青春期孩童骨密度低会增加骨折风险


  September 19, 2006 (费城) -- 青春期的时候,孩童的总骨密度若低于平均值或者骨架太小和身体体型不符,可能会有骨折的高风险;这是首次对此一族群进行的前溯世代研究的结论,在此间举行的美国骨质研究年会中发表,此研究同时也登载在最近的Journal of Bone and Mineral Research期刊中。
  
  本研究包含7333位孩童(研究开始时的年纪约为10岁),是英国西南普遍人口生育世代的一部分,这些孩童半数为女孩,大多数(96%)是白人,每一位小孩接受骨密度检查 (DEXA),这些结果被用来决定骨骼范围和头部以外的身体总骨密度。
  
  这些小孩中的6200位完成整整两年的研究,每年调查其是否有发生任何骨折事件,共有550位(9%)小孩在这两年中有发生至少一次的骨折,约半数是发生下肢创伤事件,如轻微跌倒或一般运动伤害。
  
  和这些青春期少年骨折有强烈关联的因素是总骨密度,依其身高、体重、性别和其它相关因素校正,这些结果显示,当估计之容积骨密度每降低一个标准差时,就增加 89%的骨折风险;而将参与研究前即有骨折经验的小孩排除后,仍有类似的关联。
  
  本研究中发现之预测骨折的次强因子,是小孩10岁时相对于身体体型的骨骼尺寸,结果显示,当相对于身体体型的骨骼尺寸每降低一个标准差时,就增加 51%的骨折风险。
  
  主要研究者英国Bristol大学的临床研究员Emma Clark医师表示,或许可以认为在青春期早期会有骨折的暂时风险期。
  
  Clark医师指出,许多这一年纪的小孩正经历骨骼的快速成长期,骨骼快速延展,而骨骼直径成长则没那么快速,造成潜在的骨折风险;她表示,这一年纪中瘦高型的小孩看似更容易发生骨折,此一类型小孩的骨骼相对较小。
  
  发表时的主持人,加拿大Memorial大学医学教授Christopher Kovacs医师表示,这些有关孩童时期骨折风险的观察是重要的原因,有以下两个理由。
  
  他表示,骨折在小孩常见,而最近的研究显示孩童期骨折率在最近几年急剧上升,而造成此情况的原因则尚不清楚。
  
  Kovacs医师表示,此外,在20或25岁时可达到的骨密度和骨强度,是未来面对停经或年纪等因素所带来之骨骼风险时恢复力的重要预测因素,这个研究和目前此一领域中的其它小儿研究,确认早期风险因素确有其影响力,或许我们应采取某些方式以对此有进一步的认知和因应。
  
  不过,共同作者英国Bristol皇家医院的Jon Tobias医师表示,这并不意指DEXA影像或者骨骼治疗在此刻是必要的。
  
  Tobias医师表示,对于小孩发生骨折并非本研究所关切的本质,而是一旦我们可以了解为何小孩发生骨折,将可为我们对其之后的人生所发生的(骨折事件)有更好的观点,这观点就是如果你可以在早期尽可能发展骨骼,就可以帮助你降低未来发生骨质疏松或骨折的风险。
  
  Tobias医师补充,此一研究也指出骨骼健康是同样重要的,不仅只关注骨质,同时也要关注骨骼大小、形状和宽度,这些和骨折风险的关联都远比单纯DEXA扫描结果为高。
  
  ASBMR 28届年会:摘要1068。发表于September 16, 2006.

Lower Bone Mass in Pubertal Ch

By Jennifer Reid Holman, MA
Medscape Medical News

September 19, 2006 (Philadelphia) — During puberty, children with lower-than-average total bone mass or bones that are small relative to their body size may be at considerably higher risk for bone fractures. That was the conclusion of the first prospective cohort study on the subject, which was presented here at the American Society of Bone Mineral Research annual meeting. The results were also published in the current issue of the Journal of Bone and Mineral Research.

The study included 7333 children (about 10 years of age at baseline) who were part of a larger population-based birth cohort in southwestern England. About half of the children were girls and most (96%) were white. Each child underwent dual-energy x-ray absorptiometry (DEXA). These results were used to determine bone area and total body (less head) bone mineral content.

About 6200 of the children were followed for the full 2-year study period and surveyed annually about whether they had experienced any fractures. A total of 550 children (9%) had at least 1 fracture during those 2 years. About half of these were related to low-trauma events, such as minor falls or low-energy sports injuries.

The strongest association with bone fracture in these pubescent children was total bone mass, adjusted for their height, weight, sex, and other relevant factors. These results showed an 89% increase in fracture risk per standard deviation decrease in estimated volumetric bone density. A similar association was seen even after excluding children who had experienced fractures prior to entering the study.

The second strongest predictor of bone fracture in this study was the children's bone size relative to their body size at around age 10 years. The results showed a 51% increase in fracture risk per standard deviation decrease in bone size relative to body size.

That may suggest that a transient risk period occurs for fracture around early puberty, said lead researcher Emma Clark, MD, clinical research fellow at the University of Bristol in the United Kingdom.

"Many children of this age are experiencing a rapid growth spurt in bone lengthening before that bone grows in other dimensions as well," Dr. Clark said, making bone potentially more vulnerable to fracture. "It's the long skinny child that seems to fracture more easily at this age," she said, as well as the child whose height and weight is similar to peers but whose bones are relatively smaller.


Such insights about childhood fracture risks are important for 2 reasons, said session moderator Christopher Kovacs, MD, professor of medicine at the Memorial University of Newfoundland in Canada.

Fractures are common in children, and recent studies show that childhood fracture rates have increased dramatically in the recent years, he said, although the reasons are still unclear.

In addition, "how much bone mass and bone strength you reach by about age 20 or 25 is a great predictor of how resilient you'll be to the bone risks that come with menopause, and aging," Dr. Kovacs said. "What's interesting about this and other pediatric studies being done now in this area is the recognition that earlier risk factors may be at play and perhaps with more knowledge we may be able to modify them in some way."

That doesn't mean DEXA imaging or bone therapies are warranted in children at this point, says coauthor Jon Tobias, MD, PhD, from the Bristol Royal Infirmary in the United Kingdom.

"It's not really a concern in and of itself that a child has a fracture. But if we can understand why kids might have fractures, that might give us better insight into what happens in later life as well," Dr. Tobias said. "It may be that if you can maximize bone development in early life, it may help to decrease your risk for osteoporosis or fracture in later life.

"What the study highlights, too, is that we now realize that bone health is about more than just bone mass, it's also about bone size, shape, and width," Dr. Tobias added. "These things are much more related to fracture risk than just a pure DEXA scan result."

ASBMR 28th Annual Meeting: Abstract 1068. Presented September 16, 2006.

    
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