Low bone mass in patients with motor disability: prevalence and risk factors in 59 Finnish children
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Published on: January 29, 2018
Päivi Kilpinen-Loisa1, Taava Paasio, Martti Soiva
1Department of Paediatric Neurology, Päijät-Häme Central Hospital, Lahti, Finland. paivi.kilpinen-loisa@phsotey.fi
Insights
Children with motor disabilities face high risks of bone fractures and low bone mass. Vitamin D insufficiency and hypercalciuria are key predictors of fractures in this population.
Area of Science:
- Pediatric Endocrinology
- Orthopedics
- Rehabilitation Medicine
Background:
- Children with motor disabilities exhibit an elevated risk of diminished bone health.
- Assessing bone mineral density and fracture prevalence is crucial for this vulnerable group.
Purpose of the Study:
- To determine the prevalence of low bone mass and fractures in children with motor disabilities.
- To identify risk factors associated with compromised bone health in this cohort.
Main Methods:
- A cross-sectional cohort study involving 59 children with motor disabilities (GMFCS levels II-V).
- Bone mineral density (BMD) and bone mineral apparent density (BMAD) z-scores were measured using dual-energy X-ray absorptiometry.
- Spinal radiographs and biochemical analyses, including vitamin D levels and calcium homeostasis, were performed.
Main Results:
- 17% of children experienced fractures, predominantly in the lower limbs; 25% had vertebral compression fractures.
- The median spinal BMAD z-score was significantly lower in children with fractures (-1.7) compared to those without (-0.6).
- Vitamin D insufficiency (59%) and hypercalciuria (27%) were prevalent; both were independent predictors of fractures.
Conclusions:
- Children with motor disabilities are at significant risk for peripheral and vertebral fractures, alongside low bone density.
- Regular bone health evaluations and osteoporosis prevention strategies are essential components of care for these children.
Aim:
Children with motor disabilities are at increased risk of compromised bone health. This study evaluated prevalence and risk factors of low bone mass and fractures in these children.
Method:
This cross-sectional cohort study evaluated bone health in 59 children (38 males, 21 females; median age 10 y 11 mo) with motor disability (Gross Motor Function Classification System levels II-V). Bone mineral density (BMD) in the lumbar spine was measured with dual-energy X-ray absorptiometry; BMD values were corrected for bone size (bone mineral apparent density [BMAD]) and skeletal maturity, and compared with normative data. Spinal radiographs were obtained to assess vertebral morphology. Blood biochemistry included vitamin D concentration and other parameters of calcium homeostasis.
Results:
Ten children (17%) had sustained in total 14 peripheral fractures; lower-limb fractures predominated. Compression fractures were present in 25%. The median spinal BMAD z-score was -1.0 (range -5.0 to 2.0); it was -0.6 in those without fractures and -1.7 in those with fractures (p=0.004). Vitamin D insufficiency was present in 59% of participants (serum 25-hydroxyvitamin D <50 nmol/l) and hypercalciuria in 27%. Low BMAD z-score and hypercalciuria were independent predictors for fractures.
Interpretation:
Children with motor disability are at high risk of peripheral and vertebral fractures and low BMD. Evaluation of bone health and prevention of osteoporosis should be included in the follow-up.
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