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Anatomical distribution of vertebral fractures: comparison of pediatric an adult spines.

Posted by Kathy O'Brien on July 23, 2012 in Pediatrics

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Abstract

Introduction

We hypothesized that the anatomical distribution of vertebral fractures (VF) would be different in children compared with adults.

Methods

We compared the distribution of VF defined using the Genant semi-quantitative method (GSQ method) in adults (N=221; 545 fractures) and in children early in the course of glucocorticoid therapy (N = 44; 94 fractures).

Results

The average age in the adult cohort was 62.9 years (SD, 13.4 yrs), 26% were male, the mean lumbar spine Z-score was −1.0 (SD, 1.5), and the corresponding T-score was −2.4 (SD, 1.4). The pediatric cohort median age was 7.7 years (range, 2.1–16.6 years), the mean lumbar spine Z-score was −1.7 (SD, 1.5), 52% were male, and disease categories were acute lymphoblastic leukemia (66%), rheumatological conditions (21%), and nephrotic syndrome (14%). The VF distribution was biphasic in both populations, but the peaks differed in location. In adults, the peaks were at T7/T8 and at T12/L1. In children, the focus was higher in the thoracic spine, at T6/T7, and lower in the lumbar spine, at L1/L2. When children were assessed in two age-defined sub-groups, a biphasic VF distribution was seen in both, but the upward shift of the thoracic focus to T6 was observed only in the older group, with the highest rates of fracture present between ages 7 and 10 years.

Conclusions

These results suggest that the anatomical distribution of VF differs between children and adults, perhaps relating to the different shape of the immature spine, notably the changing ratio of kyphosis to lordosis.

Keywords: Biomechanics, Corticosteroid osteoporosis, Osteoporosis, Pediatrics, Radiology, Vertebral fracture


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