MDF Magazine Issue 62 7 August 2020 (7)

Healthy
Calcium is a nutrient that strengthens bone. In addition,
vitamin D helps your body absorb calcium, and together
they help build and maintain bone. This is why it is
recommended to have adequate levels of calcium and
vitamin-D to optimize bone health. Annual assessments of
calcium intake and blood vitamin-D levels (via a laboratory
test called a “25-hydroxyvitamin D level”), and a dietician
can recommend nutrition modification if needed. Sometimes
it is not possible to get enough calcium in the diet, depending
on your or your child’s dairy intake. In such cases, a calcium
supplement may be recommended by your care team.
Monitoring you [sic] or your child’s bone health through
imaging tests can also identify osteoporosis and help you
to prevent fractures from happening. Children on steroids
should have a lateral spine X-ray at least every 1-2 years
to evaluate vertebrae health and to identify fractures of
the spine in their earliest stages, even before they become
symptomatic with back pain. Spine X-rays may need to be
repeated sooner if there is back pain.
In addition, a dual-energy x-ray absorptiometry (DEXA)
scans can also be done to measure bone density. DEXA
scans will produce a Z-score, which is a comparison of bone
density to “healthy” individuals of the same age. If the
Z-score is found to be declining, annual DEXA scans
will closely monitor any further changes in bone density.
However, if unable to have both imagining tests, it is
recommended to prioritize the lateral spine x-ray.
The current standard of care for treating osteoporosis in
childhood is IV bisphosphonate therapy (pamidronate,
zoledronic acid, or neridronate). The goal of bisphosphonate
therapy is to increase the density of the bones of the body,
including the vertebrae in the spine. Increasing the density
of bones puts you or your child at less risk for a fracture. For
adults, additional bone health therapies exist for bone health,
including those that promote additional bone growth
(Teriparitide) and prevent the breakdown and resorption of
bone (Denosumab).
WHAT TO DO IF YOU SUSPECT A FRACTURE
Due to the risk for femur fractures with low trauma, it is
important to know the signs and symptoms of a possible
femur or other leg fracture:
• Severe pain, which may worsen with movement
• Swelling of the leg
• Bruising of the leg
• Deformity or shortening of the leg
• Inability to walk (if ambulatory)
If you suspect a long bone fracture, such as the femur, it
is important to take prompt action. You should go to the
emergency room as quickly as possible to avoid harmful
risks such as infection, loss of ambulation, and Fat Embolism
Syndrome. Fat Embolism Syndrome, as mentioned above, is
a serious complication of fractures, and the emergency room
staff should be aware of this risk.
It is imperative you bring your emergency card or
download the PPMD app to show to the emergency room
staff. As with every emergency, you should contact your
neuromuscular specialist (NMS) so they are aware of the
condition. If you or your child needs surgery and you or your
child is on steroids, “stress steroid” coverage will be needed,
meaning that extra steroid will be given in order to help the
body handle the physical stress of the surgery.
There are both surgical and non-surgical treatment options
for fractures of the leg. The decision of which intervention
to undergo should include input from your neuromuscular
care team, as well as an orthopedic specialist. Factors that
should be considered include ambulation status, severity, and
location of the fracture.
[…] The above information was reviewed by Dr.
Leanne Ward, University of Ottawa, who is a pediatric
endocrinologist specializing in bone health.
Article available at: https://www.parentprojectmd.org/
winter-safety-bone-health/
TODAY IS A NEW DAY.
FRESH START!
THINK HAPPY THOUGHTS,
EXERCISE,
DRINK LOTS OF WATER,
DON'T JUST EAT,
FUEL YOUR BODY.
BE HEALTHY & HAPPY!
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