title: Lower extremity bone mineral density in children with congenital spinal dysfunction.
abstract: OBJECTIVE
  To assess lower extremity bone mineral density (BMD) of children with congenital spinal dysfunction and examine factors that may influence BMD in this population.
  
  
  METHODS
  Forty-four children (25 females, 19 males) aged 6 to 18 years (mean 11 y 11 mo, SD 3 y 6 mo) with congenital spinal dysfunction (35 with myelomeningocele, seven with lipomas, one with sacral agenesis, one with caudal regression) were enrolled in the study. A health survey including ambulatory status, history of bladder augmentation, and history of fracture was administered. Each participant had a physical examination including Tanner stage and neurological level. Dual-energy X-ray absorptiometry scans of the lateral distal femur (LDF) and, when possible, lumbar spine were obtained. We reported LDF BMD results as z-scores for three regions of interest (metaphyseal, metadiaphyseal, and diaphyseal). Univariable and multivariable analyses examined relationships between LDF BMD and the other variables.
  
  
  RESULTS
  BMD was significantly related to ambulatory status (14 non-ambulatory, 15 partly ambulatory, 15 fully ambulatory) and neurological level (13 with low-level lesions, 15 medium-level, 16 high-level) in the univariable analysis (p<0.01 for both in all three regions). Neither history of fracture, nor Tanner stage, nor history of bladder augmentation showed a significant relationship to BMD. The significance of ambulatory status and neurological level in the univariable analysis failed to persist in the multivariable analysis of this study with a small sample size.
  
  
  CONCLUSIONS
  The LDF measurement proved to be a viable technique for assessing BMD in children with congenital spinal dysfunction. LDF BMD was sensitive to differences in three categories of ambulation. The overall influence of neurological level was not deemed as important as ambulation.
authors.affiliation: Department of Pediatrics, Division of Physical Medicine and Rehabilitation, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE 19899, USA. rhaas@nemours.org
authors.forename: Rochelle E
authors.initials: RE
authors.lastname: Haas
authors.forename: Heidi H
authors.initials: HH
authors.lastname: Kecskemethy
authors.forename: Maria A
authors.initials: MA
authors.lastname: Lopiccolo
authors.forename: Jobayer
authors.initials: J
authors.lastname: Hossain
authors.forename: Rochelle T
authors.initials: RT
authors.lastname: Dy
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Bachrach
mesh_terms: D015502:Absorptiometry, Photon; D000293:Adolescent; D015519:Bone Density / Q000502:physiology*; D002648:Child; D005260:Female; D005269:Femur / Q000000981:diagnostic imaging*; D006801:Humans; D008161:Lumbosacral Region / Q000000981:diagnostic imaging*; D008297:Male; D009436:Neural Tube Defects / Q000150:complications*; D010024:Osteoporosis / Q000000981:diagnostic imaging* / Q000209:etiology; D012720:Severity of Illness Index