Increased Heterogeneity of Bone Matrix Mineralization in Pediatric Patients Prone to Fractures: A Biopsy Study

• Published in: Journal of bone and mineral research Vol. 29; no. 5; pp. 1110 - 1117
• Main Authors: Tamminen, Inari S, Misof, Barbara M, Roschger, Paul, Mäyränpää, Mervi K, Turunen, Mikael J, Isaksson, Hanna, Kröger, Heikki, Mäkitie, Outi, Klaushofer, Klaus
• Format: Journal Article
• Language: English
• Published: United States Oxford University Press 2014
• Subjects: Adolescent; Biopsy; BMDD; Bone Density; BONE MINERALIZATION DENSITY DISTRIBUTION; Child; CHILDREN; Engineering and Technology; Female; Fractures, Bone - metabolism; Fractures, Bone - pathology; HISTOMORPHOMETRY; Humans; IDIOPATHIC OSTEOPOROSIS; Male; Maskinteknik; Mechanical Engineering; Osteoporosis - metabolism; Osteoporosis - pathology; QBEI; QUANTITATIVE BACKSCATTERED ELECTRON IMAGING; Teknik; VERTEBRAL FRACTURE; QBEI; BMDD; HISTOMORPHOMETRY; IDIOPATHIC OSTEOPOROSIS; QUANTITATIVE BACKSCATTERED ELECTRON IMAGING; VERTEBRAL FRACTURE; BONE MINERALIZATION DENSITY DISTRIBUTION; CHILDREN
• ISSN: 0884-0431; 1523-4681; 1523-4681
• DOI: 10.1002/jbmr.2124

ABSTRACT Idiopathic osteoporosis (IOP) in children is characterized by fragility fractures and/or low bone mineral density in otherwise healthy individuals. The aim of the present work was to measure bone mineralization density distribution (BMDD) based on quantitative backscattered electron imaging (qBEI) in children with suspected IOP. Entire cross‐sectional areas of transiliac bone biopsy samples from children (n = 24, 17 boys; aged 6.7–16.6 years) with a history of fractures (n = 14 with at least one vertebral fracture) were analyzed for cancellous (Cn) and cortical (Ct) BMDD. Outcomes were compared with normal reference BMDD data and correlated with the patients' clinical characteristics and bone histomorphometry findings. The subjects had similar average degree but significantly higher heterogeneity of mineralization in both Cn and Ct bone (Cn.CaWidth +23%, Ct.CaWidth +15%, p < 0.001 and p = 0.002, respectively), together with higher percentages of low mineralized cancellous (Cn.CaLow +35%, p < 0.001) and highly mineralized cortical bone areas (Ct.CaHigh +82%, p = 0.032). Ct.CaWidth and Ct.CaLow were positively correlated with mineralizing surface per bone surface (MS/BS; a primary histomorphometric determinant of bone formation) and with serum bone turnover markers (all p < 0.05). The correlations of the mineralization heterogeneity with histomorphometric and serum bone turnover indices suggest that an enhanced variation in bone turnover/formation contributes to the increased heterogeneity of mineralization. However, it remains unclear whether the latter is cause for, or the response to the increased bone fragility in these children with suspected IOP. © 2014 American Society for Bone and Mineral Research.