Children with Spina Bifida are at Risk for Low Bone Density
- 1 May 2011
- journal article
- Published by Wolters Kluwer Health in Clinical Orthopaedics and Related Research
- Vol. 469 (5), 1253-1257
- https://doi.org/10.1007/s11999-010-1634-8
Abstract
Patients with spina bifida frequently sustain lower extremity fractures which may be difficult to diagnose because they feel little or no pain, although the relative contributions of low bone density to pain insensitivity are unclear. Routine dual-energy xray absorptiometry (DXA) scanning is unreliable because these patients lack bony elements in the spine, and many have joint contractures and/or implanted hardware. We asked (1) if the lateral distal femoral scan is useful in spina bifida; (2) whether nonambulatory children with spina bifida exhibit differences in bone mineral density (BMD) compared with an age-and-sex-matched population; and (3) whether Z-scores were related to extremity fracture incidence. We retrospectively reviewed 37 patients with spina bifida who had DXA scans and sufficient data. Z-scores were correlated with functional level, ambulatory status, body mass index, and fracture history. The distal femoral scan could be performed in subjects for whom total body and/or lumbar scans could not be performed accurately. Twenty-four of 37 had Z-scores below −2 SD, defined as “low bone density for age.” Ten of 35 patients (29%) with fracture information had experienced one or more fractures. Our sample size was too small to correlate Z-score with fracture. We believe BMD should be monitored in patients with spina bifida; nonambulatory patients with spina bifida and those with other risk factors are more likely to have low bone density for age than unaffected individuals. The LDF scan was useful in this population in whom lumbar and total body scans are often invalidated by contracture or artifact. Although lower extremity fractures occur regardless of ambulation or bone density, knowing an individual’s bone health status may lead to interventions to improve bone health.Keywords
This publication has 15 references indexed in Scilit:
- Bone mineral density in children with myelomeningoceleDevelopmental Medicine and Child Neurology, 2008
- Adapting Pediatric DXA Scanning to Clinical OrthopaedicsJournal of Pediatric Orthopaedics, 2006
- Osteoporosis in Adults With Meningomyelocele: An Unrecognized Problem at Rehabilitation ClinicsArchives of Physical Medicine and Rehabilitation, 2006
- Body size from birth to adulthood and bone mineral content and density at 31 years of age: results from the northern Finland 1966 birth cohort studyOsteoporosis International, 2005
- Statistical validation of surrogate endpoints: is bone density a valid surrogate for fracture?2004
- Standards and Guidelines for Performing Central Dual-Energy X-Ray Absorptiometry in Premenopausal Women, Men, and ChildrenA Report From the Canadian Panel† of the International Society of Clinical DensitometryJournal of Clinical Densitometry, 2004
- Pediatric Reference Data for Dual X-Ray Absorptiometric Measures of Normal Bone Density in the Distal FemurAmerican Journal of Roentgenology, 2002
- Lateral femoral scan: an alternative method for assessing bone mineral density in children with cerebral palsyPediatric Radiology, 1998
- OPEN SPINA BIFIDA: OUTCOME FOR A COMPLETE COHORT TREATED UNSELECTIVELY AND FOLLOWED INTO ADULTHOODDevelopmental Medicine and Child Neurology, 1990
- BONE DENSITY IN MYELOMENINGOCELE: THE EFFECTS OF AMBULATORY STATUS AND OTHER FACTORSDevelopmental Medicine and Child Neurology, 1987