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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

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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.

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Acknowledgements

The authors thank all participating children and parents and all of the medical staff at the participating institutions for providing the clinical data.

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Authors and Affiliations

  1. Department of Orthopaedics, Juntendo University Nerima Hospital, 3-1-1, Takanodai, Nerima-ku, Tokyo, 117-8421, Japan

    Yuko Sakamoto, Sung-Gon Kim, Koichi Kamata & Masahiko Nozawa

  2. Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan

    Muneaki Ishijima, Mayuko Kinoshita, Lizu Liu, Haruka Kaneko & Kazuo Kaneko

  3. Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan

    Lizu Liu

  4. Department of Pediatrics, Juntendo University Graduate School of Medicine, Tokyo, Japan

    Mitsuyoshi Suzuki & Toshiaki Shimizu

  5. Clinic Bambini, Tokyo, Japan

    Akifumi Tokita

Authors
  1. Yuko Sakamoto
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  2. Muneaki Ishijima
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  3. Mayuko Kinoshita
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  4. Lizu Liu
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  5. Mitsuyoshi Suzuki
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  7. Koichi Kamata
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  8. Akifumi Tokita
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  9. Haruka Kaneko
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  10. Toshiaki Shimizu
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  11. Kazuo Kaneko
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  12. Masahiko Nozawa
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Corresponding authors

Correspondence to Yuko Sakamoto or Muneaki Ishijima.

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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 36, 447–453 (2018). https://doi.org/10.1007/s00774-017-0851-6

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  • DOI: https://doi.org/10.1007/s00774-017-0851-6

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