Incidence and Predictors of Fractures in Children After Solid Organ Transplantation: A 5-Year Prospective, Population-Based Study

Helenius, Ilkka; Remes, Ville; Salminen, Sari; Valta, Helena; Mäkitie, Outi; Holmberg, Christer; Palmu, Petri; Tervahartiala, Pekka; Sarna, Seppo; Helenius, Mikko; Peltonen, Jari; Jalanko, Hannu

doi:10.1359/jbmr.051107

Cited by 101 publications

(87 citation statements)

References 39 publications

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“…Mineral and bone disorder in RTx children may result in decreased bone mineral density (BMD), fractures, bone pain, and growth failure [76,77]. In a cross-sectional study by Valta et al, vertebral fractures were observed in 8 % of RTx children (median age 12 years) and the majority of them were asymptomatic.…”

Section: Bone Healthmentioning

confidence: 99%

Renal transplantation in infants

2015

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Renal transplantation (RTx) has become an accepted mode of therapy in infants with severe renal failure. The major indications are structural abnormalities of the urinary tract, congenital nephrotic syndrome, polycystic diseases, and neonatal kidney injury. Assessment of these infants needs expertise and time as well as active treatment before RTx to ensure optimal growth and development, and to avoid complications that could lead to permanent neurological defects. RTx can be performed already in infants weighing around 5 kg, but most operations occur in infants with a weight of 10 kg or more. Perioperative management focuses on adequate perfusion of the allograft and avoidance of thrombotic and other surgical complications. Important long-term issues include rejections, infections, graft function, growth, bone health, metabolic problems, neurocognitive development, adherence to medication, pubertal maturation, and quality of life. The overall outcome of infant RTx has dramatically improved, with long-term patient and graft survivals of over 90 and 80 %, respectively.

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Section: Bone Healthmentioning

confidence: 99%

Renal transplantation in infants

2015

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“…In particular, illnesses associated with chronic inflammation, malabsorption, metabolic disturbances, decreased mobility, or prolonged glucocorticoid therapy may lead to impaired bone health, low BMD, and fractures. (19,20) Primary bone disorders leading to juvenile osteoporosis are relatively rare. The most common of them is osteogenesis imperfecta (OI), caused by mutations in the genes encoding type I collagen.…”

Section: J Jbmrmentioning

confidence: 99%

Impaired bone health and asymptomatic vertebral compressions in fracture-prone children: A case-control study

Mäyränpää

Viljakainen

Toiviainen-Salo

et al. 2012

Journal of Bone and Mineral Research

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Frequent fractures in children may be a sign of impaired bone health, but it remains unestablished when and how fracture‐prone children should be assessed. This prospective study elucidated skeletal characteristics and predisposing factors in children with recurrent fractures. Findings were used to establish guidelines for screening. During a 12‐month period we recorded fracture history for all children (n = 1412) treated for an acute fracture at a large university hospital. All apparently healthy children over 4 years of age, who had sustained: (1) at least one vertebral fracture; (2) two long‐bone fractures before age 10 years; or (3) three long‐bone fractures before age 16 years, were recruited. They underwent dual‐energy X‐ray absorptiometry (DXA), laboratory tests, and spinal radiography. Information regarding family history and lifestyle factors were collected. Findings were compared with healthy controls. Sixty‐six fracture‐prone children (44 males, mean age 10.7 years; 5% of all children with fractures) were identified. Altogether, they had sustained 183 long‐bone fractures (median 3, range 0–7); 11 children had sustained vertebral fracture(s). Patients had significantly lower bone mineral density (BMD) at lumbar spine (p < 0.001), hip (p = 0.007), and whole body (p < 0.001) than the controls; only 5 children (8%) had a BMD Z‐score < −2.0. Asymptomatic vertebral compressions were prevalent, especially in those under 10 years of age. Hypercalciuria (11%) and hyperphosphaturia (22%) were significantly more prevalent than in controls. Serum concentration of 25‐hydroxyvitamin D (S‐25OHD) was below 50 nmol/L in 55%; low levels were associated with low BMD and vertebral compressions. The fracture‐prone children had lower calcium intake, less physical activity, and more often had siblings with fractures than the controls. The findings suggest that a thorough pediatric evaluation, including DXA and spinal radiography, is often indicated already after a second significant low‐energy fracture in children, in order to detect potentially preventable adverse lifestyle factors and nutritional deficits and to identify those with compromised overall bone health. © 2012 American Society for Bone and Mineral Research.

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“…Hip fracture rates among adult dialysis patients undergoing renal transplantation increase even further in the early months following transplantation, then gradually decline [3]. Significantly greater vertebral and extremity fracture rates have also been demonstrated in pediatric solid organ transplant recipients compared with healthy controls: the age-and sex-adjusted hazard ratios for vertebral fractures were 61.3 [95% confidence interval (CI), 40.7-92.4) compared with over 200,000 populationbased controls [4].…”

Section: Introductionmentioning

confidence: 99%

A structural approach to the assessment of fracture risk in children and adolescents with chronic kidney disease

Leonard

2007

Pediatr Nephrol

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Children with chronic kidney disease (CKD) have multiple risk factors for impaired accretion of trabecular and cortical bone. CKD during childhood poses an immediate fracture risk and compromises adult bone mass, resulting in significantly greater skeletal fragility throughout life. Highturnover disease initially results in thickened trabeculae, with greater bone volume. As disease progresses, resorption cavities dissect trabeculae, connectivity degrades, and bone volume decreases. Increased bone turnover also results in increased cortical porosity and decreased cortical thickness. Dual-energy X-ray absorptiometry (DXA)-based measures of bone mineral density (BMD) are derived from the total bone mass within the projected bone area (g/cm 2 ), concealing distinct disease effects in trabecular and cortical bone. In contrast, peripheral quantitative computed tomography (pQCT) estimates volumetric BMD (vBMD, g/cm 3 ), distinguishes between cortical and trabecular bone, and provides accurate estimates of cortical dimensions. Recent data have confirmed that pQCT measures of cortical vBMD and thickness provide substantially greater fracture discrimination in adult dialysis patients compared with hip or spine DXA. The following review considers the structural effects of renal osteodystrophy as it relates to fracture risk and the potential advantages and disadvantages of DXA and alternative measures of bone density, geometry, and microarchitecture, such as pQCT, micro-CT (μCT), and micro magnetic resonance imaging (μMRI) for fracture risk assessment.

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Incidence and Predictors of Fractures in Children After Solid Organ Transplantation: A 5-Year Prospective, Population-Based Study

Cited by 101 publications

References 39 publications

Renal transplantation in infants

Renal transplantation in infants

Impaired bone health and asymptomatic vertebral compressions in fracture-prone children: A case-control study

A structural approach to the assessment of fracture risk in children and adolescents with chronic kidney disease

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