Gafni Rachel I, Baron Jeffrey
Unit on Growth and Development, Developmental Endocrinology Branch, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20892-1862, USA.
J Pediatr. 2004 Feb;144(2):253-7. doi: 10.1016/j.jpeds.2003.08.054.
Dual-energy x-ray absorptiometry (DEXA) is increasingly used to evaluate children for osteoporosis. However, the interpretation of pediatric DEXA is complicated by growth and development. Because most DEXA scans are performed on adults, we hypothesized that physicians who interpret DEXA may not be aware of these pediatric issues, potentially leading to misdiagnosis.
Children (n=34, aged 4-17 years) diagnosed with low bone mineral density (BMD) based on a DEXA scan were referred for possible inclusion in a childhood osteoporosis protocol. The referral DEXA scans were analyzed for accuracy.
Thirty (88%) of the scans had at least one error in interpretation. The most frequent error (62%) was use of T-score (SD score compared with young adults) to diagnose osteoporosis, which is inappropriate for children. Other errors included use of a reference database that does not consider gender or ethnic differences (21%), incorrect bone map (21%), inattention to short stature (15%), and other measurement or statistical error (12%). After correcting for these errors, 53% had normal BMD, whereas only 26% retained the diagnosis of low BMD. The remaining 21% could not be given a definitive diagnosis.
In children, the diagnosis of osteoporosis is often due to misinterpretation of a DEXA scan.
双能X线吸收法（DEXA）越来越多地用于评估儿童的骨质疏松症。然而，儿童DEXA的解读因生长发育而变得复杂。由于大多数DEXA扫描是在成人身上进行的，我们推测解读DEXA的医生可能并不了解这些儿童相关问题，这可能导致误诊。
对基于DEXA扫描诊断为低骨密度（BMD）的儿童（n = 34，年龄4 - 17岁）进行评估，以确定是否可能纳入儿童骨质疏松症方案。对转诊时的DEXA扫描结果进行准确性分析。
30份（88%）扫描结果至少存在一处解读错误。最常见的错误（62%）是使用T值（与年轻成人相比的标准差分数）来诊断骨质疏松症，这对儿童并不适用。其他错误包括使用未考虑性别或种族差异的参考数据库（21%）、骨图错误（21%）、未关注身材矮小（15%）以及其他测量或统计错误（12%）。纠正这些错误后，53%的儿童骨密度正常，而只有26%仍被诊断为低骨密度。其余21%无法给出明确诊断。
在儿童中，骨质疏松症的诊断常常是由于对DEXA扫描结果的错误解读。
