Factors associated with low bone density in patients referred for assessment of bone health

International Journal of Pediatric Endocrinology

Catherine M Gordon¹  Courtney Giancaterino²  Patrice Melvin⁴  Lisa Swartz Topor³ 

[1] Research Associate, Boston Children’s Hospital, Boston, MA, USA;Division of Adolescent Medicine, all at Boston Children’s Hospital, Boston, MA, USA;Harvard Medical School, Boston, MA, USA;Program for Patient Safety and Quality, Boston, MA, USA

关键词: Dual X-ray absorptiometry;    Vitamin D;    Chronic disease;    Low bone mineral density;    Bone health;   

Others  :  812632
DOI  :  10.1186/1687-9856-2013-4

 received in 2012-09-27, accepted in 2013-01-21,  发布年份 2013

【 摘 要 】

Background

To identify factors that predict low bone mineral density (BMD) in pediatric patients referred for dual-energy x-ray absorptiometry assessments.

Methods

This is a retrospective cohort study of 304 children and adolescents referred for dual-energy x-ray absorptiometry assessments at a tertiary care center. Outcomes included risk factors which predicted a significant low bone density for age, defined as BMD Z-score ≤ -2.0 SD. A univariate analysis involved Chi-square, Fisher’s Exact test, and analysis of variance, and multivariate logistic regression models were constructed to determine predictors of low bone mineral density.

Results

In the multivariate logistic regression model, predictors of low bone mineral density included low body mass index Z-score (odds ratio 0.52, 95% confidence interval 0.39 – 0.69), low height Z-score (OR 0.71, 95% CI 0.57 – 0.88), vitamin D insufficiency (OR 3.97, 95% CI 2.08 – 7.59), and history of bone marrow transplant (OR 5.78, 95% CI 1.00 – 33.45).

Conclusions

Underlying health problems and associated treatments can impair bone mineral accrual. We identified risk factors most predictive of low bone mineral density in subjects referred for bone density measurement. Recognition of these factors may allow for earlier assessment to maximize bone mass in at-risk children.

【 授权许可】

   
2013 Topor et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Stevenson RD, Conaway M, Chumlea WC, Rosenbaum P, Fung EB, Henderson RC, Worley G, Liptak G, O’Donnell M, Samson-Fang L, et al.: Growth and health in children with moderate-to-severe cerebral palsy. Pediatrics 2006, 118(3):1010-1018.
• [2]Khatri IA, Chaudhry US, Seikaly MG, Browne RH, Iannaccone ST: Low bone mineral density in spinal muscular atrophy. J Clin Neuromuscul Dis 2008, 10(1):11-17.
• [3]Henderson RC, Kairalla J, Abbas A, Stevenson RD: Predicting low bone density in children and young adults with quadriplegic cerebral palsy. Dev Med Child Neurol 2004, 46(6):416-419.
• [4]Szalay EA, Cheema A: Children with spina bifida are at risk for Low bone density. Clin Orthop Relat Res 2011, 469:1253-1257.
• [5]Geary DF, Schaefer F: Comprehensive pediatric nephrology. Philadelphia, PA: Mosby/Elsevier; 2008.
• [6]Burnham JM, Shults J, Semeao E, Foster B, Zemel BS, Stallings VA, Leonard MB: Whole body BMC in pediatric Crohn disease: independent effects of altered growth, maturation, and body composition. J Bone Miner Res 2004, 19(12):1961-1968.
• [7]Miller KK, Lee EE, Lawson EA, Misra M, Minihan J, Grinspoon SK, Gleysteen S, Mickley D, Herzog D, Klibanski A: Determinants of skeletal loss and recovery in anorexia nervosa. J Clin Endocrinol Metab 2006, 91(8):2931-2937.
• [8]Turner J, Pellerin G, Mager D: Prevalence of metabolic bone disease in children with celiac disease is independent of symptoms at diagnosis. J Pediatr Gastroenterol Nutr 2009, 49(5):589-593.
• [9]Robertson J, Macdonald K: Prevalence of bone loss in a population with cystic fibrosis. Br J Nurs 2010, 19(10):636-639.
• [10]Caldeira RJ, Fonseca Vde M, Gomes SC Jr, Chaves CR: Prevalence of bone mineral disease among adolescents with cystic fibrosis. J Pediatr (Rio J) 2008, 84(1):18-25.
• [11]Bhudhikanok GS, Wang MC, Marcus R, Harkins A, Moss RB, Bachrach LK: Bone acquisition and loss in children and adults with cystic fibrosis: a longitudinal study. J Pediatr 1998, 133(1):18-27.
• [12]Finkelstein JS, Klibanski A, Neer RM: A longitudinal evaluation of bone mineral density in adult men with histories of delayed puberty. J Clin Endocrinol Metab 1996, 81(3):1152-1155.
• [13]Lamberg-Allardt CJ, Viljakainen HT: 25-Hydroxyvitamin D and functional outcomes in adolescents. Am J Clin Nutr 2008, 88(2):534S-536S.
• [14]Holick MF: The role of vitamin D for bone health and fracture prevention. Curr Osteoporos Rep 2006, 4(3):96-102.
• [15]Mazziotti G, Canalis E, Giustina A: Drug-induced osteoporosis: mechanisms and clinical implications. Am J Med 2010, 123(10):877-884.
• [16]Odame I, Duckworth J, Talsma D, Beaumont L, Furlong W, Webber C, Barr R: Osteopenia, physical activity and health-related quality of life in survivors of brain tumors treated in childhood. Pediatr Blood Cancer 2006, 46(3):357-362.
• [17]Mussa A, Bertorello N, Porta F, Galletto C, Nicolosi MG, Manicone R, Corrias A, Fagioli F: Prospective bone ultrasound patterns during childhood acute lymphoblastic leukemia treatment. Bone 2010, 46(4):1016-1020.
• [18]Clark EM, Ness AR, Bishop NJ, Tobias JH: Association between bone mass and fractures in children: a prospective cohort study. J Bone Miner Res 2006, 21(9):1489-1495.
• [19]Clark EM, Tobias JH, Ness AR: Association between bone density and fractures in children: a systematic review and meta-analysis. Pediatrics 2006, 117(2):e291-e297.
• [20]Khoury DJ, Szalay EA: Bone mineral density correlation with fractures in nonambulatory pediatric patients. J Pediatr Orthop 2007, 27(5):562-566.
• [21]Skaggs DL, Loro ML, Pitukcheewanont P, Tolo V, Gilsanz V: Increased body weight and decreased radial cross-sectional dimensions in girls with forearm fractures. J Bone Miner Res 2001, 16(7):1337-1342.
• [22]Ma D, Jones G: The association between bone mineral density, metacarpal morphometry, and upper limb fractures in children: a population-based case-control study. J Clin Endocrinol Metab 2003, 88(4):1486-1491.
• [23]Gordon CM, Bachrach LK, Carpenter TO, Crabtree N, El-Hajj Fuleihan G, Kutilek S, Lorenc RS, Tosi LL, Ward KA, Ward LM, et al.: Dual energy X-ray absorptiometry interpretation and reporting in children and adolescents: the 2007 ISCD Pediatric Official Positions. J Clin Densitom 2008, 11(1):43-58.
• [24]Zemel BS, Leonard MB, Kalkwarf HJ, Specke BL, Moyer-Mileur LJ, Shepherd JA, Cole TJ, Pan H, Kelly TL: Reference data for the whole body, lumbar spine and proximal femur for American children relative to age, gender, and body size. Journal of Bone and Mineral Research 2004, 19:S231.
• [25]Ogden CL, Kuczmarski RJ, Flegal KM, Mei Z, Guo S, Wei R, Grummer-Strawn LM, Curtin LR, Roche AF, Johnson CL: Centers for Disease Control and Prevention 2000 growth charts for the United States: improvements to the 1977 National Center for Health Statistics version. Pediatrics 2002, 109(1):45-60.
• [26]Plotkin H, Rauch F, Bishop NJ, Montpetit K, Ruck-Gibis J, Travers R, Glorieux FH: Pamidronate treatment of severe osteogenesis imperfecta in children under 3 years of age. J Clin Endocrinol Metab 2000, 85(5):1846-1850.
• [27]Munns CF, Rauch F, Travers R, Glorieux FH: Effects of intravenous pamidronate treatment in infants with osteogenesis imperfecta: clinical and histomorphometric outcome. J Bone Miner Res 2005, 20(7):1235-1243.
• [28]Glorieux FH, Bishop NJ, Plotkin H, Chabot G, Lanoue G, Travers R: Cyclic administration of pamidronate in children with severe osteogenesis imperfecta. N Engl J Med 1998, 339(14):947-952.
• [29]Taskinen M, Saarinen-Pihkala UM, Hovi L, Vettenranta K, Makitie O: Bone health in children and adolescents after allogeneic stem cell transplantation: high prevalence of vertebral compression fractures. Cancer 2007, 110(2):442-451.
• [30]Ruble K, Hayat MJ, Stewart KJ, Chen AR: Bone mineral density after bone marrow transplantation in childhood: measurement and associations. Biol Blood Marrow Transplant 2010, 16(10):1451-1457.
• [31]Petryk A, Bergemann TL, Polga KM, Ulrich KJ, Raatz SK, Brown DM, Robison LL, Baker KS: Prospective study of changes in bone mineral density and turnover in children after hematopoietic cell transplantation. J Clin Endocrinol Metab 2006, 91(3):899-905.
• [32]Cheng S, Tylavsky F, Kroger H, Karkkainen M, Lyytikainen A, Koistinen A, Mahonen A, Alen M, Halleen J, Vaananen K, et al.: Association of low 25-hydroxyvitamin D concentrations with elevated parathyroid hormone concentrations and low cortical bone density in early pubertal and prepubertal Finnish girls. Am J Clin Nutr 2003, 78(3):485-492.
• [33]Institute of Medicine: Dietary Reference Intakes for Calcium and Vitamin D. Washington DC: National Academies Press; 2011.
• [34]Heaney RP, Holick MF: Why the IOM recommendations for vitamin D are deficient. J Bone Miner Res 2011, 26(3):455-457.
• [35]Gordon CM, Goodman E, Emans SJ, Grace E, Becker KA, Rosen CJ, Gundberg CM, Leboff MS: Physiologic regulators of bone turnover in young women with anorexia nervosa. J Pediatr 2002, 141(1):64-70.
• [36]Hofman M, Landewe-Cleuren S, Wojciechowski F, Kruseman AN: Prevalence and clinical determinants of low bone mineral density in anorexia nervosa. Eur J Intern Med 2009, 20(1):80-84.
• [37]Misra M, Prabhakaran R, Miller KK, Goldstein MA, Mickley D, Clauss L, Lockhart P, Cord J, Herzog DB, Katzman DK, et al.: Weight gain and restoration of menses as predictors of bone mineral density change in adolescent girls with anorexia nervosa-1. J Clin Endocrinol Metab 2008, 93(4):1231-1237.
• [38]Leonard MB, Shults J, Elliott DM, Stallings VA, Zemel BS: Interpretation of whole body dual energy X-ray absorptiometry measures in children: comparison with peripheral quantitative computed tomography. Bone 2004, 34(6):1044-1052.
• [39]Zemel BS, Leonard MB, Kelly A, Lappe JM, Gilsanz V, Oberfield S, Mahboubi S, Shepherd JA, Hangartner TN, Frederick MM, et al.: Height adjustment in assessing dual energy x-ray absorptiometry measurements of bone mass and density in children. J Clin Endocrinol Metab 2010, 95(3):1265-1273.
• [40]McQuillan R, Campbell H: Gender differences in adolescent injury characteristics: a population-based study of hospital A&E data. Public Health 2006, 120(8):732-741.
• [41]Landin LA: Epidemiology of children’s fractures. J Pediatr Orthop B 1997, 6(2):79-83.
• [42]Kalkwarf HJ, Zemel BS, Gilsanz V, Lappe JM, Horlick M, Oberfield S, Mahboubi S, Fan B, Frederick MM, Winer K, et al.: The bone mineral density in childhood study: bone mineral content and density according to age, sex, and race. J Clin Endocrinol Metab 2007, 92(6):2087-2099.
• [43]Sylvester FA, Wyzga N, Hyams JS, Davis PM, Lerer T, Vance K, Hawker G, Griffiths AM: Natural history of bone metabolism and bone mineral density in children with inflammatory bowel disease. Inflamm Bowel Dis 2007, 13(1):42-50.
• [44]Bianchi ML: Inflammatory bowel diseases, celiac disease, and bone. Arch Biochem Biophys 503(1):54-65.
• [45]Dubner SE, Shults J, Baldassano RN, Zemel BS, Thayu M, Burnham JM, Herskovitz RM, Howard KM, Leonard MB: Longitudinal assessment of bone density and structure in an incident cohort of children with Crohn’s disease. Gastroenterology 2009, 136(1):123-130.
• [46]Fickling WE, Holdaway A, Bhalla AK, Robertson DA: Prevalence of fragility fracture in inflammatory bowel disease and celiac disease. In Digestive Disease Week and the 102nd Annual Meeting of the American Gastroenterological Association: 2001. Atlanta, GA: Gastroenterology; 2001.