Pathologic Lower Extremity Fractures in Children With Alagille Syndrome
ABSTRACT Objectives: In this retrospective study, we aimed to determine the incidence and distribution of fractures in patients with Alagille syndrome, 1 of the leading inherited causes of pediatric cholestatic liver disease. Materials and Methods: Surveys regarding growth, nutrition, and organ invo...
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Published in | Journal of pediatric gastroenterology and nutrition Vol. 51; no. 1; pp. 66 - 70 |
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Main Authors | , , , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
Hagerstown, MD
Lippincott Williams & Wilkins
01.07.2010
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Subjects | |
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Abstract | ABSTRACT
Objectives:
In this retrospective study, we aimed to determine the incidence and distribution of fractures in patients with Alagille syndrome, 1 of the leading inherited causes of pediatric cholestatic liver disease.
Materials and Methods:
Surveys regarding growth, nutrition, and organ involvement were distributed to patient families in the Alagille Syndrome Alliance of the Children's Hospital of Philadelphia research database. Patients with a history of fracture were identified by their response to 1 question, and details characterizing each patient's medical, growth, and fracture history were obtained through chart review and telephone contact.
Results:
Twelve of 42 patients (28%) reported a total of 27 fractures. Patients experienced fractures at a mean age of 5 years, which contrasts with healthy children, in whom fracture incidence peaks in adolescence. Fractures occurred primarily in the lower extremity long bones (70%) and with little or no trauma (84%). Estimated incidence rate calculations yielded 399.6 total fractures per 10,000 person‐years (95% confidence interval 206.5, 698.0) and 127.6 femur fractures per 10,000 person‐years (95% confidence interval 42.4, 297.7). There were no differences in sex, age distribution, or organ system involvement between the fracture and no‐fracture groups.
Conclusions:
Children with Alagille syndrome may be at risk for pathologic fractures, which manifest at an early age and in a unique distribution favoring the lower extremity long bones. Although this preliminary study is limited by small sample size and potential ascertainment bias, the data suggest that larger studies are warranted to further characterize fracture risk and explore factors contributing to bone fragility in these children. |
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AbstractList | : In this retrospective study, we aimed to determine the incidence and distribution of fractures in patients with Alagille syndrome, 1 of the leading inherited causes of pediatric cholestatic liver disease.
: Surveys regarding growth, nutrition, and organ involvement were distributed to patient families in the Alagille Syndrome Alliance of the Children's Hospital of Philadelphia research database. Patients with a history of fracture were identified by their response to 1 question, and details characterizing each patient's medical, growth, and fracture history were obtained through chart review and telephone contact.
: Twelve of 42 patients (28%) reported a total of 27 fractures. Patients experienced fractures at a mean age of 5 years, which contrasts with healthy children, in whom fracture incidence peaks in adolescence. Fractures occurred primarily in the lower extremity long bones (70%) and with little or no trauma (84%). Estimated incidence rate calculations yielded 399.6 total fractures per 10,000 person-years (95% confidence interval 206.5, 698.0) and 127.6 femur fractures per 10,000 person-years (95% confidence interval 42.4, 297.7). There were no differences in sex, age distribution, or organ system involvement between the fracture and no-fracture groups.
: Children with Alagille syndrome may be at risk for pathologic fractures, which manifest at an early age and in a unique distribution favoring the lower extremity long bones. Although this preliminary study is limited by small sample size and potential ascertainment bias, the data suggest that larger studies are warranted to further characterize fracture risk and explore factors contributing to bone fragility in these children. OBJECTIVES: In this retrospective study, we aimed to determine the incidence and distribution of fractures in patients with Alagille syndrome, 1 of the leading inherited causes of pediatric cholestatic liver disease. MATERIALS AND METHODS: Surveys regarding growth, nutrition, and organ involvement were distributed to patient families in the Alagille Syndrome Alliance of the Children's Hospital of Philadelphia research database. Patients with a history of fracture were identified by their response to 1 question, and details characterizing each patient's medical, growth, and fracture history were obtained through chart review and telephone contact. RESULTS: Twelve of 42 patients (28%) reported a total of 27 fractures. Patients experienced fractures at a mean age of 5 years, which contrasts with healthy children, in whom fracture incidence peaks in adolescence. Fractures occurred primarily in the lower extremity long bones (70%) and with little or no trauma (84%). Estimated incidence rate calculations yielded 399.6 total fractures per 10,000 person-years (95% confidence interval 206.5, 698.0) and 127.6 femur fractures per 10,000 person-years (95% confidence interval 42.4, 297.7). There were no differences in sex, age distribution, or organ system involvement between the fracture and no-fracture groups. CONCLUSIONS: Children with Alagille syndrome may be at risk for pathologic fractures, which manifest at an early age and in a unique distribution favoring the lower extremity long bones. Although this preliminary study is limited by small sample size and potential ascertainment bias, the data suggest that larger studies are warranted to further characterize fracture risk and explore factors contributing to bone fragility in these children. ABSTRACT Objectives: In this retrospective study, we aimed to determine the incidence and distribution of fractures in patients with Alagille syndrome, 1 of the leading inherited causes of pediatric cholestatic liver disease. Materials and Methods: Surveys regarding growth, nutrition, and organ involvement were distributed to patient families in the Alagille Syndrome Alliance of the Children's Hospital of Philadelphia research database. Patients with a history of fracture were identified by their response to 1 question, and details characterizing each patient's medical, growth, and fracture history were obtained through chart review and telephone contact. Results: Twelve of 42 patients (28%) reported a total of 27 fractures. Patients experienced fractures at a mean age of 5 years, which contrasts with healthy children, in whom fracture incidence peaks in adolescence. Fractures occurred primarily in the lower extremity long bones (70%) and with little or no trauma (84%). Estimated incidence rate calculations yielded 399.6 total fractures per 10,000 person‐years (95% confidence interval 206.5, 698.0) and 127.6 femur fractures per 10,000 person‐years (95% confidence interval 42.4, 297.7). There were no differences in sex, age distribution, or organ system involvement between the fracture and no‐fracture groups. Conclusions: Children with Alagille syndrome may be at risk for pathologic fractures, which manifest at an early age and in a unique distribution favoring the lower extremity long bones. Although this preliminary study is limited by small sample size and potential ascertainment bias, the data suggest that larger studies are warranted to further characterize fracture risk and explore factors contributing to bone fragility in these children. |
Author | Leonard, Mary B Piccoli, David A Shults, Justine Horn, David Spinner, Nancy B Loomes, Kathleen M Kamath, Binita M Nguyen, Alexander Munoz, Pedro S Bales, Christina B Grimberg, Adda |
AuthorAffiliation | 5 Department of Biostatistics and Epidemiology The University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 1 Department of Pediatrics, at The University of Pennsylvania School of Medicine Philadelphia, Pennsylvania 4 The University of Pennsylvania School of Medicine Philadelphia, Pennsylvania 2 Department of Pathology and Laboratory Medicine, at The University of Pennsylvania School of Medicine Philadelphia, Pennsylvania 3 Department of Orthopaedic Surgery at The University of Pennsylvania School of Medicine Philadelphia, Pennsylvania |
AuthorAffiliation_xml | – name: 2 Department of Pathology and Laboratory Medicine, at The University of Pennsylvania School of Medicine Philadelphia, Pennsylvania – name: 4 The University of Pennsylvania School of Medicine Philadelphia, Pennsylvania – name: 1 Department of Pediatrics, at The University of Pennsylvania School of Medicine Philadelphia, Pennsylvania – name: 5 Department of Biostatistics and Epidemiology The University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania – name: 3 Department of Orthopaedic Surgery at The University of Pennsylvania School of Medicine Philadelphia, Pennsylvania |
Author_xml | – sequence: 1 givenname: Christina B surname: Bales fullname: Bales, Christina B – sequence: 2 givenname: Binita M surname: Kamath fullname: Kamath, Binita M – sequence: 3 givenname: Pedro S surname: Munoz fullname: Munoz, Pedro S – sequence: 4 givenname: Alexander surname: Nguyen fullname: Nguyen, Alexander – sequence: 5 givenname: David A surname: Piccoli fullname: Piccoli, David A – sequence: 6 givenname: Nancy B surname: Spinner fullname: Spinner, Nancy B – sequence: 7 givenname: David surname: Horn fullname: Horn, David – sequence: 8 givenname: Justine surname: Shults fullname: Shults, Justine organization: The University of Pennsylvania School of Medicine – sequence: 9 givenname: Mary B surname: Leonard fullname: Leonard, Mary B – sequence: 10 givenname: Adda surname: Grimberg fullname: Grimberg, Adda – sequence: 11 givenname: Kathleen M surname: Loomes fullname: Loomes, Kathleen M email: loomes@email.chop.edu |
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Keywords | Human Pathologic fracture Portal circulation disease Alagille syndrome Diseases of the osteoarticular system Nutrition disorder Vitamin deficiency Cardiovascular disease Arteriohepatic dysplasia Metabolic diseases Lower extremity fracture Vascular disease Metabolic disorder Vitamin D Gastroenterology Digestive diseases Bone Osteomalacia Child Nutritional status |
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Notes | Drs Grimberg and Loomes declare joint responsibility for senior authorship. The authors report no conflicts of interest. ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Drs. Grimberg and Loomes declare joint responsibility for senior authorship |
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Objectives:
In this retrospective study, we aimed to determine the incidence and distribution of fractures in patients with Alagille syndrome, 1 of... : In this retrospective study, we aimed to determine the incidence and distribution of fractures in patients with Alagille syndrome, 1 of the leading inherited... OBJECTIVES: In this retrospective study, we aimed to determine the incidence and distribution of fractures in patients with Alagille syndrome, 1 of the leading... |
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SubjectTerms | Adolescent Adult Age Factors Alagille syndrome Alagille Syndrome - complications Alagille Syndrome - genetics Biological and medical sciences Child Child, Preschool Feeding. Feeding behavior Female fracture Fractures, Spontaneous - etiology Fractures, Spontaneous - genetics Fundamental and applied biological sciences. Psychology Gastroenterology. Liver. Pancreas. Abdomen Health Surveys Humans Incidence Infant Injuries of the limb. Injuries of the spine Liver. Biliary tract. Portal circulation. Exocrine pancreas Lower Extremity - injuries Male Medical sciences osteomalacia Other diseases. Semiology Retrospective Studies Risk Factors Traumas. Diseases due to physical agents Vertebrates: anatomy and physiology, studies on body, several organs or systems Young Adult |
Title | Pathologic Lower Extremity Fractures in Children With Alagille Syndrome |
URI | https://onlinelibrary.wiley.com/doi/abs/10.1097%2FMPG.0b013e3181cb9629 https://www.ncbi.nlm.nih.gov/pubmed/20453673 https://search.proquest.com/docview/733460554 https://pubmed.ncbi.nlm.nih.gov/PMC2893241 |
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