- Email: [email protected]
Calcium homeostasis in children and adolescents with vitamin D deficiency (VDD): Effects of intramuscular injection of a megadose of cholecalciferol
S82
Abstracts / Bone 45 (2009) S59–S111
enhancer vector were transfected into RAW264.7 cell line and stimulated with M-CSF with or without RANKL. When comparing wild-type alleles with those harbouring the T allele, an increased reporter activity was observed in the latter. Reporter activity was significantly reduced in the − 721 A allele constructs also harbouring a mutated consensus sequence for the transcriptional factor GATA-1, showing that GATA-1 might be a potential enhancer of transcription. Conversely, T allele constructs still showed an increased gene expression when the GATA-1 site was mutated indicating that GATA-1 transcriptional factor was not essential for gene expression in the presence of this variant. These trends were not observed for constructs with a mutated Rfx-1 site. This study showed that GATA-1 is an enhancer of TRAF-6 expression, thus increasing osteoclast activity. Targeting this site might reduce osteoclast activity and bone loss although this might not be the case in individuals carrying the T allele for the −721 variant. Genomics could lead to the development of individualised and targeted treatment to control bone resorption that could improve fracture healing in children and control other bone disorders including inflammatory bone loss. doi:10.1016/j.bone.2009.04.108
Global Burden of Bone Disease PT-06 Calcium homeostasis in children and adolescents with vitamin D deficiency (VDD): Effects of intramuscular injection of a megadose of cholecalciferol A.T. Soliman, A. Adel, M. Wagdy, M. AlAli, A. Abushahin Hamad Medical Center, Doha, Qatar Objective: The objective was to investigate the effect of an IM injection a mega dose of vitamin D3 on serum 25-hydroxycholecalciferol (25 OH D) concentration and other calcium homeostasis parameters over the period of study in vitamin D deficient (VDD) children and adolescents. Design: In this prospective study we measured some parameters of calcium homeostasis in 40 adolescents and 40 children with vitamin D deficiency (VDD). An IM dose (10,000 IU/kg, max 600,000 IU) of cholecalciferol was injected and parameters of calcium homeostasis were measured at intervals of 3 months over the course of treatment. Results: After injecting a mega dose of cholecalciferol significant improvement of symptoms related to vitamin D deficiency had been reported in all children (40/40) and in the majority (34/40) of adolescents with VDD. In addition, complete healing of the radiological evidence of rickets was achieved in all children. Three months after the injection serum calcium (Ca), Phosphate (PO4) and 25 OH D concentrations were normal and alkaline phosphatase (ALP) and parathormone (PTH) decreased to normal in all children and adolescents with VDD. The majority of patients had 25 OH D level = or >20 ng/ml. However, 6 months after the injection, the majority of patients had 25OH D level <20 ng/ml. Conclusion: An IM mega dose of cholecalciferol is a safe and effective therapy for treatment of hypovitaminosis D in children and adolescents for 3 months but not for 6 months. doi:10.1016/j.bone.2009.04.109
PT-07 The incidence of fractures in Finnish children has decreased by 18% during the last 22 years M.K. Mäyränpääa, O. Mäkitiea,b, P. Kallioa a Children's Hospital, Helsinki University, Helsinki, Finland b Folkhälsan Research Center, Helsinki, Finland
The incidence of paediatric fractures has increased during the last decades in many countries. This may be due to decreased physical activity resulting in weaker bones. The purposes of this study were to update epidemiological data on fractures in Finnish children, and to compare the results with a previous epidemiological survey. We collected data for all new fractures in children <16 years during a 12-month period in 2005–2006 from public health care institutions in Helsinki, Finland. Patient charts and radiographs were reviewed. The patient's sex and age, number of previous fractures, fracture site and trauma mechanisms were recorded. The data were compared with a comparable study carried out in 1983. In total, 1373 children with a fracture were diagnosed during the study period. The overall annual incidence of fractures in Helsinki was 163 per 10,000 (201/10,000 for boys and 124/10,000 for girls). The mean age was 10.6 years for boys and 9.0 years for girls. 27% of the boys and 21% of the girls had a history of previous fracture(s). Most of the fractures (73%) involved upper extremities while 21% involved lower extremities, and 5% were located in the head or trunk. In comparison to the earlier population-based study, there was an 18% decrease in the overall incidence of fractures during the 22-year period. The most significant reduction (30%) was seen in children aged 10–13 years. However, the incidence of antebrachium and humerus fractures increased by 31% and 39%, respectively. The trauma mechanism was adequately described for 99% of the patients. Only 2.3% of the fractures resulted from high-energy trauma, and 23% (17% in 1983) were associated with sports. A significant reduction in the incidence of paediatric fractures was seen in Helsinki, Finland. The contributing factors remain to be elucidated in further analysis of the data. doi:10.1016/j.bone.2009.04.110
PT-08 Development of a tiny posterior walker for children with Osteogenesis Imperfecta C. Hilla, E. Knowlesa, J. Limb, D. Forda, J. Bircha, E. Walkera a Sheffield Children's Hospital, Sheffield, South Yorkshire, UK b Sheffield University, Sheffield, South Yorkshire, UK Introduction: Osteogenesis Imperfecta (OI) is a genetic disorder resulting in fractures, bony deformity and pain. Children with OI have varying degrees of skeletal deformity and short stature. They have gross motor developmental delay, reduced mobility, need assistance from carers, and often require mobility aids and adaptations to their home and school environment. This short stature, delayed development and reduced mobility necessitate a suitable walker to meet the child's needs. Currently the mobility aids/walkers on the market do not meet the needs of the OI population — they are too tall, too wide and too heavy. Method: We collaborated with two undergraduate engineering students from Sheffield University who designed a prototype posterior walker for their dissertation. This was smaller and narrower than the current smallest option (height 32 cm, width 30 cm). Discussion: The initial three wheeled prototype was unstable. The handle area was very wide and required adaptation. A local company (Kingcraft) have since taken on the project, and with charity funding and ongoing collaboration with the Metabolic Bone Disease Team at Sheffield Children's Hospital, two prototype walkers have been developed (heights 28 cm and 32 cm, width 30 cm). Initial plans included height adjustable and foldable legs. This made the walker heavy and thus two sizes of walker were developed, both are foldable. Conclusion: We now have access to a suitable walker for young children with OI. This enables the child to mobilise in a mechanically
Abstracts / Bone 45 (2009) S59–S111
enhancer vector were transfected into RAW264.7 cell line and stimulated with M-CSF with or without RANKL. When comparing wild-type alleles with those harbouring the T allele, an increased reporter activity was observed in the latter. Reporter activity was significantly reduced in the − 721 A allele constructs also harbouring a mutated consensus sequence for the transcriptional factor GATA-1, showing that GATA-1 might be a potential enhancer of transcription. Conversely, T allele constructs still showed an increased gene expression when the GATA-1 site was mutated indicating that GATA-1 transcriptional factor was not essential for gene expression in the presence of this variant. These trends were not observed for constructs with a mutated Rfx-1 site. This study showed that GATA-1 is an enhancer of TRAF-6 expression, thus increasing osteoclast activity. Targeting this site might reduce osteoclast activity and bone loss although this might not be the case in individuals carrying the T allele for the −721 variant. Genomics could lead to the development of individualised and targeted treatment to control bone resorption that could improve fracture healing in children and control other bone disorders including inflammatory bone loss. doi:10.1016/j.bone.2009.04.108
Global Burden of Bone Disease PT-06 Calcium homeostasis in children and adolescents with vitamin D deficiency (VDD): Effects of intramuscular injection of a megadose of cholecalciferol A.T. Soliman, A. Adel, M. Wagdy, M. AlAli, A. Abushahin Hamad Medical Center, Doha, Qatar Objective: The objective was to investigate the effect of an IM injection a mega dose of vitamin D3 on serum 25-hydroxycholecalciferol (25 OH D) concentration and other calcium homeostasis parameters over the period of study in vitamin D deficient (VDD) children and adolescents. Design: In this prospective study we measured some parameters of calcium homeostasis in 40 adolescents and 40 children with vitamin D deficiency (VDD). An IM dose (10,000 IU/kg, max 600,000 IU) of cholecalciferol was injected and parameters of calcium homeostasis were measured at intervals of 3 months over the course of treatment. Results: After injecting a mega dose of cholecalciferol significant improvement of symptoms related to vitamin D deficiency had been reported in all children (40/40) and in the majority (34/40) of adolescents with VDD. In addition, complete healing of the radiological evidence of rickets was achieved in all children. Three months after the injection serum calcium (Ca), Phosphate (PO4) and 25 OH D concentrations were normal and alkaline phosphatase (ALP) and parathormone (PTH) decreased to normal in all children and adolescents with VDD. The majority of patients had 25 OH D level = or >20 ng/ml. However, 6 months after the injection, the majority of patients had 25OH D level <20 ng/ml. Conclusion: An IM mega dose of cholecalciferol is a safe and effective therapy for treatment of hypovitaminosis D in children and adolescents for 3 months but not for 6 months. doi:10.1016/j.bone.2009.04.109
PT-07 The incidence of fractures in Finnish children has decreased by 18% during the last 22 years M.K. Mäyränpääa, O. Mäkitiea,b, P. Kallioa a Children's Hospital, Helsinki University, Helsinki, Finland b Folkhälsan Research Center, Helsinki, Finland
The incidence of paediatric fractures has increased during the last decades in many countries. This may be due to decreased physical activity resulting in weaker bones. The purposes of this study were to update epidemiological data on fractures in Finnish children, and to compare the results with a previous epidemiological survey. We collected data for all new fractures in children <16 years during a 12-month period in 2005–2006 from public health care institutions in Helsinki, Finland. Patient charts and radiographs were reviewed. The patient's sex and age, number of previous fractures, fracture site and trauma mechanisms were recorded. The data were compared with a comparable study carried out in 1983. In total, 1373 children with a fracture were diagnosed during the study period. The overall annual incidence of fractures in Helsinki was 163 per 10,000 (201/10,000 for boys and 124/10,000 for girls). The mean age was 10.6 years for boys and 9.0 years for girls. 27% of the boys and 21% of the girls had a history of previous fracture(s). Most of the fractures (73%) involved upper extremities while 21% involved lower extremities, and 5% were located in the head or trunk. In comparison to the earlier population-based study, there was an 18% decrease in the overall incidence of fractures during the 22-year period. The most significant reduction (30%) was seen in children aged 10–13 years. However, the incidence of antebrachium and humerus fractures increased by 31% and 39%, respectively. The trauma mechanism was adequately described for 99% of the patients. Only 2.3% of the fractures resulted from high-energy trauma, and 23% (17% in 1983) were associated with sports. A significant reduction in the incidence of paediatric fractures was seen in Helsinki, Finland. The contributing factors remain to be elucidated in further analysis of the data. doi:10.1016/j.bone.2009.04.110
PT-08 Development of a tiny posterior walker for children with Osteogenesis Imperfecta C. Hilla, E. Knowlesa, J. Limb, D. Forda, J. Bircha, E. Walkera a Sheffield Children's Hospital, Sheffield, South Yorkshire, UK b Sheffield University, Sheffield, South Yorkshire, UK Introduction: Osteogenesis Imperfecta (OI) is a genetic disorder resulting in fractures, bony deformity and pain. Children with OI have varying degrees of skeletal deformity and short stature. They have gross motor developmental delay, reduced mobility, need assistance from carers, and often require mobility aids and adaptations to their home and school environment. This short stature, delayed development and reduced mobility necessitate a suitable walker to meet the child's needs. Currently the mobility aids/walkers on the market do not meet the needs of the OI population — they are too tall, too wide and too heavy. Method: We collaborated with two undergraduate engineering students from Sheffield University who designed a prototype posterior walker for their dissertation. This was smaller and narrower than the current smallest option (height 32 cm, width 30 cm). Discussion: The initial three wheeled prototype was unstable. The handle area was very wide and required adaptation. A local company (Kingcraft) have since taken on the project, and with charity funding and ongoing collaboration with the Metabolic Bone Disease Team at Sheffield Children's Hospital, two prototype walkers have been developed (heights 28 cm and 32 cm, width 30 cm). Initial plans included height adjustable and foldable legs. This made the walker heavy and thus two sizes of walker were developed, both are foldable. Conclusion: We now have access to a suitable walker for young children with OI. This enables the child to mobilise in a mechanically