Vertebral compression fractures in pediatric patients with intestinal failure: A prospective observational case series

TL;DR

This study found vertebral fractures in 21% of pediatric intestinal failure patients, emphasizing the need for better screening and treatment guidelines.

Contribution

The study is the first to report vertebral fractures in pediatric intestinal failure patients using thoracolumbar x-rays and highlights the importance of early detection.

Findings

Three out of 14 pediatric intestinal failure patients had vertebral fractures confirmed by x-rays.

Two of the three patients with vertebral fractures were asymptomatic.

Bisphosphonate therapy was initiated in one patient with a vertebral fracture.

Abstract

Intestinal failure associated bone disease (IFABD) poses a significant threat to bone health in pediatric patients with intestinal failure (IF) reliant on life-saving parenteral nutrition (PN).

This observational study sought to determine the prevalence of vertebral fractures (VF) detected through lateral thoracolumbar x-rays using Genant criteria in pediatric patients with IF at a single center. It was conducted as part of a larger observational database study of intestinal failure long term outcomes.

Fourteen out of 79 patients with IF were included in the study. The median age of our cohort was 9 years. Short bowel syndrome (SBS) was the cause of IF in nine patients (64 %), with two patients each having a pediatric onset congenital diarrhea & enteropathy (14 %) or dysmotility (14 %) as their primary IF diagnosis, and one patient (7 %) with normal intestinal length and absorption, requiring PN for growth support in the context of chronic vomiting. Three of 14 participants (21 %) had vertebral fractures confirmed on x-rays, two of whom were asymptomatic. Notably, bisphosphonate therapy was initiated in one patient with VF, highlighting the clinical impact of early detection.

Despite study limitations, including a small single center sample size, the identification of VF in 3 out of the 14 participants underscores the need for further investigation in pediatric patients with IF, especially because 2 of these 3 patients were asymptomatic. Multicenter studies in the future may explore risk factors for VF to create guidelines for radiographic screening, surveillance, and treatment in this pediatric population.