Diagnosis and prevention of osteoporosis in children with cystic fibrosis

Osteoporosis is a metabolic disease of the skeleton characterized by a decrease in bone mass, a disruption of the microarchitecture of bone tissue and, as a result, fractures with minimal trauma. The urgency of the problem of osteoporosis in children with cystic fibrosis arises from the high risk of a decrease in bone mineral density (BMD) in this category of patients.

The aim is to investigate the patterns and mechanisms of bone mineral density reduction in children with cystic fibrosis.

Methods. 100 patients with cystic fibrosis were examined. The control group included 61 healthy children aged 6 to 17 years. Alimentary and biochemical risk factors for the decrease in BMD were analyzed. X-ray densitometry was performed in children over 6 years of age using a DEXXUM device (South Korea). The concentration of calcidiol 25(OH)D and other biochemical parameters in blood were determined using the enzyme immunoassay method.

Results. 62% of patients with CF and 82% of healthy children had normal BMD. The leading factors affecting BMD in patients with cystic fibrosis are: history of meconium ileus, chronic infection with Pseudomonas aeruginosa, lower indicators of nutritional status, and lower lung function (FEV₁, %pred). The biochemical markers of osteoremodeling that determine the risk group for osteoporosis in patients with CF are osteocalcin and acid phosphatase. Healthy children who consumed more dietary calcium had better BMD. The effect of dietary calcium intake and vitamin D dose on BMD in patients with CF was not observed.

Conclusion. The features of inflammatory and catabolic processes in cystic fibrosis influence the remodeling processes by reducing osteosynthesis and activating osteoresorption. In both groups of children studied, low nutritional status had a negative effect on BMD.

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