Vertebral compression fractures in pediatric patients with intestinal failure: A prospective observational case
Asia Smith1, Shweta S Namjoshi2, Laura K Bachrach3
1Howard University School of Medicine, USA.
Insights
Intestinal failure associated bone disease is a risk for children on parenteral nutrition. A study found 21% of pediatric patients with intestinal failure had vertebral fractures, with two-thirds being asymptomatic, highlighting the need for screening.
Area of Science:
- Pediatric Gastroenterology
- Bone Metabolism
- Parenteral Nutrition
Background:
- Intestinal failure associated bone disease (IFABD) significantly impacts bone health in children dependent on parenteral nutrition (PN).
- Early detection and management of IFABD are crucial for long-term patient outcomes.
Purpose of the Study:
- To determine the prevalence of vertebral fractures (VF) in pediatric patients with intestinal failure (IF).
- To assess the utility of lateral thoracolumbar x-rays using Genant criteria for detecting VF in this population.
Main Methods:
- Observational study of pediatric patients with IF at a single center.
- Lateral thoracolumbar x-rays were used to detect vertebral fractures based on Genant criteria.
- Data collected as part of a larger observational database study on IF long-term outcomes.
Main Results:
- 14 pediatric patients with IF were included; 3 (21%) had confirmed vertebral fractures.
- Short bowel syndrome was the most common cause of IF (64%).
- Two of the three patients with VF were asymptomatic, underscoring the potential for silent bone disease.
Conclusions:
- Vertebral fractures are prevalent in pediatric patients with IF, even in asymptomatic individuals.
- Further investigation and multicenter studies are warranted to establish risk factors and screening guidelines.
- Early detection of VF can inform treatment decisions, such as initiating bisphosphonate therapy.
Background:
Intestinal failure associated bone disease (IFABD) poses a significant threat to bone health in pediatric patients with intestinal failure (IF) reliant on life-saving parenteral nutrition (PN).
Methods:
This observational study sought to determine the prevalence of vertebral fractures (VF) detected through lateral thoracolumbar x-rays using Genant criteria in pediatric patients with IF at a single center. It was conducted as part of a larger observational database study of intestinal failure long term outcomes.
Results:
Fourteen out of 79 patients with IF were included in the study. The median age of our cohort was 9 years. Short bowel syndrome (SBS) was the cause of IF in nine patients (64 %), with two patients each having a pediatric onset congenital diarrhea & enteropathy (14 %) or dysmotility (14 %) as their primary IF diagnosis, and one patient (7 %) with normal intestinal length and absorption, requiring PN for growth support in the context of chronic vomiting. Three of 14 participants (21 %) had vertebral fractures confirmed on x-rays, two of whom were asymptomatic. Notably, bisphosphonate therapy was initiated in one patient with VF, highlighting the clinical impact of early detection.
Conclusion:
Despite study limitations, including a small single center sample size, the identification of VF in 3 out of the 14 participants underscores the need for further investigation in pediatric patients with IF, especially because 2 of these 3 patients were asymptomatic. Multicenter studies in the future may explore risk factors for VF to create guidelines for radiographic screening, surveillance, and treatment in this pediatric population.
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