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Skeletal manifestations in pediatric and adult patients with Niemann Pick disease type B
Author(s) -
Wasserstein Melissa,
Godbold James,
McGovern Margaret M.
Publication year - 2013
Publication title -
journal of inherited metabolic disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.462
H-Index - 102
eISSN - 1573-2665
pISSN - 0141-8955
DOI - 10.1007/s10545-012-9503-0
Subject(s) - medicine , bone mineral , niemann–pick disease , acid sphingomyelinase , lumbar , femoral neck , bone density , cohort , metabolic bone disease , gastroenterology , urology , nuclear medicine , surgery , disease , osteoporosis , cholesterol , sphingomyelin
Niemann‐Pick disease (NPD) due to acid sphingomyelinase deficiency is a lipid storage disease resulting from the accumulation of sphingomyelin, predominantly within cells of the monocyte‐macrophage system. In contrast to other lysosomal storage disorders, skeletal involvement in NPD has not been systematically studied. Methods Pediatric and adult NPD‐B patients underwent medical histories and physical examinations, DEXA scans to measure bone mineral content (BMC), and bone mineral density (BMD) and computed tomography scan or MRI of the abdomen for spleen volume. Z and/or T scores were calculated for the DEXA results. For the pediatric patients adjusted mean BMC (g) and BMD (g/cm 2 ) of the lumbar spine, hip, and femoral neck was compared to control subjects. For determination of the relationship between spleen volume and lumbar spine BMD Z score, linear correlation analyses were performed. Results Lumbar spine Z scores for pediatric patients ranged from 0.061 to ‐4.879. Statistically significant decreases were observed for the adjusted mean BMC and BMD at the lumbar spine, hip, and femoral neck between the pediatric NPD‐B cohort and control subjects. Most NPD‐B adults were osteopenic or osteoporotic at one or more sites according the WHO classification of BMD. In NPD‐B patients, the degree of splenomegaly was inversely correlated with lumbar spine BMD Z scores. Conclusion Skeletal involvement is a common and previously unrecognized manifestation of NPD‐B. The association between splenomegaly and BMD lends further support to spleen size as an indicator of disease severity.