青春期孩童骨密度低會增加骨折風險


  September 19, 2006 (費城) -- 青春期的時候,孩童的總骨密度若低於平均值或者骨架太小和身體體型不符,可能會有骨折的高風險;這是首次對此一族群進行的前溯世代研究的結論,在此間舉行的美國骨質研究年會中發表,此研究同時也登載在最近的Journal of Bone and Mineral Research期刊中。
  
  本研究包含7333位孩童(研究開始時的年紀約為10歲),是英國西南普遍人口生育世代的一部分,這些孩童半數為女孩,大多數(96%)是白人,每一位小孩接受骨密度檢查 (DEXA),這些結果被用來決定骨骼範圍和頭部以外的身體總骨密度。
  
  這些小孩中的6200位完成整整兩年的研究,每年調查其是否有發生任何骨折事件,共有550位(9%)小孩在這兩年中有發生至少一次的骨折,約半數是發生下肢創傷事件,如輕微跌倒或一般運動傷害。
  
  和這些青春期少年骨折有強烈關聯的因素是總骨密度,依其身高、體重、性別和其他相關因素校正,這些結果顯示,當估計之容積骨密度每降低一個標準差時,就增加 89%的骨折風險;而將參與研究前即有骨折經驗的小孩排除後,仍有類似的關聯。
  
  本研究中發現之預測骨折的次強因子,是小孩10歲時相對於身體體型的骨骼尺寸,結果顯示,當相對於身體體型的骨骼尺寸每降低一個標準差時,就增加 51%的骨折風險。
  
  主要研究者英國Bristol大學的臨床研究員Emma Clark醫師表示,或許可以認為在青春期早期會有骨折的暫時風險期。
  
  Clark醫師指出,許多這一年紀的小孩正經歷骨骼的快速成長期,骨骼快速延展,而骨骼直徑成長則沒那麼快速,造成潛在的骨折風險;她表示,這一年紀中瘦高型的小孩看似更容易發生骨折,此一類型小孩的骨骼相對較小。
  
  發表時的主持人,加拿大Memorial大學醫學教授Christopher Kovacs醫師表示,這些有關孩童時期骨折風險的觀察是重要的原因,有以下兩個理由。
  
  他表示,骨折在小孩常見,而最近的研究顯示孩童期骨折率在最近幾年急劇上升,而造成此情況的原因則尚不清楚。
  
  Kovacs醫師表示,此外,在20或25歲時可達到的骨密度和骨強度,是未來面對停經或年紀等因素所帶來之骨骼風險時恢復力的重要預測因素,這個研究和目前此一領域中的其他小兒研究,確認早期風險因素確有其影響力,或許我們應採取某些方式以對此有進一步的認知和因應。
  
  不過,共同作者英國Bristol皇家醫院的Jon Tobias醫師表示,這並不意指DEXA影像或者骨骼治療在此刻是必要的。
  
  Tobias醫師表示,對於小孩發生骨折並非本研究所關切的本質,而是一旦我們可以了解為何小孩發生骨折,將可為我們對其之後的人生所發生的(骨折事件)有更好的觀點,這觀點就是如果你可以在早期儘可能發展骨骼,就可以幫助你降低未來發生骨質疏鬆或骨折的風險。
  
  Tobias醫師補充,此一研究也指出骨骼健康是同樣重要的,不僅只關注骨質,同時也要關注骨骼大小、形狀和寬度,這些和骨折風險的關聯都遠比單純DEXA掃描結果為高。
  
  ASBMR 28屆年會:摘要1068。發表於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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