Scoliosis in
Cystinosis.
Craig B.
Langman, MD
The Isaac A.
Abt, MD Professor of Kidney Diseases
Head, Kidney
Diseases
Children’s
Scoliosis, or an angular deformity of the spine, is a
common bone condition in children.
It is most often idiopathic, or without
specific known cause.
Scoliosis is accentuated during periods of
rapid growth, such as in adolescence.
There are tests that can be performed by a
physician on routine examination of the child that may identify the condition,
but sometimes, falsely so.
Definitive diagnosis depends on
demonstration of the angular deformity by X-ray study of the spine.
Referral to a specialist in pediatric
orthopedics is encouraged for proper care.
Cystinosis is not associated with scoliosis in the
absence of some other problem in bone.
Such problems may be the co-existence of
the more common problem, such as idiopathic scoliosis, with the rarer disease,
or the result of more specific bone problems.
For example, an asymmetric vertebral crush
fracture may produce scoliosis in the growing child.
Such
fractures may result from corticosteroid therapy, for example.
Medications are generally not felt to be causative in
cases of scoliosis.
However, there are isolated case reports of
the concomitant use of recombinant human growth hormone and the “development” of
scoliosis.
A review of over 900 children treated for
over 3600 patient-years with recombinant human growth hormone did not find any
relation between that therapy and the development of scoliosis.
Kidney transplantation may have bone complications,
since most children with a functioning transplant have some form of chronic
kidney disease (CKD).
CKD is known to have associated bone
disease, including the development of scoliosis.
Since scoliosis is a common disease of children, and
there is no firm evidence that medications contribute significantly to its
presence, we must conclude that the use of recombinant human growth hormone is
unlikely as its cause.
However, a prudent approach might be to
discontinue, temporarily or permanently, the use of the growth product during
the evaluation and follow-up of scoliosis, since rapid growth spurts may be
associated with progression of scoliosis.
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