The Utility of DXA Assessment at the Forearm, Proximal Femur, and Lateral Distal Femur, and Vertebral Fracture Assessment in the Pediatric Population: 2019 ISCD Official Position

Weber, David R.; Boyce, Alison M; Gordon, Catherine M.; Högler, Wolfgang; Kecskemethy, Heidi H.; Misra, Madhusmita; Swolin-Eide, Diana; Tebben, Peter J.; Ward, Leanne M.; Wasserman, Halley; Shuhart, Christopher R.; Zemel, Babette S.

doi:10.1016/j.jocd.2019.07.002

Cited by 97 publications

(78 citation statements)

References 133 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Fragility fracture risk in patients with DMD is significantly higher (44), with a fracture prevalence 5-fold higher compared with age-matched healthy young people (48 vs. 9%) with lower limb fractures (femur and tibia) more frequent in DMD. Most of the long-bone fractures in DMD patients are caused by low-energy trauma (i.e., fall from a standing position), an extremely rare condition in healthy young people.…”

Section: Nmds Involving Skeletal Muscle Structurementioning

confidence: 99%

“…However, these skeletal sites may not be suitable for densitometric assessment for all children affected by clinical conditions adversely involving bone health. Therefore, in recent ISCD Official Positions, additional DXA scans (proximal femur, PF, LDF, and distal forearm, DF) as well as the role of vertebral fracture assessment (VFA) were thoroughly evaluated for utility, applicability, and ability to assess skeletal health and to predict fragility fractures in selected pediatric patients (44). Indeed, for many children with NMDs with poor ambulatory status and at risk of bone damage, these additional DXA scans are useful when TBLH or LS scans are not feasible (i.e., positioning issues, severe scoliosis).…”

Section: Bone Health Assessment In Nmdsmentioning

confidence: 99%

See 1 more Smart Citation

Neuromuscular Diseases and Bone

et al. 2019

View full text Add to dashboard Cite

Neuromuscular diseases (NMDs) are inherited or acquired conditions affecting skeletal muscles, motor nerves, or neuromuscular junctions. Most of them are characterized by a progressive damage of muscle fibers with reduced muscle strength, disability, and poor health-related quality of life of affected patients. In this scenario, skeletal health is usually compromised as a consequence of modified bone–muscle cross-talk including biomechanical and bio-humoral issues, resulting in increased risk of bone fragility and fractures. In addition, NMD patients frequently face nutritional issues, including malnutrition due to feeding disorders and swallowing problems that might affect bone health. Moreover, in these patients, low levels of physical activity or immobility are common and might lead to overweight or obesity that can also interfere with bone strength features. Also, vitamin D deficiency could play a critical role both in the pathogenesis and in the clinical scenario of many NMDs, suggesting that its correction could be useful in maintaining or enhancing bone health, especially in the early phases of NMDs. Last but not least, specific disease-modifying drugs, available for some NMDs, are frequently burdened with adverse effects on bone tissue. For example, glucocorticoid therapy, standard of care for many muscular dystrophies, prolongs long-term survival in treated patients; nevertheless, high dose and/or chronic use of these drugs are a common cause of secondary osteoporosis. This review addresses the current state of knowledge about the factors that play a role in determining bone alterations reported in NMDs, how these factors can modify the biological pathways underlying bone health, and which are the available interventions to manage bone involvement in patients affected by NMDs. Considering the complexity of care of these patients, an interdisciplinary and multimodal management strategy based on both pharmacological and non-pharmacological interventions is recommended, particularly targeting musculoskeletal issues that are closely related to functional independence as well as social implications.

show abstract

Section: Nmds Involving Skeletal Muscle Structurementioning

confidence: 99%

Section: Bone Health Assessment In Nmdsmentioning

confidence: 99%

Neuromuscular Diseases and Bone

et al. 2019

View full text Add to dashboard Cite

show abstract

“…Lateral distal femur (LDF) DXA measurements, correlate well with increased lower extremity fragility fracture risk in non-ambulatory children and can be used in the presence of non-removable artefacts, scoliosis, and positioning difficulties. 54 The advantages of DXA are low radiation dose, short scan time and widespread availability. DXA is a two dimensional measurement, so it can underestimate BMD in children with short stature or growth delay and overestimate BMD in tall children.…”

Section: Investigationsmentioning

confidence: 99%

“…suspected destructive inflammatory or malignant processes, congenital malformations, acquired misalignments or dislocations). 54 …”

Section: Investigationsmentioning

confidence: 99%

Management of primary and secondary osteoporosis in children

Sakka

Cheung

2020

Therapeutic Advances in Musculoskeletal

View full text Add to dashboard Cite

Osteoporosis in children differs from adults in terms of definition, diagnosis, monitoring and treatment options. Primary osteoporosis comprises primarily of osteogenesis imperfecta (OI), but there are significant other causes of bone fragility in children that require treatment. Secondary osteoporosis can be a result of muscle disuse, iatrogenic causes, such as steroids, chronic inflammation, delayed or arrested puberty and thalassaemia major. Investigations involve bone biochemistry, dual-energy X-ray absorptiometry scan for bone densitometry and vertebral fracture assessment, radiographic assessment of the spine and, in some cases, quantitative computed tomography (QCT) or peripheral QCT. It is important that bone mineral density (BMD) results are adjusted based on age, gender and height, in order to reflect size corrections in children. Genetics are being used increasingly for the diagnosis and classification of various cases of primary osteoporosis. Bone turnover markers are used less frequently in children, but can be helpful in monitoring treatment and transiliac bone biopsy can assist in the diagnosis of atypical cases of osteoporosis. The management of children with osteoporosis requires a multidisciplinary team of health professionals with expertise in paediatric bone disease. The prevention and treatment of fragility fractures and improvement of the quality of life of patients are important aims of a specialised service. The drugs used most commonly in children are bisphosphonates, that, with timely treatment, can give good results in improving BMD and reshaping vertebral fractures. The data regarding their effect on reducing long bone fractures are equivocal. Denosumab is being used increasingly for various conditions with mixed results. There are more drugs trialled in adults, but these are not yet licenced for children. Increasing awareness of risk factors for paediatric osteoporosis, screening and referral to a specialist team for appropriate management can lead to early detection and treatment of asymptomatic fractures and prevention of further bone damage.

show abstract

“…В 2007 г. Международное общество клинической денситометрии опубликовало руководство и определения по диагностике остеопороза у детей, в которых были установлены критерии диагностики остеопороза: сочетание низкой минеральной костной массы по данным денситометрии (двухэнергетической рентгеновской абсорбциометрии) и переломов в анамнезе [6]. Двухэнергетическую рентгеновскую абсорбциометрию наиболее часто используют для оценки минеральной плотности костной ткани [7], однако ее применение у детей связано с определенными методологическими ограничениями [8]. Кроме того, она не дает представления о патогенезе снижения минерализации костной ткани, а именно о повышении катаболизма или снижении анаболизма.…”

unclassified

Bone metabolism biomarkers in walking children with cerebral palsy

Kenis

Маркович²,

Bogdanova

et al. 2020

Pediatr Traum Orthop Reconstr Surg

View full text Add to dashboard Cite

Backgrоund. Osteoporosis is an important factor in the pathogenesis of orthopedic manifestations in children with cerebral palsy. It was previously demonstrated that children with cerebral palsy have specific changes in bone metabolism, which can cause changes in laboratory parameters compared with other orthopedic patients without neurological backgrounds. Aim. The aim of this study was to assess bone metabolism biomarkers in children with cerebral palsy, identifying distinguishing characteristic patterns in comparison with patients with orthopedic pathology without neurological backgrounds. Materials and methods. This study evaluated the concentrations of calcium, phosphorus, -cross laps, osteocalcin, vitamin D, CICP, and alkaline phosphatase in the blood serum of 50 children with cerebral palsy aged between 6 to 12 years with GMFCS levels IIII. The control group consisted of 50 patients with plano-valgus deformities of the feet. Results. The alkaline phosphatase activity in the group of children with cerebral palsy was 170.25 59.35 u/L, while in the control group it was 145.58 46.29 u/L; the CICP concentration in the study group was higher than in the control group (324.01 174.10 and 269.68 240.98, respectively). The concentration of -cross laps, osteocalcin, calcium, and vitamin D in the study group was lower than in children with flat feet. Conclusions. This study demonstrated multidirectional changes in the biomarkers of bone metabolism that are characteristic of walking children with cerebral palsy. These changes are characterized by a corresponding increase in the activity of osteoresorption and osteoreparation. This makes it possible to justify the combined use of metabolites and metabolic activators (calcium and vitamin D) and drugs that suppress osteoresorption (bisphosphonates) for the prevention and treatment of osteoporosis in children with cerebral palsy.

show abstract

The Utility of DXA Assessment at the Forearm, Proximal Femur, and Lateral Distal Femur, and Vertebral Fracture Assessment in the Pediatric Population: 2019 ISCD Official Position

Cited by 97 publications

References 133 publications

Neuromuscular Diseases and Bone

Neuromuscular Diseases and Bone

Management of primary and secondary osteoporosis in children

Bone metabolism biomarkers in walking children with cerebral palsy

Contact Info

Product

Resources

About