J Bone Metab.  2019 Nov;26(4):241-246. 10.11005/jbm.2019.26.4.241.

Bone Marrow Foot Oedema in Adolescents: The Role of Vitamin D

Affiliations
  • 1Pediatric Clinic, Department of Life and Reproduction Sciences, Azienda Ospedaliera Universitaria Integrata, Verona Italy. elisatadiotto@yahoo.it
  • 2Pediatric Clinic, Santa Chiara Hospital, Trento, Italy.

Abstract

BACKGROUND
Bone marrow oedema (BMO) in children/adolescents is a rare clinical condition without an etiologic cause. It is associated with typical increased signal intensity on T2-weighted magnetic resonance images (MRI) and an increase in bone turnover in which vitamin D plays a pivotal role. No treatment guidelines for these young patients are to date available.
METHODS
We performed a retrospective study in a pediatric setting of 13 patients with diagnosis of primary BMO of the foot on the basis of clinical and radiological findings. Data collection included sex, age, patient history, symptoms at presentation, clinical examination, laboratory bone turnover markers, vitamin D levels, MRI, treatment, and outcome.
RESULTS
Vitamin D deficiency or insufficiency was found in 76.9% of cases. All patients were treated with adequate vitamin D daily intake, a short course of analgesic therapy, physical therapy, avoiding detrimental feet and ankle immobilization. All fully recovered in 3-month lag period.
CONCLUSIONS
Our data highlight that environmental factors, such as underestimated articular or bone microtraumatisms, as well as joint hyper mobility, in a bone turnover milieu of vitamin D deficiency could be the cause of this clinical conditions. Adequate vitamin D supplementation, associated with physical and analgesic therapy, is crucial in the management of BMO.

Keyword

Bone marrow oedema; Child; Magnetic resonance imaging; Vitamin D

MeSH Terms

Adolescent*
Ankle
Bone Marrow*
Bone Remodeling
Child
Data Collection
Diagnosis
Foot*
Humans
Immobilization
Joints
Magnetic Resonance Imaging
Retrospective Studies
Vitamin D Deficiency
Vitamin D*
Vitamins*
Vitamin D
Vitamins
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