title: Osteoporosis in paediatric patients with spina bifida.
abstract: The prevalence and morbidity associated with osteoporosis and fractures in patients with spina bifida (SB) highlight the importance of osteoporosis prevention and treatment in early childhood; however, the issue has received little attention. The method for the selection  of appropriate patients for drug treatment has not been clarified.
  
  
  OBJECTIVE
  To review the literature concerning fracture risks and low bone density in paediatric patients with SB. We looked for studies describing state-of-the-art treatments and for prevention of secondary  osteoporosis.
  
  
  METHODS
  Articles were identified through a search in the electronic database (PUBMED) supplemented with reviews of the reference lists of selected papers. The main outcome measures were incidence of fractures and risk factors for fracture, an association between  bone mineral density (BMD) and occurrence of fracture, risk factors of low BMD, and effects of pharmacological and non-pharmacological treatments on BMD and on the incidence of fractures. We considered as a secondary outcome the occurrence of fractures in relation to the mechanism of injury.
  
  
  RESULTS
  Results indicated that patients with SB are at increased risk for fractures and low BMD. Risk factors that may predispose patients to fractures include higher levels of neurological involvement, non-ambulatory status, physical inactivity, hypercalciuria, higher body  fat levels, contractures, and a previous spontaneous fracture. Limitations were observed in the number and quality of studies concerning osteoporosis prevention and treatment in paediatric patients with SB. The safety and efficiency of drugs to treat osteoporosis in adults have not been evaluated  satisfactorily in children with SB.
authors.affiliation: Department of Paediatric Rehabilitation, Hospital Dona Estefânia, Centro Hospitalar de Lisboa Central, Lisboa, Portugal. [corrected] vicentemarreiros@hotmail.com
authors.forename: Humberto
authors.initials: H
authors.lastname: Marreiros
authors.forename: Humberto Filipe
authors.initials: HF
authors.lastname: Marreiros
authors.forename: Clara
authors.initials: C
authors.lastname: Loff
authors.forename: Eulalia
authors.initials: E
authors.lastname: Calado
mesh_terms: D015519:Bone Density; D016206:Databases, Bibliographic / Q000706:statistics & numerical data; D050723:Fractures, Bone / Q000453:epidemiology / Q000209:etiology; D020022:Genetic Predisposition to Disease; D006801:Humans; D010024:Osteoporosis / Q000453:epidemiology* / Q000209:etiology*; D010372:Pediatrics; D015995:Prevalence; D012307:Risk Factors; D016135:Spinal Dysraphism / Q000150:complications* / Q000453:epidemiology*