Bone density, structure, and estimated strength in children with congenital heart disease. A CHAMPS* cohort study.

INTRODUCTION

Children with congenital heart disease (CHD) have lower levels of physical activity, lower birth weights, and lower nutrient intake compared to their typically developing peers (TDP); which can put children with CHD at increased risk of impaired skeletal development. Therefore, the purpose of this study was to assess the bone architecture of children with CHD compared to TDP. Our secondary objective was to evaluate differences between CHD lesion complexity.

METHODS

Forty-two children with CHD 7 to 15 years of age (10.9±2.5) were age and sex-matched to 41 TDP. Peripheral quantitative computed tomography (pQCT) scans were obtained at the distal (4%) and shaft (65%, 66%) sites for the radius and tibia, respectively. pQCT bone parameters were compared between groups using multiple analysis of covariance (MANCOVA), using sex, age, height, weight, maturity, and physical activity as covariates.

RESULTS

There were no significant differences between children with CHD and TDP at the distal radius or distal tibia (p>0.05). Children with CHD had significantly lower total area, cortical content, cortical area, cortical thickness, and polar stress-strain index at the radial and tibial shaft compared to TDP (p<0.05). When sub-dividing children with CHD by lesion severity, the complex CHD group had significantly lower cortical content, cortical area, cortical thickness, and polar stress-strain index at the radius and tibia shaft when compared to TDP (p<0.05). Additionally, children with complex lesions had greater cortical density at the radius and tibia shaft when compared to TDP (p<0.05). Finally, children with simple lesions had greater cortical density at the radius shaft when compared to TDP (p<0.05).

CONCLUSION

Children with complex CHD had worse bone parameters when compared to TDP. Children with complex CHD lesions may be at increased risk of impaired bone density, structure, and estimated strength at both the radius and tibia shaft.