Children with spina bifida are at risk for low bone density

Area of Science:

• Orthopedics
• Pediatrics
• Radiology

Background:

• Spina bifida patients frequently experience lower extremity fractures, often undiagnosed due to reduced pain sensation.
• Low bone density's role in pain insensitivity is unclear.
• Standard bone density scans (DXA) are unreliable in spina bifida due to spinal bone absence, joint contractures, and hardware.

Purpose of the Study:

• Evaluate the utility of the lateral distal femoral (LDF) scan in spina bifida patients.
• Compare bone mineral density (BMD) in nonambulatory children with spina bifida to a matched population.
• Investigate the relationship between Z-scores and lower extremity fracture incidence.

Main Methods:

• Retrospective review of 37 spina bifida patients with DXA scans.
• Correlation of Z-scores with functional level, ambulatory status, BMI, and fracture history.
• Assessment of LDF scan feasibility when other DXA scans were inaccurate.

Main Results:

• LDF scans were feasible when total body/lumbar scans were inaccurate.
• 24 of 37 patients (65%) had Z-scores below -2 SD (low bone density for age).
• 10 of 35 patients (29%) reported prior fractures; sample size limited fracture correlation with Z-scores.

Conclusions:

• BMD monitoring is recommended for spina bifida patients.
• Nonambulatory patients and those with risk factors show higher likelihood of low bone density.
• LDF scan is valuable for BMD assessment in spina bifida, potentially guiding interventions.