Authors: Elizabeth A Szalay Asad Cheema
Publish Date: 2010/11/02
Volume: 469, Issue: 5, Pages: 1253-1257
Abstract
Patients with spina bifida frequently sustain lower extremity fractures which may be difficult to diagnose because they feel little or no pain although the relative contributions of low bone density to pain insensitivity are unclear Routine dualenergy xray absorptiometry DXA scanning is unreliable because these patients lack bony elements in the spine and many have joint contractures and/or implanted hardwareWe asked 1 if the lateral distal femoral scan is useful in spina bifida 2 whether nonambulatory children with spina bifida exhibit differences in bone mineral density BMD compared with an ageandsexmatched population and 3 whether Zscores were related to extremity fracture incidenceThe distal femoral scan could be performed in subjects for whom total body and/or lumbar scans could not be performed accurately Twentyfour of 37 had Zscores below −2 SD defined as “low bone density for age” Ten of 35 patients 29 with fracture information had experienced one or more fractures Our sample size was too small to correlate Zscore with fractureWe believe BMD should be monitored in patients with spina bifida nonambulatory patients with spina bifida and those with other risk factors are more likely to have low bone density for age than unaffected individuals The LDF scan was useful in this population in whom lumbar and total body scans are often invalidated by contracture or artifact Although lower extremity fractures occur regardless of ambulation or bone density knowing an individual’s bone health status may lead to interventions to improve bone health
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