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L10 THE QUALITY OF BONE TISSUE AS A RISK FACTOR FOR VERTEBRAL COMPRESSION FRACTURES IN CHILDREN

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III Środkowo Europejski Kongres Osteoporozy i Osteoartrozy oraz XV Zjazd Polskiego Towarzystwa Osteoartrologii i Polskiej Fundacji Osteoporozy, Kraków 24-26.09.2009

Streszczenia:
Ortopedia Traumatologia Rehabilitacja 2009, vol 11 (Suppl. 2), s:59.
 
 
L10
THE QUALITY OF BONE TISSUE AS A RISK FACTOR FOR VERTEBRAL COMPRESSION FRACTURES IN CHILDREN
 
Falameeva O.V., Sadovoy M.A. 
Novosibirsk Research Institute of Traumatology and Orthopaedics, Novosibirsk, Russia
 
Key words: osteoporosis, children, fracture, spine, densitometry.
 
Objective. Juvenile osteoporosis is considered as one of the causes of vertebral compression fracture in children. Spinal fractures in children are serious and prognostically unfavorable musculoskeletal injuries. The objective was to investigate parameters of bone mineral density (BMD) in children with vertebral compression fractures.
Methods. We performed dual energy X-ray absorptiometry using osteodensitometer HOLOGIC (QDR, Discovery-A, USA) to examine 166 children and adolescents of both genders aged 6 to 16 years having compression fractures of one or more vertebrae. These children also underwent plain radiography and computer tomography. Osteodensitometry results were assessed based on Z score.
Results. The injury occurred due a backfall from the own height in 53.1% of children; sliding down snow slope and a fall out from the tree or the swing in 18.2% ; fall on the buttocks in 18.4%; and due an undetermined cause in 10.3%. Traumatic vertebral compression was more frequent in the middle thoracic spine (48.6%) and in the lower thoracic spine (32.1%), versus 9.1% and 8.9% frequencies in the upper thoracic and thoracolumbar spine, respectively. Localizations of compression fractures in cervical and lumbar spine were singular – 1.3%. Decrease in bone mineral density at all skeletal regions expressed as Z-score £–2.0 SD and more was reported in 73 children (43.9%). BMD changes were 1.8-fold more often observed in boys than in girls (28.3% and 15.7%, respectively). Our study identified a prevalence of children aged 6 to 9 years among those having vertebral compression fractures (50.6%), and some less incidence in patients aged 10 to 12 years and 13 to 14 years (27.7% and 21.7%, respectively). It was found that vertebral compressive fractures, regardless of BMD deficit amount, were more frequent in the middle and lower thoracic spine (80.7%). The high incidence fractures in patients with normal BMD (24.7%) or systemic osteopenia (44%) testifies that bone mass deficit (mineralization) is not a single cause for bone strength decrease in pediatric osteoporosis, and that a fracture risk depends on qualitative and structural disorders in bone tissue occurring in the process of it’s remodeling. Among children with normal BMD compression fractures were 2.7-fold more frequent in girls than in boys (18.0% and 6.6%, respectively). With advancing age the number of children with vertebral compression fractures associated with different-grade systemic osteopenia and osteoporosis gradually increases.
Conclusion. Mineral density of the skeleton in critical periods of the growth in children reflects bone mass and size to a grater degree than bone quality. The absence of close correlation between vertebral compression fractures and BMD decrease in children and adolescents is not most likely depending on disorder in bone tissue mineralization but on that in formation of organic component of the bone matrix. This is eventually accompanied by bone density accumulation and by low peak bone mass at the appropriate age.
 



OSTEOPOROSIS AND UNCOMPLICATED SPINAL FRACTURES IN CHILDREN

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I Środkowo Europejski Kongres Osteoporozy i Osteoartrozy oraz XIII Zjazd Polskiego Towarzystwa Osteoartrologii i Polskiej Fundacji Osteoporozy, Kraków 6-8.10.2005

Streszczenia:
Ortopedia Traumatologia Rehabilitacja 2005, vol 7 (Suppl. 1), s158.


P32
OSTEOPOROSIS AND UNCOMPLICATED SPINAL FRACTURES IN CHILDREN

Shevchenko S.D.
Sytenko Institute of Spine and Joint Pathology Ukraine, Kharkiv

Keywords: osteoporosis, spine, fractures, children.

Spinal fractures in children are very frequent. Investigators note dependence of the fracture localization from the age. There is prevalence of the cervical spine trauma at the youngest age, at the middle age –thoracic spine trauma and at the adolescent period-lumbar spinal trauma (as in adults). This situation is connected with anatomical peculiarities of the vertebras and with maturation of the spine.
Mineral metabolism disturbance leads to decreasing of the bone solidity and in consequence of this lesser stress is need for spinal trauma. That is why we pay attention to osteoporosis in children with spinal fractures.
We have analyzed (with radiologist collaboration) roentgenograms of 101 patients with uncomplicated spinal fractures and concluded that in 56% of the patients was osteoporosis. We revealed boy’s prevalence at the age 8-14 years old in this group, and the girls were at the age 8, 10, 13 years old. More frequently we saw osteoporosis in girls.
Comparison of these number patients with compression spinal fractures showed that in 50% several vertebras were fractured in comparison with group of the patients without osteoporosis. The number of broken vertebras more than 4 in both groups was connected with complicity of the trauma. We did not find correlation between fracture localization and presence of the osteoporosis because of the same number patient in the both groups.
These findings allow us to conclude that spinal osteoporosis is not a sign which characterized spinal damage, but a sign of spinal tissue condition. This demands to include to the complex therapy medicinal products that improve mineral metabolism of the bone (Ca, Mg, P, Zn, D, C and others).


P32
OSTEOPOROZA I NIEPOWIKŁANE ZŁAMANIA KRĘGOSŁUPA U DZIECI

Shevchenko S.D.
Sytenko Institute of Spine and Joint Pathology Ukraine, Kharkiv, Ukraina

Słowa kluczowe: osteoporoza, kręgosłup, złamania, dzieci

Złamania kręgosłupa u dzieci są bardzo częste. Badacze zauważają zależność lokalizacji złamania od wieku. U najmłodszych dzieci przeważają urazy kręgosłupa szyjnego, u nieco starszych – kręgosłupa piersiowego, zaś u młodzieży urazy kręgosłupa lędźwiowego (podobnie jak u dorosłych). Zależność ta jezt związana z właściwościami anatomicznymi kręgów oraz ze stopniem dojrzałości kręgosłupa.
Metaboliczne zaburzenia mineralizacji prowadzą do zmniejszenia wytrzymałości kości, co w konsekwencji obniża siłę potrzebną do wywołania urazu. Z tego względu zwracamy szczególną uwagę na osteoporozę u dzieci ze złamaniami kręgosłupa.
Przeanalizowaliśmy (przy współpracy z radiologiem) rentgenogramy 101 pacjentów z niepowiklanymi złamaniami kręgosłupa i doszliśmy do wniosku, że 56% z pacjentów miało osteoporozę. W tej grupie chłopcy przeważali w wieku 8-14 lat, a dziewczęta były w wieku 8, 10 i 13 lat. Osteoporozę częściej stwierdzaliśmy u dziewcząt.
Porównanie tej liczby pacjentów z ze złamaniami kompresyjnymi wykazało, że u 50% złamanych było kilka kręgów w porównaniu do pacjentów bez osteoporozy. Liczba 4 i więcej złamanych kręgów w obu grupach była uzależniona od stopnia skomplikowania złamania. Nie znaleźliśmy korelacji pomiędzy lokalizacją złamania i obecnością osteoporozy, gdyż w obu grupach była taka sama liczba pacjentów.
Te dane pozwalają nam na konkluzję, że osteoporoza w kręgosłupie nie jest objawem charakteryzującym uszkodzenie kręgosłupa, ale objawem kondycji tkanki kostnej kręgosłupa. Wymaga to włączenia do kompleksowej terapii preparatów poprawiających metabolizm kostny (Ca, Mg, P, Zn, D, C i inne).