University of Cologne, Kerpener Strasse 62, Cologne, Germany.
Pediatr Nephrol. 2010 Dec;25(12):2393-400. doi: 10.1007/s00467-010-1517-y. Epub 2010 May 11.
Bone density and bone mass are commonly regarded as the essential parameters to describe fracture risk in osteology. Because fractures primarily depend on bone strength and secondarily on bone mass and density, bone strength should be the main parameter to describe fracture risk. The quantitative description of bone strength has the prerequisite that bone geometry is assessed despite bone density. Thus, volumetric osteodensitometric methods should be preferred, which enable the physician to evaluate parameters primarily associated with bone modeling or remodeling. Modeling describes the adaptation of bone geometry to applied muscular forces in contrast to remodeling representing bone turnover. The adaptation of bone geometry to muscle forces led to the term functional muscle-bone unit, which enables the physician to differentiate between primary and secondary bone diseases. Primary bone diseases are characterized by a defective adaptation of bone to muscle forces in contrast to secondary bone diseases, which are primary diseases of the neuromuscular system. Because muscle forces are essential in the feedback loop of bone adaptation to forces (mechanostat), the assessment of muscle function has become an essential part of osteologic diagnostics in pediatrics. Dynamometric and mechanographic methods have been introduced to properly characterize kinetic aspects of muscle function in children and adolescents. Therefore, emphasis should be put on the assessment of muscle function despite the evaluation of osteodensitometric parameters in pediatric osteology.
骨密度和骨量通常被认为是描述骨骼中骨折风险的基本参数。因为骨折主要取决于骨强度，其次取决于骨量和密度，所以骨强度应该是描述骨折风险的主要参数。骨强度的定量描述的前提是评估骨几何形状，尽管有骨密度。因此，应该优先选择体积骨密度测量方法，这使医生能够评估主要与骨形成或重塑相关的参数。形成描述了骨几何形状对施加的肌肉力量的适应性，而重塑则代表了骨的周转率。骨几何形状对肌肉力量的适应导致了功能肌肉骨骼单位这一术语的出现，这使医生能够区分原发性和继发性骨骼疾病。原发性骨骼疾病的特征是骨对肌肉力量的适应性缺陷，而继发性骨骼疾病则是神经肌肉系统的原发性疾病。由于肌肉力量在骨对力的适应反馈环中至关重要（力学稳定器），因此评估肌肉功能已成为儿科骨骼诊断学的重要组成部分。已经引入了测力和力学记录方法，以正确描述儿童和青少年肌肉功能的动力学方面。因此，尽管在儿科骨骼学中评估骨密度测量参数，但应强调评估肌肉功能。
