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Children with acute Perthes' disease have asymmetrical lower leg growth and abnormal collagen turnover
Patricia M Crofton1, Catherine Macfarlane, Barbara Wardhaugh
1Department of Paediatric Biochemistry, Royal Hospital for Sick Children, Edinburgh, UK. patricia.crofton@luht.scot.nhs.uk
Insights
Children with Perthes' disease show impaired growth and collagen turnover, with low insulin-like growth factor-I (IGF-I) potentially affecting soft tissue synthesis and growth during the acute phase.
Area of Science:
- Pediatric Orthopedics
- Endocrinology
- Biochemistry
Background:
- Perthes' disease is associated with growth abnormalities and low insulin-like growth factor-I (IGF-I).
- The acute phase of Perthes' disease may involve disruptions in growth, bone, and collagen turnover.
Purpose of the Study:
- To investigate growth abnormalities, bone turnover, and collagen turnover during the acute phase of Perthes' disease.
Main Methods:
- Cross-sectional and longitudinal study of 15 children with Perthes' disease (3-11 years).
- Measurements included lower leg length, height, weight, IGF-I, IGFBP-3, collagen markers, and bone alkaline phosphatase.
- Data collected at acute presentation and over a 2-year follow-up period.
Main Results:
- Height SD scores declined post-presentation; lower leg growth was initially asymmetrical, then ceased and resumed symmetrically.
- Patients exhibited persistently low IGF-I, reduced soft tissue collagen synthesis, and increased collagen breakdown.
- Bone formation markers increased during follow-up, suggesting bone healing.
Conclusions:
- Acute lower leg growth changes reflect altered weight-bearing and immobilization/remobilization phases.
- Persistently low IGF-I may contribute to reduced soft tissue collagen synthesis and impaired growth.
- Increased bone formation markers likely indicate bone healing processes in Perthes' disease.
Background:
Abnormalities in distal growth and low levels of insulin-like growth factor (IGF)-I have been reported in children with Perthes' disease. Our aim was to establish whether the acute phase of Perthes' disease is associated with abnormalities of growth, of bone or of collagen turnover.
Methods:
We performed a cross-sectional study of 15 children (3-11 years of age, 13 boys) at acute presentation and a longitudinal cohort study of 9 children. We measured (1) the lengths of both lower legs (by knemometry) at weeks 1, 2, 6 and 12, (2) height and weight at presentation and at the second-year follow-up, and (3) levels of IGF-I, IGFBP-3, collagen markers and bone alkaline phosphatase at weeks 1 and 12, and in year 2.
Results:
Height SD scores were normal at presentation but declined thereafter. Lower leg growth was not impaired at presentation but was asymmetrical, ceased during weeks 2-6, and then resumed symmetrically. Patients had persistently low IGF-I, low soft tissue collagen synthesis and enhanced collagen breakdown compared with age- and sex-related reference data. Markers of bone formation increased during follow-up.
Interpretation:
Acute changes in lower leg growth reflected differential weight bearing, then immobilization and remobilization. Persistently low IGF-I may have contributed to low soft tissue collagen synthesis and growth. Changes in bone formation markers most likely reflected bone healing.
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