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Early characteristics of bone deficits in children with Fontan palliation
Kyriakie Sarafoglou1, Anna Petryk1, Pooja E Mishra1
1Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA.
Insights
Children with Fontan circulation show early bone deficits in non-weight-bearing bones like the radius. This study highlights potential vulnerabilities in bone health for these patients.
Area of Science:
- Pediatric Cardiology
- Bone Metabolism
- Congenital Heart Disease
Background:
- Children with Fontan circulation often face long-term health challenges.
- Bone health in this population is not fully understood, particularly in early stages.
- Early identification of bone health impairment is crucial for management.
Purpose of the Study:
- To investigate early bone health characteristics in clinically well children with Fontan circulation.
- To compare bone parameters between children with Fontan circulation and healthy controls.
- To identify specific bones affected by the Fontan circulation's unique hemodynamics.
Main Methods:
- Cross-sectional study including 10 children with Fontan palliation and 11 healthy controls.
- Peripheral quantitative CT (pQCT) used to assess bone density, cortical thickness, and strength.
- Clinical data, cardiac index, and biochemical markers were collected for the Fontan group.
- Linear regression analysis compared pQCT measures between groups.
Main Results:
- Fontan patients exhibited significantly decreased bone mineral density, cortical thickness, and bone strength index at the radius compared to controls.
- No significant differences in tibial bone measures were observed between the groups.
- Height-adjusted lumbar and total body bone mineral density z-scores in Fontan patients were below average but within normal limits.
Conclusions:
- Clinically well children with Fontan circulation demonstrate significant bone deficits in the radius.
- Non-weight-bearing bones appear more susceptible to the effects of Fontan circulation's hemodynamics.
- These findings suggest a need for monitoring bone health in pediatric Fontan patients.
Background:
This is a cross-sectional study aiming to understand the early characteristics and background of bone health impairment in clinically well children with Fontan circulation.
Methods:
We enrolled 10 clinically well children with Fontan palliation (operated >5 years before study entrance, Tanner stage ≤3, age 12.1 ± 1.77 years, 7 males) and 11 healthy controls (age 12.0 ± 1.45 years, 9 males) at two children's hospitals. All patients underwent peripheral quantitative CT. For the Fontan group, we obtained clinical characteristics, NYHA class, cardiac index by MRI, dual x-ray absorptiometry, and biochemical studies. Linear regression was used to compare radius and tibia peripheral quantitative CT measures between Fontan patients and controls.
Results:
All Fontan patients were clinically well (NYHA class 1 or 2, cardiac index 4.85 ± 1.51 L/min/m2) and without significant comorbidities. Adjusted trabecular bone mineral density, cortical thickness, and bone strength index at the radius were significantly decreased in Fontan patients compared to controls with mean differences -30.13 mg/cm3 (p = 0.041), -0.31 mm (p = 0.043), and -6.65 mg2/mm4 (p = 0.036), respectively. No differences were found for tibial measures. In Fontan patients, the mean height-adjusted lumbar bone mineral density and total body less head z scores were -0.46 ± 1.1 and -0.63 ± 1.1, respectively, which are below the average, but within normal range for age and sex.
Conclusions:
In a clinically well Fontan cohort, we found significant bone deficits by peripheral quantitative CT in the radius but not the tibia, suggesting non-weight-bearing bones may be more vulnerable to the unique haemodynamics of the Fontan circulation.
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