Scott Webb (Host): Shriners Children's Portland offers comprehensive care for children with low bone density, weak bones and other conditions associated with fragility fractures. Using innovative technology in a collaborative approach, their multidisciplinary team works with families to promote growing healthy bones. We're joined today by Dr. Lindsey Nicol. She's here to discuss the importance of bone development in children and discuss other frequently asked questions.

Welcome to Healing Heroes pdx, the podcast series from Shriner's Children's, Portland. I'm Scott Webb.

Host: Doctor, thanks so much for your time today. We're going to talk about bone density in children and what that means and how it's measured and why we should care about it. But before we get to that, an opportunity here for you to introduce yourself, who you are, what you do, approach to care, all that good stuff.

Dr. Lindsey Nicol: Yeah. So, I'm Dr. Lindsey Nicol. I am an associate professor at Doernbecher Hospital at OHSU. But one of the favorite parts of my job is I'm also a medical consultant for Shriners Hospital Portland. This is where I get the chance to promote bone health and also provide medical management for various types of bone diseases. I work in what's called the skeletal dysplasia clinic at Portland, Shriners, the neuromuscular clinic at Shriners as well as the Bone Health Clinic. So, I have a lot of different venues in which I see kids.

Host: Yeah. And I wanted to ask you specifically about one of those venues, the Bone Health Clinic. Talk about your role as a pediatric endocrinologist. What role do you play? What part do you play? As you say, you're at different venues. But what do you do there?

Dr. Lindsey Nicol: So, you know, Portland Shriners and Shriners Hospitals in general, we treat a lot of kids with various bone disorders. So, my role as an endocrinologist is providing expertise in growth, which primarily comes from the bones and all those messages that are important in normal growth of our pediatric skeleton. So, that can include thyroid, growth hormone, it includes puberty. Also, I provide expertise in things like calcium and phosphorus regulation and vitamin D, and those are all very, very important ingredients in bone density. And additionally, I provide interpretation and review of bone density scans. So, I augment some of our multidisciplinary clinics by including my expertise in basically growth, development and interpretation of bone density.

Host: Yeah. It's such a fun area. So, let's talk about the DEXA scan at Shriners Children's Portland, what it is, you know, what does that stand for, and what does it really mean for patients.

Dr. Lindsey Nicol: A DEXA scan is basically like other imaging studies. You use a kind of a low source of radiation to define basically the density of a bone. So, it's similar to like a chest x-ray or an x-ray of the femur, but it's designed specifically to quantify or measure density. And it's important because in kids, it's considered the gold standard for measuring bone density. Sometimes we get clues here and there that a kid's density is not great or not normal by the x-rays that we see, so we can pick up clues that way. But really to get down to quantifying that, you need a DEXA scan.

And the DEXA scan's used in a couple different ways. One is that it can be important in helping us diagnose what's going on. So, confirming low bone density in a child who may be having issues with fractures or growth helps direct us to certain other diagnoses as opposed as if it were normal. It's also used in monitoring treatment. So for example, I see a lot of kids with osteogenesis imperfecta and many of those kids who are having issues with frequent fractures receive medical treatment using bisphosphonates. And those bisphosphonates improve the bone mineral density in kids with this particular skeletal disorder and can reduce the number of fractures that they have. We use the DEXA scan in this population on other kids who are treated with bisphosphonates to monitor how we're doing with the therapy, are we successful or not. And also, in many cases, to adjust the dose and tell us what dose they should be on. So, it's really important and very helpful.

Host: Yeah. I've hosted some podcasts on like osteoporosis and things like that, so DEXA scans have come up before, but really interesting to hear how you're using it there and using it to help kids and, you know, measure the success of treatment and so on. And my daughter broke her wrist and I was shocked at the time at how fast children's bones heal. You know, I remember the doctor saying that, you know, if an adult had the same injury that your daughter had, it may never really completely heal because children's bones are just generally so resilient and they heal so fast. But why is it such an important time for bone development in children? Is it just that once we become an adult, that's it, your bones are done, whatever happened happened? How does that work, doctor?

Dr. Lindsey Nicol: Well, first of all, just in general, kids are amazing, which is why I encourage every medical student to go into pediatrics because we can make small interventions in a kid, which have huge outcomes because they're designed to grow, they're designed to heal. And that's true for the pediatric skeleton. It's an extremely dynamic tissue. Oftentimes, we don't think about our bones. We don't think about our kids' bones until there's a problem with it. But kids are constantly reshaping, resorbing, remodeling, building their bones. And in fact, the process in which kids acquire bone is exponentially higher than what we do as an adult. I mean, as adults, we're remodeling and rebuilding and reshaping, but at a lot much slower process.

Host: Yeah, much slower. Right.

Dr. Lindsey Nicol: So, kids during puberty can gain up to 60% even more of their total bone mass. And then, they continue to acquire bone mass up until age 20 or 30. At which point, there's that natural decline that all adults have. We gradually lose our bone mass density over time. So, kids are amazing.

Host: Yeah, they are.

Dr. Lindsey Nicol: Yeah. And their bones are no exception to that.

Host: Yeah. So true. And I meant to ask you, when we were talking about the DEXA scans, are there some other benefits beyond use with kids with fragile bones? Are there some other advantages to using DEXA scans?

Dr. Lindsey Nicol: Well, you know, there's a lot of advantages to using a DEXA scan. For the most part, we're using it to assess bone density in a kid who we are worried about bone fragility or in the other area that I mentioned, if we're treating and we want to monitor therapy. But the overall benefits, if we do need to use it is that it's very fast, it takes three to 10 minutes for the scan, depending on which regions we're looking at. It's extremely low radiation compared to other modalities of looking at CT scans or other, you know, types of x-rays. So, it's very safe, low radiation exposure. The scan is open, so it's not like you're trying to push a kid through a small tube. It's not loud. We don't need sedation.

Host: It's not like an MRI where it's just so busy and loud.

Dr. Lindsey Nicol: Yes, it's very kid-friendly. And then, like I said, it's the gold standard for now for measuring density. So, it's really, really beneficial, really easy to do.

Host: Yeah. I want to give you an opportunity, you know, you talked earlier about how you, you know, work at different venues, and obviously it's all related to kids, but what's unique about the experience of working at Shriners Children's?

Dr. Lindsey Nicol: When I think about Shriners, specifically Portland Shriners, it really has to be looked at as not just a Portland thing, it's a regional thing. I mean, we serve kids from a really broad or huge geographical range. You know, Southern Washington to Northern California. And, you know, sometimes even see kids from Alaska. And so, to be able to work at a center that can serve a region is extremely important. And to also, you know, work with kids who have bone disease, who are very unique and special and brave and to be able to provide care for them is really an honor. I've learned a ton from the kids themselves, from the families, and then also from my colleagues.

I mean, I think Portland Shriners has, you know, recognized that multidisciplinary care is the best care. And I think we're able to offer that for people who are traveling long distances to get the care that they need for unique bone disease. And then, you know, frankly, adding on a DEXA the machine into that means that we can offer same-day evaluations if that's indicated. We don't have to ask them to come back at a different date. And we also have the ability to make it really pediatric-specific. I mean, kids are not small adults. Their scans and their blood work need to be interpreted in the context of their size, their age, their development. And so, I think that's really important. And I think working at Shriners means that all of those things have come together. I feel like I can really offer comprehensive care to patients who need it.

Host: Yeah. Well, you know, those parents, me and those in the audience listening who've ever had to take their kids to the doctor, just a simple pediatric visit or, you know, the dreaded checking for strep throat or then COVID and broken bones and, you know, why isn't my kid growing? I mean, what we want, what we need really is to be able to trust the folks that are taking care of our kids, to feel like they're using the cutting edge gold standard. As you say, folks are coming from all over the place, including Alaska, so they want to be able to do one stop shopping, right? They want their office visit, they want their DEXA scans, they want to do everything while they're there. So, it's just so great to hear, great to meet you. Thank you so much for your time. You stay well.

Dr. Lindsey Nicol: Yeah. Thanks for having me.

Scott Webb (Host): And for more information, check out our website@shrinersportland.org. And that concludes this episode of Healing Heroes pdx, the podcast series from the specialists at Shriners Children's, Portland. Head over to our website@shrinersportland.org.

For more podcast episodes, I'm Scott Webb. Stay well.