Vertebral fractures in children with osteoporosis.

Background. The aim of our study was to analyze the results of biochemical, densitometic and calcaneous ultrasound examination in children with vertebral fractures. Material and methods. The study involved 19 patients (7 girls, 12 boys) with pathological vertebral fractures diagnosed radiologically. Bone mineral densitometry (DXA method) and ultrasound examinations of the calcaneous bone were performed. The biochemical examinations including serum concentration and diurnal elimination of calcium, phosphorus and magnesium. Concentrations of parathormon (PTH) were assessed by radioimmunometry, and 25OHD by the Elisa method. Results. Fifteen children had back pain complaints; in 5 cases there had been vertebral trauma before diagnosis, and in 12 at least one fracture of a long bone. The most common fractures occurred at Th6-L1 and L4- L5. Fractures of only one vertebra appeared in 3 children. In 10 patients the DXA Z-score was below -2.0, and in 7 from -1.0 to -2.0. In 11 patients at least one of the ultrasound parameters fell below -2.0. Seven patients had a low concentration of 25OHD and PTH, and there were 5 cases of hypomagnesemia. Conclusions. In children with pain complaints from the vertebral region and a significant quantitative decrease of bone mineral density (even without clinical symptoms), lateral X-rays of the lower thoracic and lumbar region are indicated. Pathological vertebral fractures (after exclusion of local changes and metastases) should be an important diagnostic criterion for osteoporosis regardless of quantitative bone examination results.