence of a spontaneous first fracture increases the risk of a second fracture [7].…”

Section: Risk Factors For Fractures In Sbmentioning

confidence: 99%

“…An association between secondary inactivity due to cast immobilization and/or operative orthopaedic procedures and the occurrence of fractures was detected [6][7][8][9][10][11][12]19,20,40]. The occurrence of a spontaneous first fracture increases the risk of a second fracture [7].…”

Section: Risk Factors For Fractures In Sbmentioning

confidence: 99%

“…aetiopathogenesis from a clinical perspective For clinicians, the central quandary remains that despite the existence of systemic factors associated with a low BMD, involving both the appendicular and axial skeleton, fractures occur predominantly topographically in the paretic zone [7,13,16,36,41]. Contrary to the possible infrequency of vertebral involvement [7,8,23], studies have shown a low BMD in the lumbar spine [15,17,32,35,39]. It is possible that most studies did not evaluate spine X-rays for the detection of asymptomatic vertebral fractures, which may be an under-recognized problem in this population.…”

Section: Weight Of Local and Systemic Factors In Fracturementioning

confidence: 99%

“…Furthermore, skeletal adaptations that occur during childhood and adolescence are less reversible than adaptations that occur in adulthood [4]. Prior studies have demonstrated an 11-30% frequency of fractures in paediatric patients with spina bifida (SB) [5][6][7][8][9][10][11][12], highlighting the importance of evaluating this topic. This narrative review will outline a comprehensive overview of how the characteristics of SB and its associated comorbidities intersect with bone fragility to identify possible pathophysiological mechanisms of fractures and low bone mineral density (BMD).…”

Section: Introductionmentioning

confidence: 99%

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Update on bone fragility in spina bifida

Marreiros¹

2018

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BACKGROUND CONTEXT: Patients with spina bifida (SB) are at risk for pathological fractures and low bone mineral density (BMD). PURPOSE AND METHODS: This article reviews the literature and provides a comprehensive overview of how the characteristics of SB and its associated comorbidities intersect with bone fragility to identify possible pathophysiological mechanisms of fractures and low BMD. RESULTS: Bone fragility occurs early in the life of patients with SB as a result of a disturbance that determines changes in bone shape, quantity, and quality, as poor mineralization reduces bone stiffness. Bone fragility in SB occurs due to local and systemic factors and may be considered a state of impaired bone quality of multifactorial aetiology, with complex interacting influences of neurological, metabolic, and endocrinological origins and the presence of smaller bones. Bone fragility should be evaluated globally according to skeletal age and Tanner staging. The phases of the evolution of Charcot joints seem to intercept the evolution of epiphyseal fractures. Charcot arthropathy in SB may be initiated by the occurrence of repetitive trauma and fractures in epiphyseal and subepiphyseal regions, where there is a deficit of bone mineralization and greater bone mass deficits. CONCLUSION: Bone fragility in MMC potentially has a multifactorial neuro-endocrinological-metabolic-renal dimension, with smaller bones, lower bone mass, and mineralization deficits affecting bone strength.

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Section: Resultsmentioning

confidence: 99%

Section: Risk Factors For Fractures In Sbmentioning

confidence: 99%

Section: Risk Factors For Fractures In Sbmentioning

confidence: 99%

Section: Weight Of Local and Systemic Factors In Fracturementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Update on bone fragility in spina bifida

Marreiros¹

2018

PRM

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Quantitative Computed Tomography Assessment of Bone Deficits in Ambulatory Children and Adolescents with Spina Bifida: Importance of Puberty

et al. 2020

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Pathologic fractures of the femur and tibia are common in youth with spina bifida (SB). These fractures may be associated with deficient bone accrual due to decreased ambulation and skeletal loading. This prospective cohort study used quantitative computed tomography (QCT) to assess three‐dimensional (3D) bone properties in children and adolescents with SB. Eighty‐three ambulatory youth with SB underwent QCT imaging of the tibia at up to four annual visits between ages 6 to 16 years (294 total visits averaging 3.5 visits/patient). A total of 177 controls without disability and 10 non‐ambulatory youth with SB underwent imaging once. Bone geometric properties (cortical bone area, cross‐sectional area, cortical thickness, cortical density, and moments of inertia) were measured at the mid‐diaphysis (50% of bone length); cross‐sectional area, cancellous density, and density‐weighted area were measured in the proximal (13% of bone length) and distal (90% of bone length) metaphyses. Bone properties were compared between the ambulatory SB and control participants, among SB neurosegmental subgroups (sacral, low lumbar, mid lumbar and above) as a function of pubertal stage (prepubertal, pubertal, postpubertal), and considering SB type (myelomeningocele, lipomyelomeningocele) using linear mixed effects models adjusted for sex, age, height percentile, and body mass index (BMI) percentile. Only cancellous density of both metaphyses and weighted area of the proximal metaphysis differed between ambulatory children with SB and controls before puberty. However, significant deficits in all bone properties manifested during and after puberty as moderate bone growth in the SB group failed to keep pace with the large increases normally observed during puberty. The bone deficits primarily affected patients with myelomeningocele, and similar deficits were observed at all neurosegmental levels except that cancellous density was closer to normal in the sacral group. Descriptive analysis of the 10 non‐ambulatory youth with SB showed greater bone deficits than ambulatory children, particularly for cancellous density in the distal metaphysis. © 2020 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

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Psychological morbidity among adults with cerebral palsy and spina bifida

et al. 2020

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Background Very little is known about the risk of developing psychological morbidities among adults living with cerebral palsy (CP) or spina bifida (SB). The objective of this study was to compare the incidence of and adjusted hazards for psychological morbidities among adults with and without CP or SB. Methods Privately insured beneficiaries were included if they had an International Classification of Diseases, Ninth revision, Clinical Modification diagnostic code for CP or SB (n = 15 302). Adults without CP or SB were also included (n = 1 935 480). Incidence estimates of common psychological morbidities were compared at 4-years of enrollment. Survival models were used to quantify unadjusted and adjusted hazard ratios for incident psychological morbidities. Results Adults living with CP or SB had a higher 4-year incidence of any psychological morbidity (38.8% v. 24.2%) as compared to adults without CP or SB, and differences were to a clinically meaningful extent. Fully adjusted survival models demonstrated that adults with CP or SB had a greater hazard for any psychological morbidity [hazard ratio (HR): 1.60; 95% CI 1.55–1.65], and all but one psychological disorder (alcohol-related disorders), and ranged from HR: 1.32 (1.23, 1.42) for substance disorders, to HR: 4.12 (3.24, 5.25) for impulse control disorders. Conclusions Adults with CP or SB have a significantly higher incidence of and risk for common psychological morbidities, as compared to adults without CP or SB. Efforts are needed to facilitate the development of improved clinical screening algorithms and early interventions to reduce the risk of disease onset/progression in these higher-risk populations.

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Fractures in children and adolescents with spina bifida - experience of a Portuguese tertiary care hospital

Cited by 6 publications

References 17 publications

Update on bone fragility in spina bifida

Update on bone fragility in spina bifida

Quantitative Computed Tomography Assessment of Bone Deficits in Ambulatory Children and Adolescents with Spina Bifida: Importance of Puberty

Psychological morbidity among adults with cerebral palsy and spina bifida

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