Diagnosis of osteoporotic vertebral fractures in children

Fawaz F Alqahtani,Amaka C Offiah

doi:10.1007/s00247-018-4279-5

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.

Highlights

Mayranpaa et al [12], in their 2007 study, showed that vertebral fracture assessment produces uncertain results in children with low bone mineral density, and they argued that improvements in the image quality of lateral dual energy x-ray absorptiometry and in scoring systems for vertebral fracture assessment were necessary before this approach could be used reliably in children
Quantitative morphometric definitions [85,86,87,88] and semiquantitative assessments of vertebral fractures, including methods by Smith [89] and Kleerekoper [90] have been introduced for adults; this review focuses only on methods that have been used in children
Recent pediatric studies have shown that dual energy x-ray absorptiometry vertebral fracture assessment has similar sensitivity and specificity to radiographs with lower radiation dose; dual energy x-ray absorptiometry should be considered for vertebral fracture diagnosis in children, when feasible

Summary

Introduction

Mayranpaa et al [12], in their 2007 study, showed that vertebral fracture assessment produces uncertain results in children with low bone mineral density, and they argued that improvements in the image quality of lateral dual energy x-ray absorptiometry and in scoring systems for vertebral fracture assessment were necessary before this approach could be used reliably in children. A recent study concluded that SpineAnalyzer is a reliable and ideal system for measuring vertebral height and identifying vertebral fracture from dual energy x-ray absorptiometry scans in adults, with significant observer agreement (ranging from 96 to 98.6%) using the Genant semiquantitative method [98]. Training of current software programmes on paediatric images or development of paediatric specific software and reference values is required

Summary

Conclusion

Findings

Conflicts of interest None