Children on long term ventilation are prone to fragility fractures

Introduction: The clinical consequence of long term ventilation on bone health is an area of scarce knowledge. This retrospective study aims to assess bone status in long term ventilated (LTV) children. Methodology: Data was collected for 105 LTV children who are on our current database looking at their medical records. This data comprised of clinic letters and biochemistry results and radiology reports (plain x-rays, dual energy x-ray absorptiometry (DXA) scan). Patients were divided into two groups; 82/105(78%) patients received non-invasive ventilation (NIV) and 23/105 (22%) patients received invasive ventilation (IV). Results: The median age of IV and NIV patients was 6 and 12 years (95%CI) respectively. IV patients: 8/23(35%) of had evidence of osteopenia based on radiology reports. 5 of these patients (63%) developed fractures, the majority of which occurred in the distal shaft of the femur. All 5 patients had normal serum calcium. Only 1 patient had a vitamin D deficiency. NIV patients: 21/82(26%) patients had evidence of osteopenia based on radiology reports. 12 of these patients (57%) patients developed fractures, the majority of which occurred in the femoral region. All 12 patients had normal serum calcium and only 1 patient had low vitamin D. 3/82 NIV patients with vitamin D deficiency. Conclusion: Fragility fractures are common in LTV patients around the knee joint. There was radiographic evidence of osteopenia; which is likely to have occurred due to immobility. The ‘bone biochemistry’ was normal in the majority of patients. Caregivers should be aware of increased fracture risk in these patients.