Dual-energy X-ray absorptiometry bone densitometry in pediatrics: a practical review and update
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REVIEW
Dual-energy X-ray absorptiometry bone densitometry in pediatrics: a practical review and update Hedieh Khalatbari 1
&
Larry A. Binkovitz 2 & Marguerite T. Parisi 1,3
Received: 26 February 2020 / Revised: 13 May 2020 / Accepted: 15 June 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract The assessment of pediatric bone mineral content and density is an evolving field. In this manuscript we provide a practical review and update on the interpretation of dual-energy X-ray absorptiometry (DXA) in pediatrics including historical perspectives as well as a discussion of the recently published 2019 Official Position Statements of the International Society of Clinical Densitometry (ISCD) that apply to children. Keywords Bone . Bone mineral density . Children . Density . Dual-energy X-ray absorptiometry
Introduction Osteoporosis is a systemic skeletal disease characterized by low bone mass, microarchitectural disruption and increased bone fragility with resultant increased risk of fragility fractures [1, 2]. Low bone mass can be caused by low peak bone mass, excessive bone resorption, decreased bone formation during remodeling, or a combination thereof. Fragility fractures occur in bones with reduced mechanical strength and can occur spontaneously or from minor trauma [3]. These fractures result from mechanical forces that would not cause fractures in bones with normal strength. Vertebral body, hip and wrist — sites rich in trabecular bone — are the most common sites of osteoporotic-related fragility fractures in adults. In contradistinction, fracture patterns in children differ from those in Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00247-020-04756-4) contains supplementary material, which is available to authorized users. * Hedieh Khalatbari [email protected] 1
Department of Radiology, Seattle Children’s Hospital, University of Washington School of Medicine, 4800 Sand Point Way NE, Seattle, WA 98105, USA
2
Department of Radiology, Divisions of Pediatric Radiology and Nuclear Medicine, Mayo Clinic Graduate School of Medicine, Rochester, MN, USA
3
Department of Pediatrics, Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, WA, USA
osteoporotic adults. More than 80% of fractures in healthy children occur in the upper extremities, most commonly in the distal forearm and hand; less than 2% occur in the femur [3, 4]. Further, while spinal compression fractures are prevalent in the osteoporotic elderly adult population, they are rare in children [4]. In the pediatric population, vertebral compression fractures represent only 1–5% of all fractures in childhood and, when present, should raise concern for an underlying bone fragility disorder [3]. Finally, in pediatric patients with cerebral palsy, Duchenne muscular dystrophy or other physical disabilities that limit ambulation, up to 50% of fractures occur in the femur [4]. A substantial accrual of bone mass normally occurs during child
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