LONG-TERM REDUCTION IN BONE MASS AFTER SEVERE BURN INJURY IN CHILDREN

Objective: Because burn victims are at risk of having bone loss, a cro ss-sectional study was undertaken to determine whether severe burn inj ury had acute and long-term effects on bone mass or on the incidence o f fractures in children.Methods: Dual-energy x-ray absorptiometry of t he lumbar portion of the spine was performed on 68 children: 16 modera tely burned (15% to 36% of total body surface area) and 52 age-matched severely burned (greater than or equal to 40% of total body surface a rea), Twenty-two severely burned children were hospitalized and studie d within 8 weeks of their burn, and 30 others were studied approximate ly 5 years after discharge, In the severely burned group, both hospita lized and discharged, serum and urine were analyzed for calcium, phosp horus, intact parathyroid hormone, osteocalcin, and type I collagen te lopeptide. Results: Sixty percent of severely burned patients had age- related z scores for bone density less than -1, and 27% of severely bu rned patients had age-related z scores for bone density less than -2 ( p <0.005, for each). In the moderately burned group, 31% of patients h ad z scores less than -1 (p <0.005 vs normal distribution), but only 6 % had z scores less than -2 (p value not significant), There was evide nce of increased incidence of fractures after discharge in the severel y burned patients. Biochemical studies were compatible with a reductio n in bone formation and an increase in resorption initially, and with a long-term persistence of low formation. Conclusion: We conclude that acute burn injury leads to profound and long-term bone loss, which ma y adversely affect peak bone mass accumulation.