Skip to main content
SpringerLink
Log in

Bone mineral density in pediatric patients with meningomyelocele

  • Original Paper
  • Published:
Child's Nervous System Aims and scope Submit manuscript

Abstract

Purpose

The aim of this study was to determine the bone mineral density (BMD) and the factors leading to reduction in BMD in children diagnosed with meningomyelocele.

Methods

A total of 31 patients with meningomyelocele (mean (SD) age, 8.5 (3.9) years; 51.6 % were females) and 22 healthy children were included. BMD of femoral neck and spinal L1–L4 levels and markers for bone metabolism were recorded.

Results

BMD of femoral neck (p = 0.001) and spinal L1–L4 (p = 0.01), serum calcium (p = 0.031), and urinary deoxypyridinoline (p = 0.015) levels were significantly lower in patients than in controls. Mobilization was significantly reduced in lumbar (p = 0.001) and thoracic (p = 0.002) level meningomyelocele compared to controls, while a significant positive correlation was noted between BMD of spinal L1–L4 and mobility (r = 0.58, p = 0.015).

Conclusions

Our findings suggest a decrease in BMD in meningomyelocele patients being associated with osteoporosis rather than nutritional and hormonal factors and the negative impact of higher levels of lesion on the mobility.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Apkon SD, Fenton L, Coll JR (2009) Bone mineral density in children with myelomeningocele. Dev Med Child Neurol 51(1):63–67

    Article  PubMed  Google Scholar 

  2. Okurowska-Zawada B, Konstantynowicz J, Kułak W, Kaczmarski M, Piotrowska-Jastrzebska J, Sienkiewicz D, Paszko-Patej G (2009) Assessment of risks factors for osteoporosis and fractures in children with meningomyelocele. Adv Med Sci 54(2):247–252

    Article  CAS  PubMed  Google Scholar 

  3. Wall EJ (2003) Myelomeningocele (spina bifida). In: Rudolph ED, Rudolph AM, Hostetter MK, Lister G, Siegel NJ (eds) Rudolph’s pediatrics, 21st edn. McGraw-Hill, New York, p 2955

    Google Scholar 

  4. James CCM (1970) Fractures in the lower limbs in spina bifida cystica: a survey of 44 fractures in 122 children. Dev Med Child Neurol 12(Suppl 22):88–93

    Google Scholar 

  5. Quan A, Adams R, Ekmark E, Baum M (1998) Bone mineral density in children with myelomeningocele. Pediatrics 102(3), E34

    Article  CAS  PubMed  Google Scholar 

  6. Laurence KM (1974) Effect of early surgery for spina bifida cystica on survival and quality of life. Lancet 1(7852):301–4

    Article  CAS  PubMed  Google Scholar 

  7. Eckstein HB, Macnab GH (1966) Myelomeningocele and hydrocephalus, the impact of modern treatment. Lancet 1(7442):842–845

    Article  CAS  PubMed  Google Scholar 

  8. Quilis AN (1974) Fractures in children with myelomeningocele. Acta Orthop Scand 45(6):883–897

    Article  CAS  PubMed  Google Scholar 

  9. Anshuetz RH, Freehafer AA, Shaffer JW, Dixon MS Jr (1984) Severe fracture complications in myelodysplasia. J Pediatr Orthop 4(1):22–24

    Article  Google Scholar 

  10. Lock TR, Aronson DD (1989) Fractures in patients who have myelomeningocele. J Bone Joint Surg 71(8):1153–1157

    CAS  PubMed  Google Scholar 

  11. Martinelli V, Dell'Atti C, Ausili E, Federici E, Magarelli N, Leone A, Massimi L, Di Rocco C, Bonomo L, Rendeli C (2015) Risk of fracture prevention in spina bifida patients: correlation between bone mineral density, vitamin D, and electrolyte values. Childs Nerv Syst 31(8):1361–1365

  12. Ausili E, Focarelli B, Tabacco F, Fortunelli G, Caradonna P, Massimi L, Sigismondi M, Salvaggio E, Rendeli C (2008) Bone mineral density and body composition in a myelomeningocele children population: effects of walking ability and sport activity. Eur Rev Med Pharmacol Sci 12(6):349–354

  13. Akbar M, Bresch B, Raiss P, Fürstenberg CH, Bruckner T, Seyler T, Carstens C, Abel R (2010) Fractures in myelomeningocele. J Orthop Traumatol 11(3):175–182

  14. Valtonen KM, Goksör LA, Jonsson O, Mellström D, Alaranta HT, Viikari-Juntura ER (2006) Osteoporosis in adults with meningomyelocele: an unrecognized problem at rehabilitation clinics. Arch Phys Med Rehabil 87(3):376–382

  15. Kumar SJ, Cowell HR, Townsend P (1984) Physeal, metaphyseal, and diaphyseal injuries of the lower extremities in children with myelomeningocele. J Pediatr Orthop 4(1):25–27

    Article  CAS  PubMed  Google Scholar 

  16. Okurowska-Zawada B, Kozerska A, Żelazowska B, Kułak W, Wasilewska A, Wysocka J (2012) Serum 25-hydroxyvitamin D, osteocalcin, and parathormone status in children with meningomyelocele. Neuropediatrics 43(6):314–319

  17. Rosenstein BD, Greene WB, Herrington RT, Blum AS (1987) Bone density in myelomeningocele: the effects of ambulatory status and other factors. Dev Med Child Neurol 29(4):486–494

    Article  CAS  PubMed  Google Scholar 

  18. Apkon SD, Fenton L, Coll JR (2009) Bone mineral density in children with myelomeningocele. Dev Med Child Neurol 51(1):63–67

    Article  PubMed  Google Scholar 

  19. Quan A, Adams R, Ekmark E, Baum M (2003) Bone mineral density in children with myelomeningocele: effect of hydrochlorothiazide. Pediatr Nephrol 18(9):929–933

    Article  PubMed  Google Scholar 

  20. Tuckerman K, Hofmaster P, Rosen CJ, Turi M (2002) Bone density in ambulatory and immobile children. J Clin Densitom 5(4):327–334

    Article  PubMed  Google Scholar 

  21. Boytim MJ, Davidson RS, Charney E, Melchionni JB (1991) Neonatal fractures in myelomeningocele patients. J Pediatr Orthop 11(1):28–30

    Article  CAS  PubMed  Google Scholar 

  22. Bartl Reiner (2006). Anti-Osteoporotika. Wissenschaftliche Verlagsgesellschaft Stuttgart

  23. Henderson RC, Lark RK, Newman JE, Kecskemthy H, Fung EB, Renner JB, Harcke HT (2002) Pediatric reference data for dual X-ray absorptio- metric measures of normal bone density in the distal femur. Am J Roentgenol 178(2):439–443

  24. Lewiecki EM, Gordon CM, Baim S, Leonard MB, Bishop NJ, Bianchi ML, Kalkwarf HJ, Langman CB, Plotkin H, Rauch F, Zemel BS, Binkley N, Bilezikian JP, Kendler DL, Hans DB, Silverman S (2008) International Society for clinical Densitometry 2007 adult and pediatric official positions. Bone 43(6):1115–1121

  25. Marreiros H, Monteiro L, Loff C, Calado E (2010) Fractures in children and adolescents with Spina Bifida—experience of a Portuguese tertiary care hospital. Dev Med Child Neurol 52(8):754–759

    Article  PubMed  Google Scholar 

  26. Szalay EA, Harriman D (2006) Adapting pediatric DXA scanning to clinical orthopaedics. J Pediatr Orthop 26(5):686–690

    Article  PubMed  Google Scholar 

Download references

Author contributions

IK designed research and performed interpretation of data, drafting the article and revising it; BK and FY performed drafting the article; MK performed analysis and interpretation of data; IK provided intellectual content of critical importance to the work. IK had primary responsibility for final content. All authors read and approved the final manuscript.

Author information

Authors and Affiliations

  1. Clinics of Pediatrics, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey

    Ihsan Kafadar & Betul Aydin Kilic

  2. Physical Therapy and Rehabilitation, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey

    Figen Koymen Yilmaz

  3. Neurosurgery, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey

    Mustafa Kilic

Authors
  1. Ihsan Kafadar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Betul Aydin Kilic
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Figen Koymen Yilmaz
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mustafa Kilic
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Betul Aydin Kilic.

Ethics declarations

Declaration of conflicting interests

Authors declare they have no conflict of interest.

Funding

None.

Ethical Approval

Written informed consent was obtained from the parents of each subject following a detailed explanation of the objectives and protocol of the study which was conducted in accordance with the ethical principles stated in the “Declaration of Helsinki” and approved by the Republic of Turkey Ministry of Health Ethics Committee and institutional ethics committee of Istanbul Sisli Hamidiye Etfal Research and Training Hospital (23.03.2009).

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kafadar, I., Kilic, B.A., Yilmaz, F.K. et al. Bone mineral density in pediatric patients with meningomyelocele. Childs Nerv Syst 32, 111–119 (2016). https://doi.org/10.1007/s00381-015-2930-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00381-015-2930-0

Keywords

Search

Navigation