The Assessment of Bone Metabolısm Parameters in Paedıatrıc patıents wıth Genu varum and Genu valgus deformıtıes

Year 2024, Volume: 8 Issue: 1, 56 - 61, 30.04.2024

Hüseyin Kürüm Şükrü Demir Sefa Key

https://doi.org/10.30565/medalanya.1452540

Abstract

Aim: There are a limited number of studies in the literature explaining the relationship between bone metabolism parameters such as vitamin D, calcium (Ca), parathormone (PTH), magnesium (Mg), and alkaline phosphatase (ALP) and pediatric lower extremity coronal plane deformities.This study aimed to examine the impact of bone metabolism parameters on the development of genu varum or genu valgus deformities.

Methods: 45 patients with genu varum and genu valgus whose vitamin D, Ca, PTH, Mg and ALP parameters were evaluated in our polyclinic were included in the study.

Results: 44 (97.8%) of the patients were bilateral and one (2.2%) was unilateral. The mean age of patients with genu varum (4.3±4.8) was significantly lower than that of patients with genu valgus (11.9±4.1) (p<0.001). Ca values were normal in 44 (97.8%), vitamin D in 23 (51.1%), PTH in 33 (73.3%), ALP in 2 (4.4%) and Mg in 43 (95.6%) patients. 3% (6.7) of the patients had comorbidities. 2 of these (66.7%) were rickets.

Conclusion: The study shows that ALP can be used as a screening test especially in the coming years. In addition, although there are no sufficient incidence and prevalence studies in the literature, we can say that genu varum is seen more frequently and mostly bilaterally than genu valgus.It is not uncommon for rickets to accompany lower extremity coronal deformities in children. In addition, McCune-Albright Syndrome (MAS) may be accompanied not only by fibrous dysplasia (FD) but also by bilateral genu valgum deformity.

Keywords

Genu varum, genu valgus, bone metabolism parameters

Ethical Statement

Approval for the study was given by the local Ethics Committee (2021/01-04).

Thanks

We would like to thank Murat Kürüm for his contribution to the conduct of the study.

Genu varum ve genu valgus deformitesi olan pediatrik hastalarda kemik metabolizmasi parametrelerinin değerlendirilmesi

Abstract

Amaç: Literatürde D vitamini, kalsiyum (Ca), parathormon (PTH), magnezyum (Mg) ve alkalen fosfataz (ALP) gibi kemik metabolizması parametreleri ile pediatrik alt ektremite koronal plan deformiteleri arasındaki ilişkiyi açıklayan sınırlı sayıda çalışma mevcuttur. Bu çalışmanın amacı, kemik metabolizması parametrelerinin genu varum veya genu valgus deformitelerinin oluşumundaki rolünü araştırmaktır.

Yöntemler: Polikliniğimizde D vitamini, Ca, PTH, Mg ve ALP parametreleri değerlendirilen 45 genu varum ve genu valguslu hasta retrospektif olarak çalışmaya dahil edildi.

Bulgular: Hastaların 44'ü (%97.8) bilateral, biri (%2.2) unilateral idi. Genu varumlu hastaların yaş ortalaması (4.3±4.8) genu valguslu hastalara (11.9±4.1) göre anlamlı derecede düşüktü (p<0.001). Ca değerleri 44 (%97,8), D vitamini 23 (%51,1), PTH 33 (%73,3), ALP 2 (%4,4) ve Mg 43 (%95,6) hastada normaldi. Hastaların 3'ünde (%6,7) ek patoloji vardı. Bunların 2'si (%66,7) raşitizmdi.

Sonuç: Çalışma, ALP'nin özellikle önümüzdeki yıllarda bir tarama testi olarak kullanılabileceğini göstermektedir. Ayrıca literatürde yeterli insidans ve prevalans çalışması olmamakla birlikte genu varumun genu valgusa göre daha sık ve çoğunlukla bilateral olarak görüldüğünü söyleyebiliriz. Riketsin çocuk alt ekstremite koronal deformitelerine eşlik etmesi nadir değildir. Ayrıca McCune-Albright Syndrome (MAS) sendorumuna sadece fibröz displazi (FD) değil bilateral genu valgum deformitesi eşlik edebilir.

Keywords

Genu varum, genu valgus, kemik metabolizması parametreleri.

References

• 1. Saran N, Rathjen KE. Guided growth for the correction of pediatric lower limb angular deformity. J Am Acad Orthop Surg. 2010;18(9):528-36. doi: 10.5435/00124635-201009000-00004
• 2. Ain MC, Shirley ED, Pirouzmanesh A, Skolasky RL, Leet AI. Genu varum in achondroplasia. J Pediatr Orthop. 2006;26(3):375-9. doi: 10.1097/01.bpo.0000203013.04272.b6.
• 3. Bryson DJ, Shivji FS, Price KR, Lawniczak D, Chell J, Hunter JB. The lost art of conservative management of paediatric fractures. The Bone & Joint Journal. 2016;5(1):2–8. doi: 10.1302/2048-0105.51.360403.
• 4. Cho TJ, Choi IH, Chung CY, Yoo WJ, Park MS, Lee DY. Hemiepiphyseal stapling for angular deformity correction around the knee joint in children with multiple epiphyseal dysplasia. J Pediatr Orthop. 2009;29(1):52-6. doi: 10.1097/BPO.0b013e3181901c4d.
• 5. Holick MF. Vitamin D: A millenium perspective. J Cell Biochem. 2003;88(2):296-307. doi: 10.1002/jcb.10338.
• 6. Belluci MM, de Molon RS, Rossa C Jr, et al. Severe magnesium deficiency compromises systemic bone mineral density and aggravates inflammatory bone resorption. J Nutr Biochem. 2020;77:108301. doi: 10.1016/j.jnutbio.2019.108301.
• 7. Abildgaard N, Glerup H, Rungby J, et al. Biochemical markers of bone metabolism reflect osteoclastic and osteoblastic activity in multiple myeloma. Eur J Haematol. 2000;64(2):121-9. doi:10.1034/j.1600-0609.2000.90074.x.
• 8. Bout-Tabaku S, Shults J, Zemel BS, et al. Obesity is associated with greater valgus knee alignment in pubertal children, and higher body mass index is associated with greater variability in knee alignment in girls. J Rheumatol. 2015;42(1):126-33. doi: 10.3899/jrheum.131349.
• 9. Akpede G.O., Solomon E.A., Jalo I., Addy E.O., Banwo A.I., Omotara B.A. Nutritional rickets in young Nigerian children in the Sahel savanna. East Afr. Med. J. 2001;78:568–75. doi: 10.4314/eamj.v78i11.8945.
• 10. Oyemade G. Aetiological Factors in Genu Valga, Vara and Varovalga in Nigerian Children. J Trop Pediatr. 1975;21:167–72. doi: 10.1093/tropej/21.4.167.
• 11. Arazi M, Oğün TC, Memik R. Normal development of the tibiofemoral angle in children: a clinical study of 590 normal subjects from 3 to 17 years of age. J Pediatr Orthop. 2001;21(2):264-7. PMID: 11242264
• 12. Soheilipour F, Pazouki A, Mazaherinezhad A, Yagoubzadeh K, Dadgostar H, Rouhani F. The Prevalence of Genu Varum and Genu Valgum in Overweight and Obese Patients: Assessing the Relationship between Body Mass Index and Knee Angular Deformities. Acta Biomed. 2020;91(4):e2020121. doi: 10.23750/abm.v91i4.9077.
• 13. Hatun Ş, Ozkan B, Bereket A. Vitamin D deficiency and prevention: Turkish experience. Acta Paediatr. 2011;100(9):1195-9. doi: 10.1111/j.1651-2227.2011.02383.x.
• 14. Jagtap VS, Sarathi V, Lila AR, Bandgar T, Menon P, Shah NS. Hypophosphatemic rickets. Indian J Endocrinol Metab. 2012;16(2):177-82. doi: 10.4103/2230-8210.93733.
• 15. Sakamoto Y, Ishijima M, Kinoshita M, et al. Association between leg bowing and serum alkaline phosphatase level regardless of the presence of a radiographic growth plate abnormality in pediatric patients with genu varum. J Bone Miner Metab. 2018;36(4):447-53. doi: 10.1007/s00774-017-0851-6.
• 16. Szulc P, Seeman E, Delmas PD. Biochemical measurements of bone turnover in children and adolescents. Osteoporos Int. 2000;11(4):281-94. doi: 10.1007/s001980070116.
• 17. Topak D, Seyithanoğlu M, Doğar F, et al. Are vitamin D and vitamin D receptor levels different in children with developmental dysplasia of the hip?. J Orthop Surg Res. 2021;16(1):24. doi: 10.1186/s13018-020-02162-y.
• 18. Taylor JA, Richter M, Done S, Feldman KW. The utility of alkaline phosphatase measurement as a screening test for rickets in breast-fed infants and toddlers: a study from the puget sound pediatric research network. Clin Pediatr (Phila). 2010;49(12):1103-10. doi: 10.1177/0009922810376993.
• 19. Levıne M., Zapalowskı C., Kappy M. Disorders of calcium, phosphate, PTH and vitamin D metabolism. Principles and Practice of Pediatric Endocrinology. Charles C. Thomas Publisher, Springfield, USA, 2005, 762.
• 20. Corsi A, Collins MT, Riminucci M, Howell PG, Boyde A, Robey PG, Bianco P. Osteomalacic and hyperparathyroid changes in fibrous dysplasia of bone: core biopsy studies and clinical correlations. J Bone Miner Res. 2003;18:1235–46. doi: 10.1359/jbmr.2003.18.7.1235.
• 21. Collins MT. Spectrum and natural history of fibrous dysplasia of bone. J Bone Miner Res. 2006;21:P99–104. doi: 10.1359/jbmr.06s219.
• 22. Gorgolini G, Caterini A, Efremov K, Marsiolo M, De Maio F, Farsetti P. Surgical correction of valgus deformities of the knee in Polyostotic Fibrous Dysplasia. Orthop Rev (Pavia). 2022;14(5):38827. doi: 10.52965/001c.38827.
• 23. Kobayashi M, Hara K, Akiyama Y. Effects of vitamin K2 (menatetrenone) and alendronate on bone mineral density and bone strength in rats fed a low-magnesium diet. Bone. 2004;35(5):1136-1143. doi: 10.1016/j.bone.2004.05.012.
• 24. Castiglioni S, Cazzaniga A, Albisetti W, Maier JA. Magnesium and osteoporosis: current state of knowledge and future research directions. Nutrients. 2013;5(8):3022-3033. doi: 10.3390/nu5083022.
• 25. Shinohara Y, Kamegaya M, Kuniyoshi K, Moriya H. Natural history of infantile tibia vara. J Bone Joint Surg Br. 2002;84(2):263-268. doi: 10.1302/0301-620x.84b2.11821.