Radiographic vertebral morphology: A diagnostic tool in pediatric osteoporosis

University of Toronto, Toronto, Ontario, Canada
Journal of Pediatrics (Impact Factor: 3.79). 04/2005; 146(3):395-401. DOI: 10.1016/j.jpeds.2004.10.052
Source: PubMed


To assess the value of spinal radiographs in determining the significance of reductions in bone mass or density in chronically ill children.
A pediatric scoring method for assessment of osteoporotic vertebral changes, developed on the basis of radiographs of 70 healthy controls and established adult scoring methods, was subsequently used to assess 32 pediatric patients with suspected secondary osteoporosis. Radiographic findings were correlated with bone mineral density (BMD), clinical data, and biochemistry.
Thirty-two patients (median age 14.1 years) were included. Assessment of spinal radiographs with the developed scoring method found previously undiagnosed spinal compression deformities in 11 patients (34%) of whom 9 were asymptomatic and 8 had lumbar spine (size-corrected) BMD measurements within +/-2.0 SD of the age- and sex-specific norms. Fracture history and cumulative glucocorticoid (GC) dose did not differ between those with and without compression deformities.
Vertebral compression fractures can be documented in a significant number of chronically ill children and are poorly predicted by single BMD measurements and clinical history. Assessment of vertebral morphology is recommended as an additional tool in the diagnostic workup of pediatric osteoporosis.

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    • "The vertebrae were compared with adjacent vertebrae and graded depending on percent reduction in anterior, mid-or posterior vertebral height. A 20% reduction in vertebral height was used as cut off to define abnormal morphology (Mäkitie et al, 2005). "
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    • "All thoracic and lumbar radiographs were reviewed by two radiologists. Changes in vertebral morphology were graded by inspection of digitized images (AGFA ImPacs System®) and classified according to the grading methods of Genant [33] for adults and of Mäkitie [34] for children to identify vertebral morphological changes suggestive of osteoporosis. Compression of 20% or more in the anterior, middle or posterior vertebral height was considered significant. "
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    • "With the increasing number of children diagnosed with secondary osteoporosis it has become evident that vertebral fractures do occur also in children [2] [4] [23]. Their overall incidence in pediatric population is low and clinical significance and predictive value for future fracture risk presently unknown [4,24–27]. "
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