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

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Bone Health Assessment in Pediatrics

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.

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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

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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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Authors and Affiliations

  1. Division of Endocrinology and Metabolism, Department of Pediatrics, Children’s Hospital of Eastern Ontario, University of Ottawa, 401 Smyth Road, Ottawa, ON, Canada, K1H 8L1

    Leanne M. Ward M.D., F.A.A.P., F.R.C.P.C.

  2. School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Children’s Hospital of Eastern Ontario Research Institute, Room 250E, 401 Smyth Road, Ottawa, ON, Canada, K1H 8L1

    Jinhui Ma Ph.D.

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  1. Leanne M. Ward M.D., F.A.A.P., F.R.C.P.C.
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  2. Jinhui Ma Ph.D.
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Correspondence to Leanne M. Ward M.D., F.A.A.P., F.R.C.P.C. .

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  1. UCSF Benioff Children’s Hospital Oakland, Children’s Hospital Oakland Research Institute, Oakland, California, USA

    Ellen B. Fung

  2. Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA

    Laura K. Bachrach

  3. Department of Orthopaedic Surgery, University of California, San Francisco, USA

    Aenor J. Sawyer

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Ward, L.M., Ma, J. (2016). Bone Mineral Density as a Predictor of Vertebral Fractures in Children and Adolescents. In: Fung, E., Bachrach, L., Sawyer, A. (eds) Bone Health Assessment in Pediatrics. Springer, Cham. https://doi.org/10.1007/978-3-319-30412-0_10

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