Pieropan Sara, Antoniazzi Franco, Tadiotto Elisa, Caldonazzi Federico, Maschio Maddalena, Aiello Giulia, Melotti Giulia, Cavarzere Paolo, Piacentini Giorgio
Pediatric Clinic, Department of Life and Reproduction Sciences, Azienda Ospedaliera Universitaria Integrata, Verona Italy.
Pediatric Clinic, Santa Chiara Hospital, Trento, Italy.
J Bone Metab. 2019 Nov;26(4):241-246. doi: 10.11005/jbm.2019.26.4.241. Epub 2019 Nov 30.
Bone marrow oedema (BMO) in children/adolescents is a rare clinical condition without an etiologic cause. It is associated with typical increased signal intensity on T2-weighted magnetic resonance images (MRI) and an increase in bone turnover in which vitamin D plays a pivotal role. No treatment guidelines for these young patients are to date available.
We performed a retrospective study in a pediatric setting of 13 patients with diagnosis of primary BMO of the foot on the basis of clinical and radiological findings. Data collection included sex, age, patient history, symptoms at presentation, clinical examination, laboratory bone turnover markers, vitamin D levels, MRI, treatment, and outcome.
Vitamin D deficiency or insufficiency was found in 76.9% of cases. All patients were treated with adequate vitamin D daily intake, a short course of analgesic therapy, physical therapy, avoiding detrimental feet and ankle immobilization. All fully recovered in 3-month lag period.
Our data highlight that environmental factors, such as underestimated articular or bone microtraumatisms, as well as joint hyper mobility, in a bone turnover milieu of vitamin D deficiency could be the cause of this clinical conditions. Adequate vitamin D supplementation, associated with physical and analgesic therapy, is crucial in the management of BMO.
儿童/青少年骨髓水肿（BMO）是一种罕见的临床病症，病因不明。它与T2加权磁共振成像（MRI）上典型的信号强度增加以及骨转换增加有关，其中维生素D起着关键作用。迄今为止，尚无针对这些年轻患者的治疗指南。
我们在儿科环境中对13例根据临床和影像学检查结果诊断为足部原发性BMO的患者进行了回顾性研究。数据收集包括性别、年龄、患者病史、就诊时症状、临床检查、实验室骨转换标志物、维生素D水平、MRI、治疗及结果。
76.9%的病例存在维生素D缺乏或不足。所有患者均接受了每日充足的维生素D摄入、短期镇痛治疗、物理治疗，并避免足部和踝关节的有害固定。所有患者在3个月的延迟期内完全康复。
我们的数据表明，在维生素D缺乏的骨转换环境中，诸如未被充分认识的关节或骨微创伤以及关节过度活动等环境因素可能是这种临床病症的病因。充足的维生素D补充以及物理和镇痛治疗在BMO的管理中至关重要。
