[15162482]
This female pt is a survivor of child abuse by battering. She had multiple fractures and soft tissue injuries at her diagnosis at 2 months of age including left pleural effusion and retroperitoneal hematoma. Her fractures included many ribs and spine and both femurs. Pt has been followed with dexa scan densitometry since then by a neonatologist. All dexa results have been "normal" based on limited comparison databases for age-matched pts. In 2007, the same neonatologist decided to do radial and tibia ultrasounds as well as the densitometry. Densitometry showed wonderful results for bone density -lumbar spine 84th percentile; femoral neck 46th percentile; total body calcium 95th percentile; total body bmd 50th percentile. The sos bone ultrasound device , omnisense 7000p, showed radial 7th percentile/-1. 5 z score and tibial sos 0 percentile/-3. 5 z score. How can this be true? Manufacturer of ultrasound device claims densitometry is unnecessary since osteoporosis is a systemic disease affecting all bones in body. Neonatologist has advised family child is at high risk of fractures based only on this ultrasound result. Pt is in gymnastics, now with no fractures since her battering at 2 months of age. This discrepancy with densitometry results previously reported in medical literature. See gianni ml et al. Quantitative ultrasound and dual-energy x-ray absorptiometry in bone status assessment of ex-preterm infants. Arch dis child fetal neonatal edd 2008;93:f146-147. "no significant correlation between spinal dxa and sos measurements at each skeletal site was found. " as pediatrician, i am distressed parents are given ludicrous information disregarding the better testing that is available. Dates of use: months to years. Diagnosis or reason for use: history of fractures in infancy, court room testimony. Event abated after use stopped: no.
Patient Sequence No: 1, Text Type: D, B5