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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):447-453JB

Abstract

When children around 2 years of age show leg bowing and diseases are ruled out based on radiographic findings without conducting blood tests, they are classified as "physiologic" genu varum. Since whether or not physiologic genu varum is associated with bone metabolism is unclear, this study was conducted to clarify the association between genu varum and bone metabolism in children. Thirty-five pediatric patients with genu varm who visited our out-patient clinic were enrolled. While two of the 35 children had nutritional rickets, showing abnormalities on both blood test (ALP, ≥1000 IU/L; iPTH, >65 pg/mL and 25(OH)D, ≤20 ng/mL) and radiographs (such as cupping, fraying or splaying), five of 35 children showed abnormalities on blood tests but not radiographs. While metaphyseal-diaphyseal angle (MDA) correlated with serum 25-hydroxy vitamin D (r = -0.35, p = 0.04) and magnesium (r = -0.36, p = 0.04), MDA and femorotibial angle (FTA) correlated with alkaline phosphatase (r = 0.43, p = 0.01 and r = 0.51, p = 0.006, respectively). A ridge regression analysis adjusted for age and body mass index indicated that ALP was associated with MDA and FTA. A logistic regression analysis adjusted for age and BMI indicated that higher ALP influenced an MDA >11°, which indicates the risk for the progression of genu varum (odds ratio 1.002, 95% confidence interval 1.0003-1.003, p = 0.021). The higher ALP (+100 IU), the higher risk of an MDA >11° (odds ratio 1.22). In conclusion, genu varum is associated with the alkaline phosphatase level regardless of the presence of radiographic abnormalities in the growth plate in children.

Authors+Show Affiliations

Department of Orthopaedics, Juntendo University Nerima Hospital, 3-1-1, Takanodai, Nerima-ku, Tokyo, 117-8421, Japan. u-sakamo@juntendo.ac.jp.Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan. ishijima@juntendo.ac.jp.Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan. Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan.Department of Pediatrics, Juntendo University Graduate School of Medicine, Tokyo, Japan.Department of Orthopaedics, Juntendo University Nerima Hospital, 3-1-1, Takanodai, Nerima-ku, Tokyo, 117-8421, Japan.Department of Orthopaedics, Juntendo University Nerima Hospital, 3-1-1, Takanodai, Nerima-ku, Tokyo, 117-8421, Japan.Clinic Bambini, Tokyo, Japan.Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.Department of Pediatrics, Juntendo University Graduate School of Medicine, Tokyo, Japan.Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.Department of Orthopaedics, Juntendo University Nerima Hospital, 3-1-1, Takanodai, Nerima-ku, Tokyo, 117-8421, Japan.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28664247

Citation

Sakamoto, Yuko, 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." Journal of Bone and Mineral Metabolism, vol. 36, no. 4, 2018, pp. 447-453.
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):447-453.
Sakamoto, Y., Ishijima, M., Kinoshita, M., Liu, L., Suzuki, M., Kim, S. G., ... Nozawa, M. (2018). 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. Journal of Bone and Mineral Metabolism, 36(4), pp. 447-453. doi:10.1007/s00774-017-0851-6.
Sakamoto Y, 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):447-453. PubMed PMID: 28664247.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 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. AU - Sakamoto,Yuko, AU - Ishijima,Muneaki, AU - Kinoshita,Mayuko, AU - Liu,Lizu, AU - Suzuki,Mitsuyoshi, AU - Kim,Sung-Gon, AU - Kamata,Koichi, AU - Tokita,Akifumi, AU - Kaneko,Haruka, AU - Shimizu,Toshiaki, AU - Kaneko,Kazuo, AU - Nozawa,Masahiko, Y1 - 2017/06/29/ PY - 2016/12/19/received PY - 2017/05/24/accepted PY - 2017/7/1/pubmed PY - 2018/8/14/medline PY - 2017/7/1/entrez KW - Alkaline phosphatase KW - Genu varum KW - Infantile tibia vara KW - Nutritional rickets KW - Physiologic leg bowing SP - 447 EP - 453 JF - Journal of bone and mineral metabolism JO - J. Bone Miner. Metab. VL - 36 IS - 4 N2 - When children around 2 years of age show leg bowing and diseases are ruled out based on radiographic findings without conducting blood tests, they are classified as "physiologic" genu varum. Since whether or not physiologic genu varum is associated with bone metabolism is unclear, this study was conducted to clarify the association between genu varum and bone metabolism in children. Thirty-five pediatric patients with genu varm who visited our out-patient clinic were enrolled. While two of the 35 children had nutritional rickets, showing abnormalities on both blood test (ALP, ≥1000 IU/L; iPTH, >65 pg/mL and 25(OH)D, ≤20 ng/mL) and radiographs (such as cupping, fraying or splaying), five of 35 children showed abnormalities on blood tests but not radiographs. While metaphyseal-diaphyseal angle (MDA) correlated with serum 25-hydroxy vitamin D (r = -0.35, p = 0.04) and magnesium (r = -0.36, p = 0.04), MDA and femorotibial angle (FTA) correlated with alkaline phosphatase (r = 0.43, p = 0.01 and r = 0.51, p = 0.006, respectively). A ridge regression analysis adjusted for age and body mass index indicated that ALP was associated with MDA and FTA. A logistic regression analysis adjusted for age and BMI indicated that higher ALP influenced an MDA >11°, which indicates the risk for the progression of genu varum (odds ratio 1.002, 95% confidence interval 1.0003-1.003, p = 0.021). The higher ALP (+100 IU), the higher risk of an MDA >11° (odds ratio 1.22). In conclusion, genu varum is associated with the alkaline phosphatase level regardless of the presence of radiographic abnormalities in the growth plate in children. SN - 1435-5604 UR - https://www.unboundmedicine.com/medline/citation/28664247/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_ L2 - https://dx.doi.org/10.1007/s00774-017-0851-6 DB - PRIME DP - Unbound Medicine ER -