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Bone Mineral Density as a Predictor of Vertebral Fractures in Children and Adolescents

Chapter

Abstract

There has been significant progress in our understanding of the natural history of vertebral fractures and associated risk and protective factors in children with osteoporotic conditions in recent years. This knowledge has allowed us to develop logical approaches to the diagnosis, monitoring, and timing of intervention in this setting. Current treatment strategies are predicated upon monitoring at-risk children to identify and then treat early signs of vertebral collapse in those with less potential for spontaneous vertebral body reshaping (i.e. a secondary prevention approach). On the other hand, trials addressing primary prevention are needed for children with both a high likelihood of developing vertebral fractures and with persistent risk factors for vertebral fractures (thereby obviating the potential for spontaneous vertebral body reshaping). Bone mineral density provides important, adjuvant information about the child’s overall bone health trajectory, signaling a child who is at increased risk for vertebral fractures or who is showing signs of spontaneous recovery from a transient bone health threat.

Overall, this chapter focuses on the following aspects of the pediatric bone health assessment: (a) vertebral fractures as a manifestation of osteoporosis in children (diagnostic methods, prevalence, and incidence in various disease states), (b) clinical predictors of vertebral fractures, including BMD, (c) BMD restitution and vertebral body reshaping of previously fractured vertebral bodies as indices of recovery, and (d) the impact of the relationship between BMD and vertebral fractures on clinical practice. Taken together, these discussion points will assist clinicians in the diagnosis and monitoring of bone health in at-risk children, and in making decisions around optimal candidates for bone-targeted treatment.

Keywords

Vertebral fractures Bone mineral density Children Genant semiquantitative method Vertebral fracture assessment 

Abbreviations

ABQ

Algorithm-based qualitative method

ALL

Acute lymphoblastic leukemia

BMD

Bone mineral density

CT

Computed tomography

DMD

Duchenne muscular dystrophy

DXA

Dual energy X-ray absorptiometry

GC

Glucocorticoid(s)

LS

Lumbar spine

MRI

Magnetic resonance imaging

OI

Osteogenesis imperfecta

SDI

Spinal deformity index

VF

Vertebral fracture(s)

VFA

Vertebral fracture assessment

Notes

Acknowledgements

Dr. Ward has been supported by a CIHR New Investigator Award (2004–2009), by a Canadian Child Health Clinician Scientist Career Enhancement Award (2007–2010), by a University of Ottawa Research Chair Award (2011 to current) and by the Children’s Hospital of Eastern Ontario Department of Surgery, Division of Orthopedics (2009 to current). Dr. Ma is supported by the Children’s Hospital of Eastern Ontario Research Institute. Drs. Ward and Ma would like to thank Victor Konji for his support in carrying out literature searches and preparing figures for this chapter and Poppy DesClouds and Liz Sykes for editorial work.

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© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Division of Endocrinology and Metabolism, Department of Pediatrics, Children’s Hospital of Eastern OntarioUniversity of OttawaOttawaCanada
  2. 2.School of Epidemiology, Public Health and Preventive MedicineUniversity of Ottawa, Children’s Hospital of Eastern Ontario Research InstituteOttawaCanada

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