Pediatr Gastroenterol Hepatol Nutr.
2024 May;27(3):158-167. 10.5223/pghn.2024.27.3.158.
Prevalence and Associated Factors of Vertebral Fractures in Children with Chronic Liver Disease with and without Liver Transplantation
- Pornsiripratharn W
1 - Treepongkaruna S1,2
- Tangkittithaworn P3
- Chitrapaz N3
- Lertudomphonwanit C1,2
- Getsuwan S1,2
- Tanpowpong P1,2
- Mahachoklertwattana P4
- Affiliations
-
- 1Division of Gastroenterology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- 2Ramathibodi Excellence Center in Organ Transplantation, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- 3Department of Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- 4Division of Endocrinology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- KMID: 2555823
- DOI: http://doi.org/10.5223/pghn.2024.27.3.158
Abstract
- Purpose
To evaluate the prevalence of vertebral fracture (VF) in children with chronic liver disease (CLD) with and without liver transplantation (LT) and to determine the associated factors.
Methods
A cross-sectional study was conducted. Patients aged 3–21 years with CLD both before and after LT were enrolled in the study. Lateral thoracolumbar spine radiographs were obtained and assessed for VF using Mäkitie’s method. Clinical and biochemical data were collected.
Results
We enrolled 147 patients (80 females; median age 8.8 years [interquartile range 6.0–11.8]; 110 [74.8%] in the LT group and 37 [25.2%] in the non-LT group). VF was identified in 21 patients (14.3%): 17/110 (15.5%) in the LT group and 4/37 (10.8%) in the non-LT group (p=0.54). Back pain was noted in only three patients with VF. In the univariate analysis, a height z-score below –2.0 (p=0.010), pre-LT hepatopulmonary syndrome (p=0.014), elevated serum direct and total bilirubin levels (p=0.037 and p=0.049, respectively), and vitamin D deficiency at 1-year post-LT (p=0.048) were associated with VF in the LT group. In multivariate analysis, height z-score below –2.0 was the only significant associated factor (odds ratio, 5.94; 95% confidence interval, 1.49–23.76; p=0.012) for VF. All VFs in the non-LT group were reported in males.
Conclusion
In children with CLD, VF is common before and after LT. Most patients with VF are asymptomatic. Screening for VF should be considered in patients with a height z-score below –2.0 after LT.
