Experimental Laboratory for Children's Bone Metabolism Research, Istituto Auxologico Italiano IRCCS, Milano, Italy.
Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
J Clin Densitom. 2014 Apr-Jun;17(2):281-94. doi: 10.1016/j.jocd.2014.01.005. Epub 2014 Mar 19.
The aim of this Task Force was to review the use of dual-energy X-ray absorptiometry (DXA) in children and adolescents with underlying chronic diseases that pose risk factors for compromised bone health, such as inflammation, glucocorticoid therapy, or decreased mobility. The Task Force systematically analyzed more than 270 studies, with an emphasis on those published in the interval since the original 2007 Position Statements. Important developments over this period included prospective cohort studies demonstrating that DXA measures of areal bone mineral density (aBMD) predicted incident fractures and the development of robust reference data and strategies to adjust for bone size in children with growth impairment. In this report, we summarize the current literature on the relationship between DXA-based aBMD and both fracture (vertebral and non-vertebral) outcomes and non-fracture risk factors (e.g., disease characteristics, ambulatory status, and glucocorticoid exposure) in children with chronic illnesses. Most publications described the aBMD profile of children with underlying diseases, as well as the cross-sectional or longitudinal relationship between aBMD and clinically relevant non-fracture outcomes. Studies that addressed the relationship between aBMD and prevalent or incident fractures in children with chronic illnesses are now emerging. In view of these updated data, this report provides guidelines for the use of DXA-based aBMD in this setting. The initial recommendation that DXA is part of a comprehensive skeletal healthy assessment in patients with increased risk of fracture is unchanged. Although the prior guidelines recommended DXA assessment in children with chronic diseases at the time of clinical presentation with ongoing monitoring, this revised Position Statement focuses on the performance of DXA when the patient may benefit from interventions to decrease their elevated risk of a clinically significant fracture and when the DXA results will influence that management.
本工作组的目的是回顾双能 X 射线吸收法（DXA）在患有潜在慢性疾病的儿童和青少年中的应用，这些疾病存在影响骨骼健康的风险因素，如炎症、糖皮质激素治疗或活动能力下降。工作组系统地分析了 270 多项研究，重点关注自 2007 年最初立场声明以来发表的研究。这期间的重要进展包括前瞻性队列研究表明，DXA 测量的面积骨矿物质密度（aBMD）预测了骨折的发生以及建立了强大的参考数据和策略，以调整生长障碍儿童的骨大小。在本报告中，我们总结了当前关于 DXA 基于 aBMD 与骨折（椎体和非椎体）结果以及非骨折风险因素（例如疾病特征、活动状态和糖皮质激素暴露）之间关系的文献，这些因素与患有慢性疾病的儿童有关。大多数出版物描述了患有潜在疾病的儿童的 aBMD 特征，以及 aBMD 与临床相关的非骨折结果之间的横断面或纵向关系。现在有研究探讨了慢性疾病儿童的 aBMD 与现患或新发骨折之间的关系。鉴于这些更新的数据，本报告提供了在这种情况下使用 DXA 基于 aBMD 的指南。最初的建议是，DXA 是骨折风险增加患者全面骨骼健康评估的一部分，这一建议没有改变。尽管先前的指南建议在患有慢性疾病的儿童出现持续监测的临床症状时进行 DXA 评估，但本修订立场声明侧重于在患者可能受益于干预措施以降低其临床显著骨折风险以及 DXA 结果可能影响该管理时进行 DXA。
