Fonseca Adriana, Gordon Christopher L, Barr Ronald D
Departments of *Pediatrics ‡Radiology †Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada.
J Pediatr Hematol Oncol. 2013 Nov;35(8):581-9. doi: 10.1097/MPH.0000000000000017.
The bone health of adults is dependent on the appropriate acquisition of peak bone mineral mass during late childhood and adolescence. Measurement of bone mineral density (BMD) in clinical practice is accomplished usually by dual energy x-ray absorptiometry that provides 2-dimensional (areal) values for BMD, does not distinguish cortical from trabecular bone, and should be adjusted for height and weight when used for children and adolescents. Peripheral quantitative computed tomography (pQCT) provides volumetric measures of BMD and geometry in both cortical and trabecular bone and, unlike dual energy x-ray absorptiometry, does not need adjustment for body size. Studies of bone health in young people require reference data for normative comparison. A literature review from 1946 to 2012 identified 1886 titles suggesting use of pQCT, with only 32 reporting some form of normative data. A detailed review of these 32 reports revealed a lack of consensus among users for standard scan locations in upper and lower limbs, acquisition protocols and analytical steps, and variables reported. Meaningful and effective use of pQCT for assessing bone strength and overall bone health in all age groups will require better defined normative data derived with common measuring techniques, equipment, and analytical approaches.
成年人的骨骼健康取决于儿童晚期和青春期峰值骨量的适当获取。在临床实践中，骨密度（BMD）的测量通常通过双能X线吸收法完成，该方法提供BMD的二维（面积）值，无法区分皮质骨和小梁骨，并且在用于儿童和青少年时应根据身高和体重进行调整。外周定量计算机断层扫描（pQCT）可提供皮质骨和小梁骨中BMD和几何形状的体积测量值，与双能X线吸收法不同，它不需要根据身体大小进行调整。对年轻人骨骼健康的研究需要参考数据进行规范比较。一项1946年至2012年的文献综述确定了1886篇建议使用pQCT的文献，其中只有32篇报告了某种形式的规范数据。对这32份报告的详细审查发现，使用者在上下肢的标准扫描位置、采集方案和分析步骤以及报告的变量方面缺乏共识。要在所有年龄组中有效且有意义地使用pQCT评估骨强度和整体骨骼健康，将需要采用通用测量技术、设备和分析方法得出更明确的规范数据。
