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FAQ's

What are metabolic bone diseases (MBD)?
Bone is a dynamic living tissue and any disturbance in this regulation causes metabolic bone tissue.
What are the common causes of MBD in children ?
“Rickets” or Vitamin D deficiency, Fragile Bone Disease or Osteogenesis Imperfecta, and defect in PTH (Parathyroid hormone) and Calcitonin, and thyroid hormone can also lead to deformities in bone.
How do we diagnose these MBD ?
The main issue here is about awareness. Any child who present with progressive bow legs or knock knees that is not age appropriate, or has fracture of bone with minor fall, or has a bent bone which develops after birth must be evaluated for MBD.
What are the test to diagnose Rickets ?
Radiograph of the wrist or knee, blood tests Alkaline Phosphotase, Vit D3 Level.
How does one diagnose “Fragile Bone Disease” or Osteogenesis Imperfecta?
Child may present with multiple fractures which occurs with trivial injury. Typically, a child will present with 3 - 4 fractures per year or more during the growing years.

So the treating physician must ascertain the cause of injury and the impact that lead to the fracture.

Many times the diagnosis is delayed as treating physician fails to elicit proper history.

We have encountered children where the diagnosis has not been made despite repeated fractures. This can lead to muscle wasting, poor mobility and functional limitations in the active years of childhood life.
How does one treat OI ?
The aim of treatment is to decrease pain and improve mobility for these children. Avoidance of contact sports, jarring and twisting activities, keeping play area free from obstacles, encouraging healthy diet also helps to preserve muscle and bone function in some of these children.
Are there any medications available to treat OI ?
The aim of treatment is to decrease pain and improve mobility for these children. Avoidance of contact sports, jarring and twisting activities, keeping play area free from obstacles, encouraging healthy diet also helps to preserve muscle and bone function in some of these children.
What about surgery for MBD and specifically in OI?
The use of bone strengthening drugs called bisphosphonates, used to treat osteoporosis in the elderly, have markedly change the management of this condition.
What about surgery for MBD and specifically in OI ?
In rickets and related ailments specially designed “Growth Modulation” plates can be used to correct the deformity. In other MBD, the entire bone is involved and if the bone breaks repeatedly or there is progressive bend in the bone then special steel rods are inserted inside the bone to straighten it. Also we have expandable rods which can be inserted in older children and these elongate with growth.
What is incidence of MBD and OI in India ?
Rickets is very common. For MBD, we see about 10 – 15 cases per year in the clinics.

Publications

Paediatric Fracture Management" Synopsis of Children Fracture Management & Orthopaedic Management of Duchenne Muscular Dystrophy: A guide for parents and caregivers...