Risk Factors for Osteoporosis in Children & Adolescents with Myelomeningocele

儿童骨质疏松症的危险因素

• 批准号: 8442319
• 负责人: TISHYA A L WREN
• 金额: $ 44.97万
• 依托单位: CHILDREN'S HOSPITAL OF LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-05-01 至 2015-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8442319
• 关键词: 16 year old; Adolescence; Adolescent; Age; Americas; Area; Bone Density; Characteristics; Child; Complex; Congenital Abnormality; Contracture; Development; Dietary intake; Failure; Fracture; Gait; Image; Interview; Joints; Kyphosis deformity of spine; Life; Longevity; Lower Extremity; Measures; Mechanics; Medical History; Meningomyelocele; Monitor; Musculoskeletal; Neurologic; Osteogenesis; Osteoporosis; Osteoporosis prevention; Paralysed; Persons; Physical Examination; Population; Pregnancy; Property; Puberty; Research Priority; Risk; Risk Factors; Severities; Sexual Development; Skeleton; Spinal Cord; Spinal Dysraphism; Spinal nerve structure; Staging; Stimulus; Study Subject; Vertebral column; Walking; Wheelchairs; X-Ray Computed Tomography; bone; bone mass; cohort; computerized; critical period; follow-up; gait examination; osteoporosis with pathological fracture; prevent; public health relevance; scoliosis; skeletal; tibia

DESCRIPTION (provided by applicant) Spina bifida or myelomeningocele (MM) is the most common permanently disabling condition in the U.S. and one of the most complex birth defects compatible with life. It is caused by failure of the spinal column to close completely during the first month of pregnancy, resulting in varying degrees of paralysis and weakness in the lower extremities. Osteoporosis and fractures are common problems in this population, most likely due to decreased ambulation and mechanical loading of the skeleton. A top priority for research in spina bifida is the identification of risk factors for osteoporosis and subsequent mitigation of these risk factors to prevent osteoporosis and osteoporotic fractures. Since adolescence is a critical period for bone acquisition in non-disabled children, it is hypothesized that bone mass may be maximized in children with MM by maintaining upright mobility (walking) as long as possible through adolescence. This study will identify risk factors for osteoporosis in MM, particularly risk factors related to ambulation and mechanical loading of the skeleton. The specific aims are (1) to examine longitudinal changes in bone density, size, and structural (strength) properties in children and adolescents with MM and to compare these changes with those in typically developing controls, (2) to identify potential risk factors for deficient bone acquisition and the development of osteoporosis, including level of neurological involvement, ambulatory status, gait characteristics, and amount of walking (steps per day), and (3) to explore whether maintaining ambulation (upright mobility) through adolescence is associated with significant gains in bone mass. To achieve these aims, children and adolescents with MM ages 6-13 years and controls of the same age will be assessed longitudinally over a 3-year follow-up period. Bone density, size, and strength will be measured in the tibia using computed tomography (CT) imaging. Gait characteristics will be measured through three-dimensional computerized gait analysis, and the amount of walking will be quantified with an activity monitor. To fully characterize the study subjects, other relevant information will also be obtained, including medical history, physical examination, Tanner stage of sexual development, skeletal age, dietary intake, and major determinants of bone formation. The bone properties will be related to the other measures to identify the most important risk factors for osteoporosis and to assess the importance of upright mobility (walking) in stimulating bone acquisition in children and adolescents with MM.

描述（由申请人提供）脊柱裂或脊髓脊膜膨出（MM）是美国最常见的永久性致残疾病，也是最复杂的出生缺陷之一。它是由于在怀孕的第一个月脊柱不能完全闭合，导致不同程度的下肢瘫痪和无力。骨质疏松和骨折是这一人群的常见问题，很可能是由于活动减少和骨骼的机械负荷。脊柱裂研究的首要任务是确定骨质疏松症的危险因素，并随后减轻这些危险因素以预防骨质疏松症和骨质疏松性骨折。由于青春期是非残疾儿童骨骼获得的关键时期，因此假设在青春期尽可能长时间地保持直立活动（行走）可以使MM儿童的骨量最大化。本研究将确定MM骨质疏松症的危险因素，特别是与行走和骨骼机械负荷有关的危险因素。具体目的是：(1)检查骨密度、大小和骨结构（强度）特性的纵向变化，并将这些变化与典型发展对照进行比较；(2)确定骨获取不足和骨质疏松症发展的潜在危险因素，包括神经系统受损伤水平、走动状态、步态特征和步行量（每天步数）。(3)探讨在青春期维持行走（直立活动）是否与骨量的显著增加有关。为了实现这些目标，6-13岁的MM儿童和青少年以及相同年龄的对照组将在3年的随访期间进行纵向评估。骨密度，大小和强度将在胫骨测量使用计算机断层扫描（CT）成像。步态特征将通过三维计算机步态分析来测量，步行量将通过活动监视器来量化。为了充分描述研究对象的特征，还将获得其他相关信息，包括病史、体格检查、Tanner性发育阶段、骨骼年龄、饮食摄入量和骨形成的主要决定因素。骨特性将与其他措施相关，以确定骨质疏松症最重要的危险因素，并评估直立活动（行走）在刺激MM儿童和青少年骨获取中的重要性。