Osteopenia in children: CT assessment.

Kovanlıkaya, Arzu; Loro, M L; Hangartner, Thomas N.; Reynolds, R. A.; Roe, Thomas; Gilsanz, Vicente

doi:10.1148/radiology.198.3.8628871

Cited by 39 publications

(12 citation statements)

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“…Bone density assessments are frequently performed in pediatric patients to facilitate the evaluation of the multiple conditions associated with a deficiency in bone acquisition during growth and to assess response to therapies (27)(28)(29)(30). The aim of the current study was to provide normal reference values for the density of trabecular bone in the axial skeleton of male and female subjects from childhood to young adulthood.…”

Section: Discussionmentioning

confidence: 99%

“…The data presented in this study are a compilation of multiple investigations on the determinants of bone acquisition in healthy children, adolescents, and young adults at Childrens Hospital Los Angeles, Los Angeles, Calif, from 1992 to 2006 (19,20,(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35). Included in this study were 1222 white subjects, aged 5-21 years, who were not taking any medications and were not known to have any illness.…”

Section: Methodsmentioning

confidence: 99%

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Quantitative CT Reference Values for Vertebral Trabecular Bone Density in Children and Young Adults

Gilsanz¹,

Pérez²,

Campbell³

et al. 2009

Radiology

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Purpose:To determine normative reference values for vertebral trabecular bone density (TBD) obtained by using quantitative computed tomography (CT) in healthy white children, teenagers, and young adults of both sexes. Materials and Methods:The data presented in this HIPAA-compliant study are a compilation of data from multiple investigations on the determinants of bone acquisition in healthy children conducted at this institution from 1992 to 2006. The institutional review board for clinical investigations approved the protocols for each of these studies, and written informed consent was provided by all parents and/or participants. Quantitative CT measurements of TBD (in milligrams per cubic centimeter) were obtained at the first, second, and third lumbar vertebrae in 1222 healthy white male and female subjects aged 5-21 years (mean age for male subjects, 15.1 years Ϯ 3.6 [standard deviation]; range, 5.6 -21.9 years; mean age for female subjects, 14.2 years Ϯ 3.9; range, 5.7-21.6 years; mean age for both sexes, 14.6 years Ϯ 3.8). Mean and standard deviations for TBD were determined for each age group in 1-year intervals, and Student t tests for unpaired data were performed to compare male subjects with female subjects. Results:TBD increased equally during growth in male and female subjects. Although the percentage increase in TBD was similar for both sexes (23.7% [57 of 241] for male subjects, 22.2% [54 of 243] for female subjects), the rise began and reached peak values at an earlier age in female subjects; increases in TBD occurred from 10 -15 years of age in female subjects, whereas in male subjects, these increases were not observed until age 12 years and were completed at 17 years. Conclusion:This study provides reference standards for quantitative CT bone measurements in children and young adults, which may aid in the diagnosis, prevention, and treatment of pediatric metabolic bone disorders. Note: This copy is for your personal, non-commercial use only. To order presentation-ready copies for distribution to your colleagues or clients, use the Radiology Reprints form at the end of this article.M easurements of bone density during childhood are commonly obtained to assess the deficiencies in bone accumulation associated with a multitude of pediatric disorders. Moreover, the amount of bone that is gained during growth is an important determinant of the risk for osteoporosis later in life (1,2), and available data suggest that the genetic susceptibility to osteoporosis is detectable in childhood (3). Peak bone mass, a major determinant of the future risk of fractures in the elderly, is largely achieved by the end of sexual development (4).Because of its availability, minimal radiation exposure, and relative ease of use, dual-energy x-ray absorptiometry (DXA) is the most commonly employed quantitative radiologic method to assess bone mass at any age (5). The interpretation of DXA bone studies is considerably more challenging in children than in adults. Although reference data and diagnostic algorithms are avai...

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Quantitative CT Reference Values for Vertebral Trabecular Bone Density in Children and Young Adults

Gilsanz¹,

Pérez²,

Campbell³

et al. 2009

Radiology

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“…An early pQCT study on 9 children with hypophosphatemic rickets found normal or elevated trabecular volumetric bone mineral density (vBMD) (14). Another report mentioned extremely low cortical vBMD at the midshaft femur of 8 children with hypophosphatemic rickets (15). As cortical vBMD reflects to a large extent the average degree of mineralization of cortical bone tissue (16), it might be a useful parameter to study the effect of XLH on the skeleton and to assess changes in bone mineralization brought about by therapeutic interventions.…”

mentioning

confidence: 99%

Cortical and Trabecular Bone Density in X-Linked Hypophosphatemic Rickets

Cheung

Roschger

Klaushofer

et al. 2013

The Journal of Clinical Endocrinology &Amp; Metabolism

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Context: X-linked hypophosphatemic rickets is caused by mutations in PHEX. Even though the disease is characterized by disordered skeletal mineralization, detailed bone densitometric studies are lacking.Objective: The aim of the study was to assess volumetric bone mineral density (vBMD) in X-linked hypophosphatemic rickets using forearm peripheral quantitative computed tomography. Setting:The study was conducted in the metabolic bone clinic of a pediatric orthopedic hospital.Patients: Thirty-four patients (age, 6 to 60 years; 24 female) with PHEX mutations were studied, of whom 7 children (age, 6 to 11 years) were actively being treated with calcitriol and phosphate supplementation. Twenty-one patients (age, 16 to 40 years) had received the same therapy before but had discontinued the treatment; 6 patients (age, 12 to 60 years) had never received this treatment. Main Outcome Measures: Trabecular and cortical vBMD of the radius.Results: Trabecular vBMD was elevated (mean age-specific and sex-specific z-score: ϩ1.0) when all patients were analyzed together, due to very high results in currently treated patients (mean z-score: ϩ2.4) and slightly above-average mean values in the other patients. Cortical vBMD was low when the entire cohort was analyzed together (mean z-score: Ϫ3.3), but was higher in currently treated patients (mean z-score: Ϫ1.3) than in patients who had discontinued therapy (mean zscore: Ϫ3.8) or who had never been treated (mean z-score: Ϫ4.1). Conclusions:Patients with PHEX mutations have elevated trabecular vBMD at the distal radius while receiving calcitriol and phosphate supplementation, but low cortical vBMD at the radius diaphysis. Low cortical vBMD presumably reflects the underlying mineralization defect that is not entirely corrected by current treatment approaches. (J Clin Endocrinol Metab 98: E954 -E961, 2013) H ereditary hypophosphatemic rickets is characterized by hypophosphatemia due to renal phosphate wasting, resulting in leg deformities and short stature (1, 2). Hypophosphatemic rickets is most commonly caused by mutations in the phosphate-regulating endopeptidase gene (PHEX), transmitted as an X-linked trait (X-linked hypophosphatemic rickets, XLH) (1, 3, 4).The current treatment for XLH consists of oral phosphate supplementation and calcitriol and aims at maximizing growth and preventing bone deformities (1, 2). Because these main benefits are dependent on skeletal growth and the treatment schedule is quite burdensome, therapy is often discontinued once final height is achieved. Abbreviations: BMD, bone mineral density; LS-aBMD, lumbar spine areal bone mineral density; pQCT, peripheral quantitative computed tomography; vBMD, volumetric bone mineral density; XLH, X-linked hypophosphatemic rickets.

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“…Accordingly, this technique may be well suited for studies of children, whose bone sizes vary with age [13,14]. QCT also permits a separate assessment of cortical and trabecular compartments.…”

Section: Quantitative Ctmentioning

confidence: 99%

Pediatric bone density and fracture

Scheven

2007

Curr Osteoporos Rep

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As children grow, they accumulate bone mineral, which serves as a "bone bank" for the future. Any condition that interferes with normal bone mineral accrual during childhood has the potential to reduce peak bone mass and subsequently increase future risk for fracture. In contrast to adults, for whom dual-energy x-ray absorptiometry (DXA) has become the standard clinical instrument for assessing bone mineral density and criteria have been developed to define osteopenia and osteoporosis, information for children is still limited. Numerous issues confound the interpretation of DXA-derived bone mineral density measurements in children, and clinicians often find themselves caught between the limitations of these methods and the practical issue of taking care of their pediatric patient. The explosion of treatment options for postmenopausal osteoporosis has resulted in new options for the treatment of children and adolescents. However, most of these agents have not been sufficiently well studied in children to permit the development of standardized treatment guidelines.

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Osteopenia in children: CT assessment.

Abstract: CT measurements of area and density of cortical bone aided the differentiation of the various disorders that cause osteopenia in children.

Cited by 39 publications

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Quantitative CT Reference Values for Vertebral Trabecular Bone Density in Children and Young Adults

Quantitative CT Reference Values for Vertebral Trabecular Bone Density in Children and Young Adults

Cortical and Trabecular Bone Density in X-Linked Hypophosphatemic Rickets

Pediatric bone density and fracture

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