Bone mineral density and bone scintigraphy in children and adolescents with osteomalacia

Abstract

In order to demonstrate the role of bone mineral density (BMD) measurement and bone scans in the management of patients with osteomalacia, radioisotope bone scintigraphy using technetium-99m methylene diphosphonate (MDP) and BMD measurements of the lumbar spine and femur by means of dual X-ray absorptiometry (DXA) were performed at the time of diagnosis and 6 months after therapy in 26 Saudi patients (17 females and nine males). Their mean age was 13.5 years (range, 5-16). BMD measurements were compared with those of normal Saudi subjects matched for age and sex. Bone scan showed an increase in tracer uptake throughout the skeleton ("superscan") in all children and demonstrated multiple stress fractures in eight. The mean BMD for the lumbar spine was 0.53 g/cm2 (Z-score, -3.1) and for the femoral neck 0.55 g/cm2 (Z-score, -2.8). Repeated bone scan and BMD after 6 months of therapy with oral vitamin D, calcium and proper sun exposure demonstrated a significant increase (P<0.001) in BMD and healing of pseudofractures. In conclusion, as a non-invasive method with minimal radiation exposure, measurements of BMD in children with osteomalacia are to be recommended in the initial assessment of the severity of osteopenia and in the follow-up to monitor the response to therapy. Bone scintigraphy is valuable in demonstrating the site and severity of stress fractures.

Vitamin D Deficiency and Pseudofractures in Child-Bearing Egyptian Women: Successful Medical Treatment Helps to Avoid Fractures and Surgical Interference

“…A pseudofracture may be transferred to a true fracture, as a result of stress on the weak bone zone. No patient in our study got a true fracture as we agree with other authors [29]- [32], who reported that Pseudofractures often heal with calcium and vitamin D supplements if the diagnosis is made early. But, we add to them the high index of suspicion and adherence of the patients to the treatment protocol and instructions to avoid the potentially serious complications including true fractures.…”

Vitamin D and skeletal health in infancy and childhood

“…No differences in mineralisation were identified. Conversely, a report of 26 children and adolescents with osteomalacia and/or rickets in Saudi Arabia suggested that aBMD z-scores at the LS and FN femur were reduced, and that these improved following calcium and vitamin D therapy [52]. It is unclear though whether these differences were statistically significant.…”

“…El Desouki et al performed total body scintigraphy in 26 children and adolescents with rickets or osteomalacia. They reported that "multiple stress fractures" were present in 8 (31%) of the participants and healing was evident 6 months after vitamin D and calcium therapy [52]. However, these "pseudofractures" were not confirmed radiologically, and may have represented Looser zones rather than true fractures.…”

Effect of monthly high‐dose vitamin D on bone density in community‐dwelling older adults substudy of a randomized controlled trial

“…Despite the generally null findings of randomized controlled trials of vitamin D supplementation on bone end‐points, it is quite clear that very low levels of vitamin D result in osteomalacia, which is associated with reduced bone density as well as with musculoskeletal symptoms. Treatment of osteomalacia results in substantial increases in bone density . It has not been established what the threshold is, in terms of baseline serum 25‐hydroxyvitamin D, for any beneficial effects of vitamin D supplementation on bone density to occur.…”