BACKGROUND: Postoperative bone density loss is an accepted phenomenon that has not been objectively quantified. The extent of this bone loss is documented using preoperative and postoperative dual energy x-ray absorptiometry scans to demonstrate the magnitude of the problem and to underline the need for prevention and treatment. METHODS: Children undergoing lower extremity surgery who required a minimum of 4 weeks of either non-weight bearing or cast immobilization postoperatively were recruited to undergo preoperative and postoperative dual energy x-ray absorptiometry scans of lumbar spine and both distal femora. Percent change in bone mineral density (BMD) as well as Z-scores in preoperative and postoperative scans were compared, as were operated and nonoperated limbs, using paired t tests. RESULTS: Fifteen of 18 subjects completed the second scan. Children lost up to 34% BMD in the cancellous region of the operated leg (average, 16.5%), up to 28% in transitional bone (average, 11.5%), and up to 16% (average, 4.8%) in the cortical region (P < 0.05). The Z-scores fell 1.0 SD for cancellous, 0.75 transitional, and 0.45 cortical. CONCLUSIONS: That children can lose up to 34% of BMD in 4 to 6 weeks is sobering. A 1 SD drop in T score, in adults, can infer a 2-fold increase in fracture risk. This may be insignificant in a healthy child with good BMD, but to a chronically ill child, a doubling of fracture risk may lead to insufficiency fracture. Avoiding the problem and proactive treatment are the goals. LEVEL OF EVIDENCE: Level I, prospective diagnostic study.
BACKGROUND: Postoperative bone density loss is an accepted phenomenon that has not been objectively quantified. The extent of this bone loss is documented using preoperative and postoperative dual energy x-ray absorptiometry scans to demonstrate the magnitude of the problem and to underline the need for prevention and treatment. METHODS:Children undergoing lower extremity surgery who required a minimum of 4 weeks of either non-weight bearing or cast immobilization postoperatively were recruited to undergo preoperative and postoperative dual energy x-ray absorptiometry scans of lumbar spine and both distal femora. Percent change in bone mineral density (BMD) as well as Z-scores in preoperative and postoperative scans were compared, as were operated and nonoperated limbs, using paired t tests. RESULTS: Fifteen of 18 subjects completed the second scan. Children lost up to 34% BMD in the cancellous region of the operated leg (average, 16.5%), up to 28% in transitional bone (average, 11.5%), and up to 16% (average, 4.8%) in the cortical region (P < 0.05). The Z-scores fell 1.0 SD for cancellous, 0.75 transitional, and 0.45 cortical. CONCLUSIONS: That children can lose up to 34% of BMD in 4 to 6 weeks is sobering. A 1 SD drop in T score, in adults, can infer a 2-fold increase in fracture risk. This may be insignificant in a healthy child with good BMD, but to a chronically ill child, a doubling of fracture risk may lead to insufficiency fracture. Avoiding the problem and proactive treatment are the goals. LEVEL OF EVIDENCE: Level I, prospective diagnostic study.
Authors: David R Weber; Alison Boyce; Catherine Gordon; Wolfgang Högler; Heidi H Kecskemethy; Madhusmita Misra; Diana Swolin-Eide; Peter Tebben; Leanne M Ward; Halley Wasserman; Christopher Shuhart; Babette S Zemel Journal: J Clin Densitom Date: 2019-07-10 Impact factor: 2.617