Height Adjustment in Assessing Dual Energy X-Ray Absorptiometry Measurements of Bone Mass and Density in Children

Zemel, Babette S.; Leonard, Mary B.; Kelly, Andrea; Lappe, Joan M.; Gilsanz, Vicente; Oberfield, Sharon E.; Mahboubi, Soroosh; Shepherd, John; Hangartner, Thomas N.; Frederick, Margaret; Winer, Karen K.; Kalkwarf, Heidi J.

doi:10.1210/jc.2009-2057

Cited by 363 publications

(347 citation statements)

References 23 publications

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“…10 DXA reference data corrected for all these variables have been published. 23 The terms "osteopenia" and "osteoporosis" are used in older adults to describe lesser or greater deficits in bone mass. These terms should not be used to describe densitometry findings in pediatric patients.…”

Section: Interpretation Of Dxa Resultsmentioning

confidence: 99%

Bone Densitometry in Children and Adolescents

Bachrach¹,

Gordon²,

Sills³

et al. 2016

Pediatrics

137

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Concerns about bone health and potential fragility in children and adolescents have led to a high interest in bone densitometry. Pediatric patients with genetic and acquired chronic diseases, immobility, and inadequate nutrition may fail to achieve expected gains in bone size, mass, and strength, leaving them vulnerable to fracture. In older adults, bone densitometry has been shown to predict fracture risk and reflect response to therapy. The role of densitometry in the management of children at risk of bone fragility is less clear. This clinical report summarizes current knowledge about bone densitometry in the pediatric population, including indications for its use, interpretation of results, and risks and costs. The report emphasizes updated consensus statements generated at the 2013 Pediatric Position Development Conference of the International Society of Clinical Densitometry by an international panel of bone experts. Some of these recommendations are evidence-based, whereas others reflect expert opinion, because data are sparse on many topics. The statements from this and other expert panels provide general guidance to the pediatrician, but decisions about ordering and interpreting bone densitometry still require clinical judgment. The interpretation of bone densitometry results in children differs from that in older adults. The terms “osteopenia” and “osteoporosis” based on bone densitometry findings alone should not be used in younger patients; instead, bone mineral content or density that falls >2 SDs below expected is labeled “low for age.” Pediatric osteoporosis is defined by the Pediatric Position Development Conference by using 1 of the following criteria: ≥1 vertebral fractures occurring in the absence of local disease or high-energy trauma (without or with densitometry measurements) or low bone density for age and a significant fracture history (defined as ≥2 long bone fractures before 10 years of age or ≥3 long bone fractures before 19 years of age). Ongoing research will help define the indications and best methods for assessing bone strength in children and the clinical factors that contribute to fracture risk. The Pediatric Endocrine Society affirms the educational value of this publication.

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Section: Interpretation Of Dxa Resultsmentioning

confidence: 99%

Bone Densitometry in Children and Adolescents

Bachrach¹,

Gordon²,

Sills³

et al. 2016

Pediatrics

137

View full text Add to dashboard Cite

show abstract

“…Therefore, a correction should be made for height or height age, and a number of mathematical corrections have been proposed. [108][109][110] The International Society for Clinical Densitometry recommends that the term "osteopenia" no longer be used in pediatric DXA reports and that the diagnosis of osteoporosis not be made on the basis of DXA results alone. 107 In the pediatric age group, the diagnosis of osteoporosis requires both a low BMD or BMC (defined as a z score less than -2) and a clinically significant fracture (defined as a long-bone fracture of the lower extremity, a vertebral compression fracture, or 2 or more long-bone fractures of the upper extremity).…”

Section: Assessment Of Bone Healthmentioning

confidence: 99%

Optimizing Bone Health in Children and Adolescents

Daniels¹,

Abrams²,

Corkins³

et al. 2014

Pediatrics

367

287

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The pediatrician plays a major role in helping optimize bone health in children and adolescents. This clinical report reviews normal bone acquisition in infants, children, and adolescents and discusses factors affecting bone health in this age group. Previous recommended daily allowances for calcium and vitamin D are updated, and clinical guidance is provided regarding weight-bearing activities and recommendations for calcium and vitamin D intake and supplementation. Routine calcium supplementation is not recommended for healthy children and adolescents, but increased dietary intake to meet daily requirements is encouraged. The American Academy of Pediatrics endorses the higher recommended dietary allowances for vitamin D advised by the Institute of Medicine and supports testing for vitamin D deficiency in children and adolescents with conditions associated with increased bone fragility. Universal screening for vitamin D deficiency is not routinely recommended in healthy children or in children with dark skin or obesity because there is insufficient evidence of the cost–benefit of such a practice in reducing fracture risk. The preferred test to assess bone health is dual-energy x-ray absorptiometry, but caution is advised when interpreting results in children and adolescents who may not yet have achieved peak bone mass. For analyses, z scores should be used instead of T scores, and corrections should be made for size. Office-based strategies for the pediatrician to optimize bone health are provided. This clinical report has been endorsed by American Bone Health.

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“…1 Salah satu efek samping dari terapi ini adalah penurunan nilai densitas mineral tulang (DMT) yang dapat diketahui melalui pengecekan Dual Energy X-Ray Absorptiometry (DEXA). 5,6 DMT merupakan cara pengukuran kalsium (mineral tulang) di dalam jaringan biologis dengan satuan g/cm 2 , dan berhubungan dengan kekuatan tulang, kapasitas beban tulang, serta risiko patah tulang. Penilaian DMT dapat dinyatakan dengan T-skor, dengan nilai T-skor -1 sampai dengan -2,5 tergolong ke dalam ostopenia, sedangkan nilai lebih dari -2,5 tergolong osteoporosis.…”

Section: Pendahuluanunclassified

“…Dari hasil analisis statistik antara tingkat kepatuhan penggunaan MP dengan nilai DMT didapatkan hubungan signifikan pada area lumbar spine (L1, L2, L3 dan total spine), 5 walaupun hubungan tersebut dalam kategori rendah yang ditunjukkan dengan nilai r (r 0,20-0,399 = rendah). L4 memberikan hasil yaitu tidak ada hubungan yang signifikan walaupun susunan jaringan tulang L1, L2, L3 dan L4 serupa.…”

Section: Kepatuhan Terapi Metilprednisolon Dapat Dilihat Berdasarkan unclassified

The Relationship of Lowering the Values of Bone Mineral Density in Methylprednisolone Medication Adherence on Rheumatoid Arthritis and Systemic Lupus Erythematosus Patients

Soeroso

Suryana

Amalia

2018

Indones J Clin Pharm

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AbstrakMetilprednisolon merupakan glukokortikoid yang memiliki efek samping penurunan densitas mineral tulang (DMT). Tingkat kepatuhan berhubungan dengan terjadinya efek. Penelitian ini bertujuan untuk mengetahui hubungan penurunan nilai DMT dengan kepatuhan terapi metilprednisolon pada pasien artritis reumatoid dan lupus eritematosus sistemik. Penelitian ini dilakukan pada 43 pasien di Poliklinik Rheumatologi RSUD dr. Saiful Anwar Malang pada bulan Desember 2016-Januari 2017 dan termasuk penelitian deskriptif noneksperimental dengan analisis kualitatif dan kuantitatif menggunakan metode cross-sectional. Data diambil dari rekam medis pasien dan wawancara. Kriteria inklusi pada penelitian ini adalah perempuan berusia 31-50 tahun, menggunakan terapi metilprednisolon minimal selama 3 bulan serta memiliki data DMT. Kriteria eksklusi adalah menopause, riwayat fraktur tulang, merokok, mengonsumsi alkohol, sindrom cushing, hipertiroidisme, hiperparatiroidisme, gangguan kelenjar pituitari, dan osteoartritis serta mengonsumsi obat bifosfonat, heparin, anti-konvulsan, dan thiazid. Analisis data menggunakan uji korelasi Pearson dan regresi linier. Terdapat hubungan antara kepatuhan dengan area DMT Spine-L1 (r= -0,313; p=0,041), Spine-L2 (r= -0,349; p=0,022), Spine-L3 (r= -0,375; p=0,013), dan total spine (r = -0,380; p = 0,012). Metilprednisolon sensitif pada jaringan tulang trabekular yang menyusun area lumbar spine dibandingkan tulang kortikal. Hubungan rendah (r) antara tingkat kepatuhan dan DMT disebabkan sosial ekonomi, perawatan kesehatan, karakteristik penyakit, dan genetik. Kepatuhan terapi metilprednisolon menurunkan nilai DMT (lumbar spine) yang berakibat meningkatkan osteoporosis.Kata kunci: Artritis reumatoid, densitas mineral tulang, eritematosus sistemik, kepatuhan, lupus metilprednisolon The Relationship of Lowering the Values of Bone Mineral Density in Methylprednisolone Medication Adherence on Rheumatoid Arthritis and Systemic Lupus Erythematosus Patients AbstractMethylprednisolone is a glucocorticoid which has a side effect of decreasing bone mineral density (DMT). The degree of compliance relates to the occurrence of effects. The objective of this study was to investigate the association of DMT impairment with adherence to methylprednisolone therapy in patients with rheumatoid arthritis (AR) and systemic lupus erythematosus (LES). The research was conducted to 43 patients in Rheumatology Polyclinic of dr. Saiful Anwar (RSSA) Malang. The study was conducted in December 2016-January 2017 and included nonexperimental description with qualitative and quantitative analysis using cross sectional method. The data were taken from the patient's medical record and interview. The inclusion criteria in this research were women, aged 31-50 years, using metilprednisolon therapy for at least three months and have mineral bone density data. Exclusion criteria were menopause, history of bone fracture, smoking, alcohol consumption, cushing syndrome, hyperthyroidism, hyperparathyroidism, pituitary gland disorders, and oste...

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Height Adjustment in Assessing Dual Energy X-Ray Absorptiometry Measurements of Bone Mass and Density in Children

Abstract: Most methods to adjust BMC/BMD Z-scores for height were biased by age and/or HAZ. Adjustments using HAZ were least biased relative to HAZ and age and can be used to evaluate the effect of short or tall stature on BMC/BMD Z-scores.

Cited by 363 publications

References 23 publications

Bone Densitometry in Children and Adolescents

Bone Densitometry in Children and Adolescents

Optimizing Bone Health in Children and Adolescents

The Relationship of Lowering the Values of Bone Mineral Density in Methylprednisolone Medication Adherence on Rheumatoid Arthritis and Systemic Lupus Erythematosus Patients

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