Bone Health in Immobile Adolescents

  • M. Zulf Mughal


Adolescents with disorders associated with chronic immobilization have low bone mass and are at increased risk of sustaining fragility fractures of long bones and the vertebrae. Immobilization, whether it is abrupt, progressive or chronic, disrupts normal bone growth (length, diameter, cortical and trabecular thickness) and mineralization that occurs during childhood and adolescence. This results in slender, thin and under-mineralized bones, which are prone to fragility fractures. In addition to immobilization, inadequate dietary calcium intake, vitamin D deficiency, pubertal delay/arrest and treatment with high doses of glucocorticoids may contribute to reduced bone strength in this population. While fragility fractures of long bones are associated with low bone mineral content and density, vertebral fractures can occur without significant reduction (Z-score ≥ −2) in lumbar spine bone mineral density. Thus, screening for vertebral fractures is recommended in youngsters with Duchenne muscular dystrophy who are treated with high doses of glucocorticoids. Management includes physical therapy, optimization of nutrition, correction of vitamin D deficiency, treatment of delayed puberty and judicious use of bisphosphonates on compassionate grounds to in those with fragility fractures.


Immobilization Cerebral palsy Duchenne muscular dystrophy Spinal muscular atrophy Spinal cord injury Fractures Bone mineral content Bone mineral density Bisphosphonates Physical therapy 


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Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Department of Paediatric EndocrinologyRoyal Manchester Children’s HospitalManchesterUK

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