Partial or Total Non-Ambulation

Bone strength is impaired in motor disability

(Henderson 1995, 2002)

Henderson et al., 2002

Fracture rate

Alfred duPont hosp. for children

Fractures
Global incidence is 34%
Diagnosis N Cerebral palsy Neuromuscular disorder Myelomeningocele Chromosomal anomaly Unknown
NA, not assessed

(Paivi Kilpinen-Loisa, 2010)

Spinal fractures 7 4 NA 2 1 Peripheral fractures 5 1 1 3 -

Table 8. Etiology of disability and presence of fractures.

Patients with fractures % 25 100 14 45 50

9/36 5/5 1/7 4/9 1/2

No differences were observed in age and gender distribution or in anthropometric characteristics in children with (N=20) and without (N=39) spinal and/or peripheral

With minimal or no trauma

Stevenson et al. 2006

Low BMD
Stevenson et al. 2006

Laboratory studies (calcium, phosphorus, alkaline phosphatase) do not correlate with bone mineral density

 Cost issues Interference with metal implants and movement

The preferred method for assessing BMC and area BMD

ISCD Journal of clinical densitometry, 2007

 Includes all skeletal regions (trabecular and cortical) Low radiation Longer scan time

 Significant fracture history

Long bone fracture of LE Vertebral compression fracture Two or more long bone fracture of UE

ISCD Journal of clinical densitometry, 2007

ISCD Journal of clinical densitometry, 2007

Henderson, 2002

SCD, journal of clinical desitometry 2008

25-OH-Vit. D The major circulating form of Vit. D

Hollis, 2005

 90% <32 ng/ml 50% < 20 ng/ml

Pally et al, 2011

Age 1-3 ys 4-8 ys 9-18 ys

< 1 year 400 IU

Ca
700 mg 1000 mg 1300 mg

P
460 mg 500 mg 1250 mg

Vit. D 600 IU 600 IU 600 IU

Food and Nutrition Board of Institute of medicines new (Nov. 2010)

 Pts. with disabilities have in addition , poor dietary intake, on anticonvalscents therapy.

Caulton et al. Archives of Disease in Childhood, 2004

Wren et al. J Pediatric Orthop. 2010

Rauch et al. 2006

Henderson et all. J Pediatr, 2002

Distinct bands of increased density at the growth plates of long bone.

Zebra lines

Muderis et al. JBJS 2007

Pamidronate effect last for up to 4 years

Change of Z score of R3 during and up to 4 years after ttt

Harcke et al , Pediatr Radiol, 2011

Harcke et al , Pediatr Radiol, 2011