Bone microarchitecture assessed by trabecular bone score is independent of mobility level or height in pediatric patients with cerebral palsy

Rehberg, Mirko; Azim, Manuela; Martakis, Kyriakos; Winzenrieth, Renaud; Hoyer‐Kuhn, Heike; Schoenau, Eckhard; Semler, Oliver; Duran, Ibrahim

Affiliations

¹Department of Pediatrics, University of Cologne, Medical Faculty and University Hospital, Cologne, Germany

²Department for Pediatric Neurology, Social Pediatrics and Epileptology, Justus-Liebig University Giessen and University Hospital of Giessen and Marburg (UKGM), Giessen, Germany

³Department of International Health, School Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands

⁴R&D Department, Medimaps Société par Actions Simplifiée Unipersonnelle (SASU), Merignac, France

⁵Center of Prevention and Rehabilitation, University Hospital Cologne, Cologne, Germany

⁶Cologne Centre for Rare Skeletal Dysplasia in Childhood, University Hospital Cologne, Cologne, Germany

Abstract and keywords

Bone strength and fracture risk do not only depend on bone density, but also on bone structure. The trabecular bone score (TBS) evaluates homogeneity of bone microarchitecture indirectly by measuring gray‐level variations of two‐dimensional (2D) DXA images. Although TBS is well‐established for adults, there have been only few publications in pediatrics. In this monocentric retrospective analysis, we investigated TBS in children and adolescents with cerebral palsy (CP), a patient group vulnerable to low bone mineral mass due to impaired mobility. The influence of different parameters on TBS and areal BMD (aBMD) were evaluated, as well as the relationship between TBS and aBMD. We compared TBS values of our study population to a reference population. A total of 472 lumbar spine–dual‐energy X‐ray absorptiometry (LS‐DXA) scans of children and adolescents with CP (205 female), aged between 4 and 18 years, were analyzed. The DXA‐scans were part of the routine examination. The children had no records of fractures or specific bone diseases. Our study population with CP had similar TBS as the reference population. TBS did not increase with age until an inflection point at 10 years in females, and 12 years in males. Girls had significantly higher TBS than boys (p = .049) and pubertal girls aged 8 to 13 years had significantly higher TBS than prepubertal girls (p = .009). TBS standard deviation score for age (SDS‐TBS) and aBMD Z‐scores correlated weakly (p R = 0.276 [males], R = 0.284 [females]). Other than for aBMD Z‐scores, SDS‐TBS was not influenced by age‐adjusted height Z‐scores and there was no significant difference in SDS‐TBS when grouped by mobility levels, using the Gross Motor Function Classification System (GMFCS). Our results indicate that children with CP have a similar homogeneous distribution of trabecular microarchitecture as controls. Puberty initiation appears to be essential for increase of TBS with age and for sex differences. TBS seems less influenced by body composition, height, and mobility than aBMD.

Keywords: ANALYSIS/QUANTITATION OF BONE, DXA; BONE‐MUSCLE INTERACTIONS; OSTEOPOROSIS; SCREENING

Links

DOI: 10.1002/jbmr.4047

PubMed: 32395832

WoS: 000536703200001

History

Received: 2019-10-28

Revised: 2020-04-29

Accepted: 2020-05-4

Online: 2020-06-1

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Cited By (3)

Year	Entry
2021	Ferreira CR, Kavanagh D, Oheim R, Zimmerman K, Stürznickel J, Li X, Stabach P, Rettig RL, Calderone L, MacKichan C, Wang A, Hutchinson HA, Nelson T, Tommasini SM, von Kroge S, Fiedler IAK, Lester ER, Moeckel GW, Busse B, Schinke T, Carpenter TO, Levine MA, Horowitz MC, Braddock DT. Response of the ENPP1-deficient skeletal phenotype to oral phosphate supplementation and/or enzyme replacement therapy: comparative studies in humans and mice. J Bone Miner Res. May 2021;36(5):942-955.
2022	Kalkwarf HJ, Shepherd JA, Hans D, Rodriguez EG, Kindler JM, Lappe JM, Oberfield S, Winer KK, Zemel BS. Trabecular bone score reference values for children and adolescents according to age, sex, and ancestry. J Bone Miner Res. April 2022;37(4):776-785.
2023	Valenzuela Riveros LF, Long J, Bachrach LK, Leonard MB, Kent K. Trabecular bone score (TBS) varies with correction for tissue thickness versus body mass index: implications when using pediatric reference norms. J Bone Miner Res. April 2023;38(4):493-498.