الفهرس 
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Abstract
Osteoporosis is one of the major health problems in adults however, this condition has recently become a pediatric concern too. In fact, the most important factor in the prevention of osteoporosis is the attainment of an optimal peak bone mass, which is mainly reached during late adolescence or early adulthood. In healthy subjects, bone mass increases through childhood, with maximal bone mass accrual occurring in early to mid puberty and continuing, at a lower rate, in late puberty. Thus osteoporosis prevention should begin at this age.
The attainment of peak bone mass is the result of interaction of several factors such as genetic, ethnic, hormonal and nutritional factors, lifestyle and physical activity, Any factors adversely impacting on bone acquisition during childhood and adolescence can potentially have long-lasting detrimental effects on bone tissue, predisposing it to osteoporosis. Therefore, young people affected by chronic pathologies, which are potentially harmful for the bone, should be screened for bone disturbance.
Thyroid disease is one of the most common endocrine disorders in both childhood and adulthood. Treatment with high doses of L-thyroxine (L-T4), aimed at suppressing serum thyroid-stimulating hormone (TSH) levels, leads to prolonged sub clinical hyperthyroidism, which has been associated with reduced bone mass and premature development of osteoporosis.
The aim of the present study was to evaluate the effect of long-term LT4 replacement therapy on bone mineralization and skeletal integrity; and on the biochemical markers of bone turnover in a group of children with congenital hypothyroidism and to correlate the BMD with average TSH levels.
Our present study was carried out on 10 children and adolescents (mean age SD 10.780 + 4.071 years ) with congenital hypothyroidism who were treated by replacement therapy for 7.8850 + 3.384 years.
Our results showed that 2 children (20 %) had BMD SDS > -1 (Normal BMD), and 5 children (50%) had BMD SDS < -1 (Osteopenia), and 3 children had BMD SDS < -2 (with increased risk of osteoporosis and fractures), these finding indicates that big percentage of children on long term L-Thyroxin replacement therapy had inadequate bone mineralization.
All patients are subjected to detailed history taking, lying stress on age, sex, residence, age at diagnosis, age at start of treatment, body mass index was calculated, with special emphasis on presence of any chronic disease, drug intake, regular or irregular intake of L-Thyroxin and exact dose given, History of bone fractures, and duration of L-Thyroxin treatment. Also the patients was investigated in serum TSH, T4 levels, fasting urinary Ca/Creatinine Ratio, Radiological investigation through Dual Energy X- ray absorptiometry (DEXA).
We found that a big percentage of children on long term L-thyroxine replacement therapy had inadequate bone mineralization. Also there was a significant positive correlation between BMD SDS and mean TSH level on treatment.