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Heterogeneity in fracture pathogenesis of urban South African children: The Birth to Twenty cohort
S100
Abstracts / Bone 45 (2009) S59–S111
Conclusions: 1. The significant differences of Z-score parameters in total body and spine between children with and without vertebral fractures prove these parameters to be useful in prediction of vertebral fractures. 2. No significant differences of densitometry and ultrasound findings between children with and without long bones fractures suggest other causes of these fractures, including bone protein structure disorders. 3. Significant positive correlation between the results obtained by ultrasounds and densitometry proves ultrasound examination to be extremely useful in initial screening noninvasive evaluation of bone mineralization. Acknowledgements: The study was partly financed by grant no. N407 063 32/2713. doi:10.1016/j.bone.2009.04.159
PF-14 Heterogeneity in fracture pathogenesis of urban South African children: The Birth to Twenty cohort K. Thandrayen, S. Norris, J. Pettifor University of Witwatersrand, Mineral Metabolism Research Unit, Johannesburg, Gauteng, South Africa South African black children fracture less than white children. Genetic factors and differences in bone mass and physical activity may be contributing risk factors. The aim of this study is to investigate the association between fracture prevalence and bone mass and physical activity in urban South African children. Using the Bone Health subsample of the Birth to Twenty longitudinal study, we retrospectively obtained information of lifetime fractures until age 15 years. Bone mass and anthropometric data and pubertal status were obtained at age 10 years. Comparisons were done between those who did and did not fracture within the same gender and ethnic groups. Bone mass Z-scores were adjusted for body size and pubertal status. Of the 533 subjects, 130 (24%) reported a fracture with a significant difference in fracture rates between black and white children (p < 0.001). White males who fractured were significantly taller (p = 0.011) and had greater metabolic physical activity scores (p = 0.033) with higher lean body mass (p = 0.001). White females who fractured were fatter (p = 0.047). White males who fractured had higher bone area at all sites (whole body less head: p = 0.002, radius: p = 0.003, hip: p = 0.024, spine: p = 0.017) and higher bone mineral content (BMC) at the radial (p = 0.014), hip neck (p = 0.039) and spinal (p = 0.009) sites. Black males who fractured had lower radial (p = 0.01) and hip (p = 0.003) bone mineral density (BMD) and lower hip (p = 0.045) BMC compared to those who did not fracture. There were no statistically significant differences in bone mass between black and white females who did or did not fracture. In conclusion, the pathogenesis of fractures differs between ethnic groups. Lower bone mass in black males and increased physical activity, possibly leading to increased sport injuries, in white males are contributory risk factors. doi:10.1016/j.bone.2009.04.160
PF-15 The importance of quantitative ultrasound measurement in the paediatric osteology E. Hosszua, J. Liptovszkya, Cs. Horvathb a 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary b 1st Department of Internal Medicine, Semmelweis University, Budapest, Hungary
Quantitative ultrasound (QUS) of the bone provides information not only about mineral mass but the quality of the bone, too. The application of the method to the continuously growing body size made it usable in the childhood. However, routine usage of bone ultrasound for the diagnosis of metabolic bone diseases needs to determine the normal reference range of children of both genders and in all age groups. The primary aim of this study was to build-up the Hungarian reference range. As a secondary aim, the relationship between QUS and the bone density was studied by a comparative evaluation of DXA and QUS measurements. 154 healthy girls and boys with age of 5–18 years participated in this study. Bone ultrasound was performed by Achilles Insight (Lunar, WI) and bone mineral density (BMD) was measured by DPX-L (Lunar, WI) devices. The evaluation of the measured variables showed the highest correlation between BUA (broadband ultrasound attenuation) and BMD while the SOS (speed of sound) or the Stiffness index (a variable derived from BUA and SOS) showed lighter correlation to BMD. This observation is in good parallelism with the view that SOS reflects bone quality rather than bone mineral mass. Our reference table can help to use QUS in the diagnosis of children suspected of having metabolic bone problems. doi:10.1016/j.bone.2009.04.161
PF-16 The prevalence of rib fractures in ex-preterm infants R. Noblea, H. McDevitta, J. Herbisonc, S. Butlerb, S.F. Ahmeda a Bone and Endocrine Research Group, Department of Child Health, RHSC, Yorkhill, Glasgow, UK b Diagnostic Imaging, RHSC, Yorkhill, Glasgow, UK c Child Protection Services, RHSC, Yorkhill, Glasgow, UK Introduction: Preterm infants are at risk of metabolic bone disease of prematurity and subsequent fractures. The incidence and timing of fractures are unclear. Aim: To determine the prevalence of rib fractures in ex-preterm babies after their discharge from the neonatal unit. Methods: All ex-preterm infants who were part of a RSV vaccination programme between 2003 and 2007 and who had chest radiographs were identified on the hospital database and the reports for every chest radiograph were reviewed for the presence of rib fractures. The fracture site, the age of the child, birth gestation and gender were also recorded. Results: 112 patients (34 females and 78 males; median birth gestation of 27 weeks with 10th and 90th centiles of 25 weeks and 29 weeks gestation respectively) were included in the study, and a total of 1527 chest radiograph reports were reviewed. Healing rib fractures were reported to be present in 9 (8%) of the patients. However the age of the fracture could not be determined. The median chronological age (range) and the median corrected gestational age (range) for these infants were 18 weeks (minimum of 9 weeks; maximum of 121 weeks) and 5 weeks (minimum of term; maximum of 108 weeks), respectively. In one patient, fractures were first noted at 1 month corrected gestational age, but further fractures were then commented on in chest radiographs aged 3 months and 1 year corrected gestational age. Fracture sites included postero-lateral, axillary line and anterior on both left and right. Conclusion: This retrospective review has shown that rib fractures were evident on chest radiographs of about 8% of ex-preterm infants after discharge from hospital. There is a need to identify risk factors that may predispose these infants to fractures. doi:10.1016/j.bone.2009.04.162
Abstracts / Bone 45 (2009) S59–S111
Conclusions: 1. The significant differences of Z-score parameters in total body and spine between children with and without vertebral fractures prove these parameters to be useful in prediction of vertebral fractures. 2. No significant differences of densitometry and ultrasound findings between children with and without long bones fractures suggest other causes of these fractures, including bone protein structure disorders. 3. Significant positive correlation between the results obtained by ultrasounds and densitometry proves ultrasound examination to be extremely useful in initial screening noninvasive evaluation of bone mineralization. Acknowledgements: The study was partly financed by grant no. N407 063 32/2713. doi:10.1016/j.bone.2009.04.159
PF-14 Heterogeneity in fracture pathogenesis of urban South African children: The Birth to Twenty cohort K. Thandrayen, S. Norris, J. Pettifor University of Witwatersrand, Mineral Metabolism Research Unit, Johannesburg, Gauteng, South Africa South African black children fracture less than white children. Genetic factors and differences in bone mass and physical activity may be contributing risk factors. The aim of this study is to investigate the association between fracture prevalence and bone mass and physical activity in urban South African children. Using the Bone Health subsample of the Birth to Twenty longitudinal study, we retrospectively obtained information of lifetime fractures until age 15 years. Bone mass and anthropometric data and pubertal status were obtained at age 10 years. Comparisons were done between those who did and did not fracture within the same gender and ethnic groups. Bone mass Z-scores were adjusted for body size and pubertal status. Of the 533 subjects, 130 (24%) reported a fracture with a significant difference in fracture rates between black and white children (p < 0.001). White males who fractured were significantly taller (p = 0.011) and had greater metabolic physical activity scores (p = 0.033) with higher lean body mass (p = 0.001). White females who fractured were fatter (p = 0.047). White males who fractured had higher bone area at all sites (whole body less head: p = 0.002, radius: p = 0.003, hip: p = 0.024, spine: p = 0.017) and higher bone mineral content (BMC) at the radial (p = 0.014), hip neck (p = 0.039) and spinal (p = 0.009) sites. Black males who fractured had lower radial (p = 0.01) and hip (p = 0.003) bone mineral density (BMD) and lower hip (p = 0.045) BMC compared to those who did not fracture. There were no statistically significant differences in bone mass between black and white females who did or did not fracture. In conclusion, the pathogenesis of fractures differs between ethnic groups. Lower bone mass in black males and increased physical activity, possibly leading to increased sport injuries, in white males are contributory risk factors. doi:10.1016/j.bone.2009.04.160
PF-15 The importance of quantitative ultrasound measurement in the paediatric osteology E. Hosszua, J. Liptovszkya, Cs. Horvathb a 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary b 1st Department of Internal Medicine, Semmelweis University, Budapest, Hungary
Quantitative ultrasound (QUS) of the bone provides information not only about mineral mass but the quality of the bone, too. The application of the method to the continuously growing body size made it usable in the childhood. However, routine usage of bone ultrasound for the diagnosis of metabolic bone diseases needs to determine the normal reference range of children of both genders and in all age groups. The primary aim of this study was to build-up the Hungarian reference range. As a secondary aim, the relationship between QUS and the bone density was studied by a comparative evaluation of DXA and QUS measurements. 154 healthy girls and boys with age of 5–18 years participated in this study. Bone ultrasound was performed by Achilles Insight (Lunar, WI) and bone mineral density (BMD) was measured by DPX-L (Lunar, WI) devices. The evaluation of the measured variables showed the highest correlation between BUA (broadband ultrasound attenuation) and BMD while the SOS (speed of sound) or the Stiffness index (a variable derived from BUA and SOS) showed lighter correlation to BMD. This observation is in good parallelism with the view that SOS reflects bone quality rather than bone mineral mass. Our reference table can help to use QUS in the diagnosis of children suspected of having metabolic bone problems. doi:10.1016/j.bone.2009.04.161
PF-16 The prevalence of rib fractures in ex-preterm infants R. Noblea, H. McDevitta, J. Herbisonc, S. Butlerb, S.F. Ahmeda a Bone and Endocrine Research Group, Department of Child Health, RHSC, Yorkhill, Glasgow, UK b Diagnostic Imaging, RHSC, Yorkhill, Glasgow, UK c Child Protection Services, RHSC, Yorkhill, Glasgow, UK Introduction: Preterm infants are at risk of metabolic bone disease of prematurity and subsequent fractures. The incidence and timing of fractures are unclear. Aim: To determine the prevalence of rib fractures in ex-preterm babies after their discharge from the neonatal unit. Methods: All ex-preterm infants who were part of a RSV vaccination programme between 2003 and 2007 and who had chest radiographs were identified on the hospital database and the reports for every chest radiograph were reviewed for the presence of rib fractures. The fracture site, the age of the child, birth gestation and gender were also recorded. Results: 112 patients (34 females and 78 males; median birth gestation of 27 weeks with 10th and 90th centiles of 25 weeks and 29 weeks gestation respectively) were included in the study, and a total of 1527 chest radiograph reports were reviewed. Healing rib fractures were reported to be present in 9 (8%) of the patients. However the age of the fracture could not be determined. The median chronological age (range) and the median corrected gestational age (range) for these infants were 18 weeks (minimum of 9 weeks; maximum of 121 weeks) and 5 weeks (minimum of term; maximum of 108 weeks), respectively. In one patient, fractures were first noted at 1 month corrected gestational age, but further fractures were then commented on in chest radiographs aged 3 months and 1 year corrected gestational age. Fracture sites included postero-lateral, axillary line and anterior on both left and right. Conclusion: This retrospective review has shown that rib fractures were evident on chest radiographs of about 8% of ex-preterm infants after discharge from hospital. There is a need to identify risk factors that may predispose these infants to fractures. doi:10.1016/j.bone.2009.04.162