Assessment of risk factors for osteoporosis and fractures in children with meningomyelocele.
OBJECTIVE
Our objective was to assess bone and muscular mass in children with meningomyelocele (MMC), and to analyze risk factors for osteoporosis and fractures based on densitometric examination.


METHODS
The study group included 30 patients (15 girls and 15 boys) with MMC, aged 6-17 years, treated in the Department of Pediatric Rehabilitation, University Hospital. Physiotherapeutic assessment and laboratory tests (serum parathormone, alkaline phosphatase levels, calcium, and phosphate levels, and urine calcium levels) were performed. Densitometry was measured by dual energy X-ray absorptiometry using a Lunar DPX-L apparatus. Lean mass (fat-free tissue content) and fat mass (% fat content) was evaluated.


RESULTS
Femur fractures were the most common 12/30 (40%); 5/30 (17%) of the children with MMC had multiple fractures. The incidence of fractures correlated significantly with BMI and body fat content (p = 0.03) Children with MMC and fractures had a tendency toward higher BMI, despite the same absolute value of body mass, compared to those without fractures. Body fat levels were higher in MMC patients with fractures than in those without fractures (BMI R = 0.393, p = 0.03). Children with MMC and fractures had significantly higher 24 h calcuria values, despite normal renal function indices (p = 0.03).


CONCLUSIONS
Low-energetic fractures in MMC children may result from metabolic disturbances that are a consequence of excessive renal calcium loss or excessive fatty tissue content.
Okurowska-Zawada
B
B
Department of Pediatric Rehabilitation, Medical University of Bialystok, Poland. zawada.bozena@wp.pl
Konstantynowicz
J
J
Kułak
W
W
Kaczmarski
M
M
Piotrowska-Jastrzebska
J
J
Sienkiewicz
D
D
Paszko-Patej
G
G
D015502:Absorptiometry, Photon; D000273:Adipose Tissue / Q000033:anatomy & histology; D000293:Adolescent; D000469:Alkaline Phosphatase / Q000097:blood; D001823:Body Composition / Q000502:physiology; D001827:Body Height / Q000502:physiology; D015992:Body Mass Index; D015519:Bone Density / Q000502:physiology; D002118:Calcium / Q000097:blood / Q000652:urine; D002648:Child; D005260:Female; D005264:Femoral Fractures / Q000209:etiology; D050723:Fractures, Bone / Q000209:etiology*; D006801:Humans; D007869:Leg Injuries / Q000209:etiology; D008124:Locomotion / Q000502:physiology; D008297:Male; D008591:Meningomyelocele / Q000150:complications*; D018482:Muscle, Skeletal / Q000033:anatomy & histology; D010024:Osteoporosis / Q000209:etiology*; D010281:Parathyroid Hormone / Q000097:blood; D010710:Phosphates / Q000097:blood; D018570:Risk Assessment; D012307:Risk Factors
D010281:Parathyroid Hormone; D010710:Phosphates; D000469:Alkaline Phosphatase; D002118:Calcium