Dual-Energy X-Ray Absorptiometry Interpretation and Reporting in Children and Adolescents: The Revised 2013 ISCD Pediatric Official Positions

Abstract

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.

Cow's Milk Allergy and Bone Mineral Density in Prepubertal Children

“…Results were transformed into age-and genderspecific z scores by using the LUNAR Prodigy normative database and interpreted according to the guidelines of the International Society for Clinical Densitometry for pediatrics. 20 To adjust for bone size, volumetric bone mineral density (vBMD) was calculated by using Kröger's cylindrical model. 21 Ageand gender-specific reference data from a cohort of white European children were used to calculate the vBMD z scores.…”

Influence of Chronic Recurrent Multifocal Osteomyelitis (CRMO) On Densitometry Measurements Obtained by Dual X-Ray Absorptiometry

“…On a per-lesion basis, 129 CRMO-related skeletal lesions were detected on MRI and/or bone scan and only 25 (19.4%) of these lesions were detected on DXA. Most of the lesions were identified in the distal femoral metadiaphysis [9,10], while other lesions were identified in the proximal tibia [6], lumbar vertebral bodies [3], clavicle [4], and mid/hind foot bones [2].…”

“…The lumbar spine and TBLH are generally considered to be the most accurate and reproducible skeletal sites for measuring BMD and BMC in children and adolescents [4]. For the lumbar spine, the L1-L4 region is used unless focal artifacts or structural changes (e.g.…”

“…In such cases, one vertebral body can be removed from the analysis, and the BMD/BMC measurements are still considered reliable [9]. No similar consensus exists for the TBLH as to what should be excluded when artifacts are present [4,8]. As such, our method of analysis may be limited as it is not known what effect removing CRMO lesions from the TBLH has on the accuracy of the obtained BMD/BMC and associated Z-score.…”

“…Dual-energy X-ray absorptiometry (DXA) is used in CRMO to assess bone mineral density (BMD) and bone mineral content (BMC), particularly in patients undergoing bisphosphonate treatment [3]. In children, total body less head (TBLH) and spine are the recommended DXA sites for bone health assessment [4]. Careful evaluation of the DXA scan image and BMD/BMC data are essential in formulating accurate DXA scan interpretations.…”