Lower bone strength in young patients with Fontan circulation compared to controls

Area of Science:

• Pediatric Cardiology
• Biomedical Engineering
• Orthopedics

Background:

• Previous studies suggest bone deficits in patients with Fontan circulation.
• The impact of Fontan circulation on bone strength and its developmental trajectory remains unclear.

Purpose of the Study:

• To compare tibial bone strength-strain index between young patients (6-19 years) with Fontan circulation and age-/sex-matched controls.
• To investigate age-specific differences in bone strength within pediatric and adolescent subgroups.

Main Methods:

• Peripheral quantitative CT was used to examine the tibia in 20 patients with Fontan circulation and 20 controls.
• Bone strength-strain index was calculated in lateral and anterior-posterior directions.

Main Results:

• Patients with Fontan circulation had a significantly lower lateral strength-strain index compared to controls (p=0.043).
• Adolescents (13-19 years) with Fontan circulation showed significantly lower strength-strain indexes in both lateral and anterior-posterior directions compared to controls (p<0.001 and p=0.004, respectively).
• No significant differences were observed in the younger children's subgroup (6-12 years).

Conclusions:

• Young patients (6-19 years) with Fontan circulation demonstrate reduced tibial bone strength-strain index compared to controls.
• The observed bone strength deficits are primarily driven by adolescents, suggesting a potential age-related decline in bone strength in this population.
• These findings underscore the importance of monitoring bone health in adolescents with Fontan circulation.