Long-term reduction in bone mass after severe burn injury in children.
OBJECTIVE
Because burn victims are at risk of having bone loss, a cross-sectional study was undertaken to determine whether severe burn injury had acute and long-term effects on bone mass or on the incidence of fractures in children.


METHODS
Dual-energy x-ray absorptiometry of the lumbar portion of the spine was performed on 68 children: 16 moderately burned (15% to 36% of total body surface area) and 52 age-matched severely burned (> or = 40% of total body surface area). Twenty-two severely burned children were hospitalized and studied within 8 weeks of their burn, and 30 others were studied approximately 5 years after discharge. In the severely burned group, both hospitalized and discharged, serum and urine were analyzed for calcium, phosphorus, intact parathyroid hormone, osteocalcin, and type I collagen telopeptide.


RESULTS
Sixty percent of severely burned patients had age-related z scores for bone density less than -1, and 27% of severely burned patients had age-related z scores for bone density less than -2 (p < 0.005, for each). In the moderately burned group, 31% of patients had z scores less than -1 (p < 0.005 vs normal distribution), but only 6% had z scores less than -2 (p value not significant). There was evidence of increased incidence of fractures after discharge in the severely burned patients. Biochemical studies were compatible with a reduction in bone formation and an increase in resorption initially, and with a long-term persistence of low formation.


CONCLUSIONS
We conclude that acute burn injury leads to profound and long-term bone loss, which may adversely affect peak bone mass accumulation.
Klein
G L
GL
Department of Pediatrics, University of Texas Medical Branch, Galveston 77555-0352.
Herndon
D N
DN
Langman
C B
CB
Rutan
T C
TC
Young
W E
WE
Pembleton
G
G
Nusynowitz
M
M
Barnett
J L
JL
Broemeling
L D
LD
Sailer
D E
DE
D000208:Acute Disease; D000293:Adolescent; D001827:Body Height; D001835:Body Weight; D015519:Bone Density; D002056:Burns / Q000150:complications / Q000378:metabolism / Q000503:physiopathology*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D005598:Fractures, Spontaneous / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D008297:Male; D013997:Time Factors