Osteoporosis in paediatric patients with spina bifida

Abstract

The prevalence and morbidity associated with osteoporosis and fractures in patients with spina bifida (SB) highlight the importance of osteoporosis prevention and treatment in early childhood; however, the issue has received little attention. The method for the selection of appropriate patients for drug treatment has not been clarified. Objective: To review the literature concerning fracture risks and low bone density in paediatric patients with SB. We looked for studies describing state-of-the-art treatments and for prevention of secondary osteoporosis. Methods: Articles were identified through a search in the electronic database (PUBMED) supplemented with reviews of the reference lists of selected papers. The main outcome measures were incidence of fractures and risk factors for fracture, an association between bone mineral density (BMD) and occurrence of fracture, risk factors of low BMD, and effects of pharmacological and non-pharmacological treatments on BMD and on the incidence of fractures. We considered as a secondary outcome the occurrence of fractures in relation to the mechanism of injury. Results: Results indicated that patients with SB are at increased risk for fractures and low BMD. Risk factors that may predispose patients to fractures include higher levels of neurological involvement, non-ambulatory status, physical inactivity, hypercalciuria, higher body fat levels, contractures, and a previous spontaneous fracture. Limitations were observed in the number and quality of studies concerning osteoporosis prevention and treatment in paediatric patients with SB. The safety and efficiency of drugs to treat osteoporosis in adults have not been evaluated satisfactorily in children with SB.

An approach for determining quantitative measures for bone volume and bone mass in the pediatric spina bifida population

“…Current techniques for measuring BMD rely most commonly on dual-energy x-ray absorptiometry (DXA) and, to a lesser extent, peripheral quantitative computed tomography (pQCT). DXA provides a projected areal measure of BMD and therefore cannot provide a complete adjustment for bone size [5]. This limitation has consequences for comparing BMD across individuals of different physical sizes [6–8], including children with spina bifida who typically have short stature in comparison to typically developing peers [9].…”

Postoperative Fracture Complications Seen in the Patients After Sitting Imbalance Correction

“…However this time; during postoperative rehabilitation that applied to the patient without prediction of low bone quality, patient had femur fracture twice in a short period. In this case we especially aimed to emphasize this complication should be in our mind in these group of patients with poor bone quality and sensory deficits (4)(5)(6)(7)(8).…”

“…In these group of patients fractures can be seen because of the low bone density, lower extremity atrophy and some other osseous problems can be seen because of less usage of extremity in a percent of 11 -30 % (4)(5)(6)(7)(8). The fractures don't seen as frequent as urologic and neurologic complications but it is very comfortless for the patient (4).…”

“…So these patients stay a long time in hospital and use antibiotics frequently (3). Also these patients have decubitus ulcers and lower extremity fractures because of their sitting imbalance (1,2,(4)(5)(6)(7)(8). In this study we aimed to present the treatment of femur fractures with acquired mobilization after spinal surgery of a paraplegic patient with the meningomyelocele, who couldn't sit without assistance before spinal surgery.…”

β₂Adrenergic Receptor Activation Suppresses Bone Morphogenetic Protein (BMP)‐Induced Alkaline Phosphatase Expression in Osteoblast‐Like MC3T3E1 Cells

“…Disuse osteoporosis occurs in patients suffering from spinal cord injury [Alizadeh‐Meghrazi et al, 2014] or spina bifida [Marreiros et al, ] and is also observed in patients with bedridden condition due to neuronal and cardiovascular diseases [Jaul et al, ]. Osteoporosis during space flight has been another major issue in addition to the pathological conditions on the ground levels [Leblanc et al, ].…”