For those with anorexia, JIA and other disorders, she said it’s important to keep in mind that DXA bone mineral density (BMD) Z-scores can be misinterpreted because these children can have short stature or delayed puberty. In JIA, she said, children will often come back with normal DXA Z-scores at the lumbar spine. Even though they may be asymptomatic, consider performing an X-ray because these children have a high prevalence of compression fractures.
“DXA may not be a sensitive tool,” Dr. Gordon said. “Spinal radiographs are likely underordered in this group.”
She said tips to optimize bone health in these patients include:
- Considering the menstrual cycle as a “vital sign,” with amenorrhea a cause for concern about a potential bone disorder;
- Taking BMD measurements in at-risk patients with a strong family history;
- Encouraging regular exercise but not overdoing it; and
- Emphasizing good nutrition with adequate calcium and vitamin D.
Stuart Goodman, MD, PhD, professor of orthopedic surgery and bioengineering at Stanford University in Palo Alto, Calif., discussed new findings in cell therapy in the treatment of osteonecrosis, a general term for a variety of conditions that result in death of the cellular components of bone.
‘I don’t think about a total hip replacement first. I think of how we can save this joint.’ —Dr. Goodman
In his lab, researchers assessed results of local debridement with osteoprogenitor cell grafting in cases of knee osteonecrosis in 12 young patients with an average age of 23, four of whom had underlying systemic lupus erythematosus. The cases involved salvageable joints (i.e., involving the joints’ weight-bearing area, but with the cartilage intact).1
The patients initially reported a constant aching in the knees with functional deficits, but, on imaging, showed no collapse of the femoral condyles and no incongruity of the joint surface. But all the osteonecrotic lesions involved at least a third of the condyle width.
At five years of follow-up, no patients had gone on to further surgery, and none were taking medication for knee pain. They had good scores for knee function.
Cell therapy has produced good results in osteonecrosis of the hip as well, Dr. Goodman said.
He said there’s room for improvement in identifying patients who will respond well to this approach, and in locating and classifying lesions better. But he said cell therapy could be an option that may spare many patients joint replacement.
When he sees a young patient with osteonecrosis, “I don’t think about a total hip replacement first,” he said. “I think of how we can save this joint.”
