Diagnosis of osteoporotic vertebral fractures in children

Abstract

Osteoporosis is a generalised disorder of the skeleton with reduced bone density and abnormal bone architecture. It increases bone fragility and renders the individual susceptible to fractures. Fractures of the vertebrae are common osteoporotic fractures. Vertebral fractures may result in scoliosis or kyphosis and, because they may be clinically silent, it is imperative that vertebral fractures are diagnosed in children accurately and at an early stage, so the necessary medical care can be implemented. Traditionally, diagnosis of osteoporotic vertebral fractures has been from lateral spine radiographs; however, a small number of studies have shown that dual energy x-ray absorptiometry is comparable to radiographs for identifying vertebral fractures in children, while allowing reduced radiation exposure. The diagnosis of vertebral fractures from dual energy x-ray absorptiometry is termed vertebral fracture assessment. Existing scoring systems for vertebral fracture assessment in adults have been assessed for use in children, but there is no standardisation and observer reliability is variable. This literature review suggests the need for a semiautomated tool that (compared to the subjective and semiquantitative methods available) will allow more reliable and precise detection of vertebral fractures in children.

Keywords: Children; Diagnostic scoring system; Dual energy x-ray absorptiometry; Osteoporosis; Vertebral fracture; Vertebral fracture assessment.

Fig. 1

An 11-year-old boy with osteogenesis imperfecta. a-c Lateral thoracic (a) and lumbar spine (b) radiographs are juxtaposed to a lateral spine dual energy x-ray absorptiometry scan (c) performed on the same day. The image quality of (c) is non-inferior to (a) and (b), with the advantage of being a single image

Fig. 2

Selected lateral spine dual energy x-ray absorptiometry scans from a series of patients demonstrate the semiquantitative visual grading system of Genant et al. [10]

Fig. 3

A 14-year-old girl with osteogenesis imperfecta. Lateral spine dual energy x-ray absorptiometry scan illustrates positioning of points used to outline the vertebral bodies between T4 and L4 using the SpineAnalyzer program. SpineAnalyzer identified a severe fracture at T11, moderate fractures at T5 and T6 and mild fractures at T7 and T8. The arrow points to the T12 vertebral body (lowest vertebral body associated with a rib). SQ Semiquantitative, Bicon. Biconcave