Bone mineral status in pediatric heart transplant recipients: a retrospective observational study of an "at risk" cohort.

There is a paucity of literature assessing the burden of bone loss in PHT recipients. We sought to describe the bone mineral status in PHT recipients by doing a retrospective medical record review of those who underwent evaluation of BMD when clinically indicated. Data collected included patient demographics, BMD evaluations, serum calcium, phosphorus, alkaline phosphatase, cumulative steroid dose, osseous complications and their management. Of 149 PHT recipients, 26 underwent BMD evaluation. This evaluation was done at a median of 3.4 yrs after PHT. There total serum calcium, phosphorus and alkaline phosphatase were similar at transplant and BMD study. The median BMD Z-scores were: whole body -0.09 (1.5 to -5.13) and lumbar spine -1.1 (1.5 to -5.16). Bone loss (Z-score <-1) was present in 14 (53.8%). Three patients had spinal fractures and/or avascular necrosis of various bones. Treatment included calcitrol and bisphosphonates; and vertebroplasty for spinal fracture. Bone loss was present in a significant proportion of PHT recipients and may be associated with fractures and avascular necrosis. More than half of our "at risk" cohort had bone loss. Careful surveillance of these patients should be performed to prevent morbidity.

Spine bone densitometry in asthmatic children treated with high dose corticosteroids: correcting for racial discrepancies.

PURPOSE: Our hypothesis is that the use of standards based on Caucasian children will under-estimate the incidence of abnormal bone density in African American children. MATERIALS AND METHODS: Eighty-two African American and 80 Caucasian asthmatic children classified as high-dose inhaled corticosteroid users comprised the study population. Bone mineral density measurements were compared to reference standards, based on Caucasians, to calculate Z-values. Regression analysis was used to compare Z-values derived from the race-specific and Caucasian standards for 32 African American children. The derived regression analysis equation was then applied to the entire African American population to determine the incidence of abnormal bone density. RESULTS: The asthmatic Caucasian mean spine bone density was significantly less than the normal standards (p < .001), but the African American mean spine bone density was not, despite the high-dose steroid use. Using the Caucasian standards, Caucasians were significantly more likely to have abnormal bone density detected (p < 0.015). Regression analysis of the 32 children with available race specific standards resulted in the following equation: Z African American= Z Caucasian-0.86. The number of African Americans with abnormal bone density detected using the regression equation was not significantly different than the Caucasian children (p > 0.12). CONCLUSIONS: Asthmatic African Americans treated with high-dose inhaled corticosteroids had denser bones than Caucasians. Caucasian standards can be adjusted using a regression equation.