Bone density in children and adolescents with cystic fibrosis☆,☆☆,★,★★
Section snippets
METHODS
The study was a cross-sectional, observational evaluation. All patients included in the previous study of thoracic kyphosis and fracture11 who were less than 18 years of age and returned to the University of North Carolina pediatric pulmonary outpatient clinics during the study enrollment period were invited to undergo the evaluation. The participants were 34 male and 28 female subjects ranging in age from 4.9 to 17.8 years, with a mean age of 10.7 ± 3.6 years (±SD). Informed consent approved
RESULTS
Bone density z scores decreased across the age range of 4 to 18 years, with a slope of 0.15 SD per year in the lumbar vertebrae (linear regression analysis: SE = 0.03, R2 = 0.25, p = 0.0001) and 0.13 per year in the proximal femur (SE = 0.04, R2 = 0.15, p = 0.003). Separate analyses for male and female subjects showed no significant differences (p >0.1). For the entire group, the mean BMD z score was –1.03 ± 0.14 (±SE) in the lumbar vertebrae and –0.71 ± 0.17 in the proximal femur.
DISCUSSION
As patients with CF live longer, the effect of the disease on growth and development of the immature skeleton becomes important. Bone mineral density in the lumbar vertebrae and proximal femur, normalized for age (z scores), decreased roughly 1 SD every 6 to 8 years across the age range of 4 to 18 years. This finding is consistent with the data of others who have used dual-energy x-ray absorptiometry to study BMD in adults with CF.5, 6, 28 In contrast to our findings in children, bone mineral
Acknowledgements
We thank Debra Riggs, RT, for technical assistance with the dual-energy x-ray absorptiometry studies; Gayle Lester, PhD, of the Division of Orthopaedics research laboratories, for her help with the vitamin D assays; Julie Dickinson, MStat, and Ralph DeMasi, PhD, for the statistical analyses; and Drs. Gerald Fernald, Robert Wood, Marianna Henry, and the other members of the University of North Carolina Division of Pediatric Pulmonary Medicine for their help with this study.
References (40)
- et al.
Vitamin D metabolites in adolescents and young adults with cystic fibrosis: effects of sun and season
J PEDIATR
(1985) - et al.
Reduced serum 25-hydroxyvitamin D concentration and disordered mineral metabolism in patients with cystic fibrosis
J PEDIATR
(1979) - et al.
Osteopenia in adults with cystic fibrosis
Am J Med
(1994) - et al.
Some biochemical indices of nutrition in treated cystic fibrosis patients
Am J Clin Nutr
(1981) - et al.
Osteoporosis in cystic fibrosis
J PEDIATR
(1988) - et al.
Kyphosis and fractures in children and young adults with cystic fibrosis
J PEDIATR
(1994) - et al.
Body composition analysis by dual-energy x-ray absorptiometry in adults with cystic fibrosis
Chest
(1994) - et al.
Growth patterns in children with cystic fibrosis
J PEDIATR
(1964) - et al.
Bone densitometry of the spine and femur in children by dual-energy x-ray absorptiometry
Bone Miner
(1992) - et al.
Influences on skeletal mineralization in children and adolescents: evidence for varying effects of sexual maturation and physical activity
J PEDIATR
(1994)
Mineralization in children and adolescents with a milk allergy
Bone Miner
Energy expenditure of patients with cystic fibrosis
J PEDIATR
Clinical features, survival rate, and prognostic factors in young adults with cystic fibrosis
Am J Med
A new prognostic score and clinical evaluation system for cystic fibrosis
J PEDIATR
Hypovitaminosis D and response to supplementation in older patients with cystic fibrosis
Q J Med
Vitamin D and parathyroid hormone and bone mineralization in adults with cystic fibrosis
Thorax
Bone mineral density and body composition in adult patients with cystic fibrosis
Thorax
Demineralization in cystic fibrosis
Arch Pediatr Adolesc Med [Am J Dis Child]
Low serum bone gamma-carboxyglutamic acid protein concentrations in patients with cystic fibrosis: correlation with hormonal parameters and bone mineral density
Horm Res
Changes in vertebral bone density in black girls and white girls during childhood and puberty
N Engl J Med
Cited by (0)
- ☆
From the Departments of Orthopedics and Pediatrics, University of North Carolina, Chapel Hill
- ☆☆
Supported by the General Clinical Research Center at the University of North Carolina under grant No. M01-RR00046.
- ★
Reprint requests: Richard C. Henderson, MD, PhD, University of North Carolina, 237 Burnett-Womack Building, CB No.7055, Chapel Hill, NC 27599-7055.
- ★★
0022-3476/96/$5.00 + 0 9/20/68474