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Scanning Skeletal Remains for Bone Mineral Density in Forensic Contexts
Published on: January 29, 2018
Bone density in children with single ventricle physiology
Edgard A Bendaly1, Linda A DiMeglio, William F Fadel
1Section of Pediatric Cardiology, Department of Pediatrics, Sanford Children's Hospital, University of South Dakota, 1600 W 22nd Street, PO Box 5039, Sioux Falls, SD, 57117, USA, edgard.bendaly@sanfordhealth.org.
Insights
Children with single ventricle (SV) heart defects have significantly reduced bone mineral density (BMD). Warfarin treatment may further lower BMD in these pediatric patients, warranting further investigation.
Area of Science:
- Pediatric Cardiology
- Pediatric Endocrinology
- Bone Metabolism
Background:
- Children with chronic diseases often exhibit low bone mineral density (BMD).
- Limited research exists on BMD in pediatric patients with congenital heart disease, specifically single ventricle (SV) physiology.
- Warfarin, a common treatment for SV, is suspected to negatively affect BMD in adults.
Purpose of the Study:
- To assess BMD in pediatric patients with SV physiology.
- To compare BMD between SV patients taking warfarin and those not on warfarin therapy.
Main Methods:
- Dual-energy X-ray absorptiometry (DXA) was used to measure BMD z scores of the spine and total body less head (TBLH) in subjects aged 5-12 years.
- Calcium intake, activity level, height, and Tanner stage were assessed.
- Linear regression models and t tests were employed to analyze data and compare subgroups.
Main Results:
- Mean spine BMD z score was significantly lower than expected (-1.0 ± 0.2, p < 0.0001), as was TBLH BMD z score (-0.8 ± 0.2, p < 0.0001).
- These reductions remained significant after adjusting for height.
- Patients on warfarin showed a trend towards lower BMD at both the spine and TBLH compared to non-warfarin users, though not statistically significant (p=0.106 and p=0.132, respectively).
Conclusions:
- Pediatric patients with SV physiology exhibit significantly reduced BMD.
- Warfarin may negatively impact BMD in this population, but further research is needed to confirm this effect.
- Continued monitoring of bone density in children with SV and evaluation in other cardiac patients on warfarin are recommended.
Abstract:
Children with chronic diseases are at risk for low bone mineral density (BMD). There are no studies of BMD in children with congenital heart disease and particularly single ventricle (SV). Children with this defect are often treated with warfarin, suspected to negatively impact BMD in adults. We assessed BMD in patients with SV physiology and compared the BMD of subjects taking warfarin to those who were not. Subjects 5-12 years with SV were included. BMD z scores by dual-energy X-ray absorptiometry of the spine and total body less head (TBLH) were obtained. Calcium intake, activity level, height, and Tanner stage were assessed. Linear regression models and t tests were used to investigate differences between participants and normative data as well as between subjects' subgroups. Twenty-six subjects were included and 16 took warfarin. Mean BMD z score at the spine was significantly lower than expected at -1.0 ± 0.2 (p < 0.0001), as was the BMD z score for TBLH at -0.8 ± 0.2 (p < 0.0001). Those results remained significant after adjusting for height. Subjects who were on warfarin tended to have lower BMD at both the spine and TBLH than those who were not, with a z score difference of 0.6 ± 0.46 at the spine (p = 0.106) and a difference of 0.4 ± 0.34 at TBLH (p = 0.132). BMD is significantly reduced in children with SV. Warfarin appears to lower BMD but the effect is less conclusive. Continued evaluation is recommended for these patients at risk for reduced bone density. Evaluation of other cardiac patients on warfarin therapy should also be considered.
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