Marreiros Humberto, Loff Clara, Calado Eulalia
Department of Paediatric Rehabilitation, Hospital Dona Estefânia, Centro Hospitalar de Lisboa Central, Lisboa, Portugal. [corrected]
J Spinal Cord Med. 2012 Jan;35(1):9-21. doi: 10.1179/2045772311Y.0000000042.
The prevalence and morbidity associated with osteoporosis and fractures in patients with spina bifida (SB) highlight the importance of osteoporosis prevention and treatment in early childhood; however, the issue has received little attention. The method for the selection of appropriate patients for drug treatment has not been clarified.
To review the literature concerning fracture risks and low bone density in paediatric patients with SB. We looked for studies describing state-of-the-art treatments and for prevention of secondary osteoporosis.
Articles were identified through a search in the electronic database (PUBMED) supplemented with reviews of the reference lists of selected papers. The main outcome measures were incidence of fractures and risk factors for fracture, an association between bone mineral density (BMD) and occurrence of fracture, risk factors of low BMD, and effects of pharmacological and non-pharmacological treatments on BMD and on the incidence of fractures. We considered as a secondary outcome the occurrence of fractures in relation to the mechanism of injury.
Results indicated that patients with SB are at increased risk for fractures and low BMD. Risk factors that may predispose patients to fractures include higher levels of neurological involvement, non-ambulatory status, physical inactivity, hypercalciuria, higher body fat levels, contractures, and a previous spontaneous fracture. Limitations were observed in the number and quality of studies concerning osteoporosis prevention and treatment in paediatric patients with SB. The safety and efficiency of drugs to treat osteoporosis in adults have not been evaluated satisfactorily in children with SB.
脊柱裂（SB）患者中骨质疏松症及骨折的患病率和发病率凸显了幼儿期骨质疏松症预防和治疗的重要性；然而，这个问题很少受到关注。选择合适药物治疗患者的方法尚未明确。
回顾有关小儿脊柱裂患者骨折风险和低骨密度的文献。我们查找了描述最新治疗方法及继发性骨质疏松症预防的研究。
通过在电子数据库（PUBMED）中检索，并补充所选论文参考文献列表的综述来确定文章。主要结局指标为骨折发生率及骨折危险因素、骨密度（BMD）与骨折发生之间的关联、低骨密度的危险因素，以及药物和非药物治疗对骨密度和骨折发生率的影响。我们将与损伤机制相关的骨折发生情况视为次要结局。
结果表明，脊柱裂患者骨折和低骨密度风险增加。可能使患者易发生骨折的危险因素包括神经受累程度较高、非行走状态、身体活动不足、高钙尿症、体脂水平较高、挛缩以及既往自发性骨折。在小儿脊柱裂患者骨质疏松症预防和治疗的研究数量和质量方面存在局限性。治疗成人骨质疏松症药物在脊柱裂儿童中的安全性和有效性尚未得到令人满意的评估。
