The International Society for Clinical Densitometry Official Revised Positions on reporting of densitometry results in children represent current expert recommendations to assist health care providers determine which skeletal sites should be measured, which, if any, adjustments should be made, reference databases to be used, and the elements to include in a dual-energy X-ray absorptiometry report. The recommended scanning sites remain the total body less head and the posterior-anterior spine. Other sites such as the proximal femur, lateral distal femur, lateral vertebral assessment, and forearm are discussed but are only recommended for specific pediatric populations. Different methods of interpreting bone density scans in children with short stature or growth delay are presented. The use of bone mineral apparent density and height-adjusted Z-scores are recommended as suitable size adjustment techniques. The validity of appropriate reference databases and technical considerations to consider when upgrading software and hardware remain unchanged. Updated reference data sets for all contemporary bone densitometers are listed. The inclusion of relevant demographic and health information, technical details of the scan, Z-scores, and the wording "low bone mass or bone density" for Z-scores less than or equal to -2.0 standard deviation are still recommended for clinical practice. The rationale and evidence for the development of the Official Positions are provided. Changes in the grading of quality of evidence, strength of recommendation, and worldwide applicability represent a change in current evidence and/or differences in opinion of the expert panelists used to validate the position statements for the 2013 Position Development Conference.

functions of vitamin D seem to be higher (30-50 ng/ml; 75-125 nmol/l), 25 but still are considered uncertain. Some authors, however, argue that even for proper bone mineralization, levels higher than 30 ng/ml (75 nmol/l) are necessary. 26 Indisputably, low 25(OH)D levels (below 20 ng/ml) are common and were reported worldwide, 1-7 and this is a drawback because epidemiological data underlined an association between vitamin D deficit and a higher risk for chronic conditions and multimorbidity, including musculoskeletal disorders, cancer, autoimmune diseases, cardiovascular disease, diabetes, and infectious diseases. 1,3,[27][28][29][30] One of the countries with limited data on vitamin D status is Poland (49-54°N; Central Europe). Results of studies carried out in our country indicated that the problem of vitamin D deficiency considerably affects the Polish population. In a study of 448 adult residents of urban areas INTRODUCTION Vitamin D is an important prohormone that can be synthesized by the skin exposed to sunlight (UVB) or ingested with food. However, low outdoor activity, sun protection, and low vitamin D content of staple foods reduce the significance of sun and diet as natural sources for efficacy of vitamin D metabolism and related health effects. In consequence, evidence from various populations highlighted vitamin D deficiency as a public health problem with high prevalence.1-17 The prevalence of vitamin D deficiency depends on diagnostic thresholds defining vitamin D status that is determined by total serum 25(OH)D levels, 18 and the recommended levels of 25(OH)D are still an issue of debate.19-22 Currently, it is accepted that maintaining serum 25(OH) D at a level of 20 ng/ml (50 nmol/l) or above is beneficial at least for bone health and calcium homeostasis.23,24 Levels required for noncalcemic PATIENTS AND METHODSThis cross-sectional study included a total of 5775 adult volunteers (4464 women; 1311 men; mean age, 54.0 ±15.9 years; range, 15.6-89.8 years), who were enrolled and examined through late winter and spring 2014. Serum concentrations of 25(OH)D were determined using the Liaison XL system (DiaSorin; CLIA method). Demographic and anthropometric data were also analyzed. RESULTSThe mean 25(OH)D concentration in the studied population was 18.0 ±9.6 ng/ml; 65.8% of the patients had 25(OH)D levels of less than 20 ng/ml; 24.1% had suboptimal levels of 20 to 30 ng/ml; and only 9.1% demonstrated the optimal levels of 30 to 50 ng/ml. In 89.9% of the studied population, 25(OH)D levels of less than 30 ng/ml were found. Obesity, defined as body mass index (BMI) over 30 kg/m 2 , was associated with lower 25(OH)D levels compared with normal weight (15.8 ±8.5 vs 18.5 ±9.7 ng/ml; P <0.0001). Lower 25(OH)D levels were observed in men, younger individuals, and individuals with excess body weight and higher BMI. CONCLUSIONSThe results of our study, which involved the most representative sample size of Polish adults, support the previously reported data on vitamin D status. The levels of 25(OH)D determined f...

Background Plant-based diets (PBDs) are increasingly recommended for human and planetary health. However, comprehensive evidence on the health effects of PBDs in children remains incomplete, particularly in vegans. Objectives To quantify differences in body composition, cardiovascular risk, and micronutrient status of vegetarian and vegan children relative to omnivores and to estimate prevalence of abnormal micronutrient and cholesterol status in each group. Methods In a cross-sectional study, Polish children aged 5–10 y (63 vegetarian, 52 vegan, 72 matched omnivores) were assessed using anthropometry, deuterium dilution, DXA, and carotid ultrasound. Fasting blood samples, dietary intake, and accelerometry data were collected. Results All results are reported relative to omnivores. Vegetarians had lower gluteofemoral adiposity but similar total fat and lean mass. Vegans had lower fat indices in all regions but similar lean mass. Both groups had lower bone mineral content (BMC). The difference for vegetarians attenuated after accounting for body size but remained in vegans (total body minus the head: –3.7%; 95% CI: –7.0, –0.4; lumbar spine: –5.6%; 95% CI: –10.6, –0.5). Vegetarians had lower total cholesterol, HDL, and serum B-12 and 25-hydroxyvitamin D [25(OH)D] without supplementation but higher glucose, VLDL, and triglycerides. Vegans were shorter and had lower total LDL (–24 mg/dL; 95% CI: –35.2, –12.9) and HDL (–12.2 mg/dL; 95% CI: –17.3, –7.1), high-sensitivity C-reactive protein, iron status, and serum B-12 (–217.6 pmol/L; 95% CI: –305.7, –129.5) and 25(OH)D without supplementation but higher homocysteine and mean corpuscular volume. Vitamin B-12 deficiency, iron-deficiency anemia, low ferritin, and low HDL were more prevalent in vegans, who also had the lowest prevalence of high LDL. Supplementation resolved low B-12 and 25(OH)D concentrations. Conclusions Vegan diets were associated with a healthier cardiovascular risk profile but also with increased risk of nutritional deficiencies and lower BMC and height. Vegetarians showed less pronounced nutritional deficiencies but, unexpectedly, a less favorable cardiometabolic risk profile. Further research may help maximize the benefits of PBDs in children.

Quantitative ultrasound of the heel captures heel bone properties that independently predict fracture risk and, with bone mineral density (BMD) assessed by X-ray (DXA), may be convenient alternatives for evaluating osteoporosis and fracture risk. We performed a meta-analysis of genome-wide association (GWA) studies to assess the genetic determinants of heel broadband ultrasound attenuation (BUA; n = 14 260), velocity of sound (VOS; n = 15 514) and BMD (n = 4566) in 13 discovery cohorts. Independent replication involved seven cohorts with GWA data (in silico n = 11 452) and new genotyping in 15 cohorts (de novo n = 24 902). In combined random effects, meta-analysis of the discovery and replication cohorts, nine single nucleotide polymorphisms (SNPs) had genome-wide significant (P < 5 × 10(-8)) associations with heel bone properties. Alongside SNPs within or near previously identified osteoporosis susceptibility genes including ESR1 (6q25.1: rs4869739, rs3020331, rs2982552), SPTBN1 (2p16.2: rs11898505), RSPO3 (6q22.33: rs7741021), WNT16 (7q31.31: rs2908007), DKK1 (10q21.1: rs7902708) and GPATCH1 (19q13.11: rs10416265), we identified a new locus on chromosome 11q14.2 (rs597319 close to TMEM135, a gene recently linked to osteoblastogenesis and longevity) significantly associated with both BUA and VOS (P < 8.23 × 10(-14)). In meta-analyses involving 25 cohorts with up to 14 985 fracture cases, six of 10 SNPs associated with heel bone properties at P < 5 × 10(-6) also had the expected direction of association with any fracture (P < 0.05), including three SNPs with P < 0.005: 6q22.33 (rs7741021), 7q31.31 (rs2908007) and 10q21.1 (rs7902708). In conclusion, this GWA study reveals the effect of several genes common to central DXA-derived BMD and heel ultrasound/DXA measures and points to a new genetic locus with potential implications for better understanding of osteoporosis pathophysiology.

Ultrasound bone measurement in healthy (n = 71) and osteopenic (n = 18) children aged 6 through 13 years of both sexes has been evaluated using the Achilles densitometer (Lunar Corporation). Measurements on the os calcis included speed of sound (SOS), broadband ultrasound attenuation (BUA), and a calculated "stiffness" index. The Achilles was adapted for children by a special positioning procedure that included the use of foot shims, and beam collimation on the receiving transducer. The precision of ultrasound results was comparable to that in adults (0.2% for SOS, 1.5% for BUA, and 1.8% for stiffness). SOS, BUA, and stiffness values increased with age in both sexes. Ultrasound measurements were correlated with bone mineral density (BMD in g/cm2) of the heel, AP spine (L2-L4), and total body by dual X-ray absorptiometry (DXA) densitometry (Lunar DPX-L). SOS, BUA, and stiffness measurements were significantly lower in osteopenic children (Z approximately -1.9 to -2.5) (P < 0.0001) than in normal age-matched controls. Total body BMD showed a higher Z-score than stiffness (-3.3 versus -2.5), but stiffness showed a greater percentage decrease (-30% versus -18%). In conclusion, ultrasound measurements of bone in children provide both good precision and discrimination of normals from osteopenic patients.