Zemel Babette S, Shepherd John A, Kazemi Laila, Kelly Andrea, Stallings Virginia A, Kecskemethy Heidi, Weber David R, Wasserman Halley, Kalkwarf Heidi J
Division of Gastroenterology, Hepatology and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA; Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA.
Cancer Center, University of Hawaii, Honolulu, HI, USA.
J Clin Densitom. 2025 Jul-Sep;28(3):101594. doi: 10.1016/j.jocd.2025.101594. Epub 2025 May 7.
Many children with musculoskeletal disorders are at high risk of fracture, and the lateral distal femur (LDF) may be the only feasible site to measure bone mineral density (BMD) by dual energy X-ray absorptiometry (DXA). Pediatric reference ranges and adjustment for linear growth are needed to interpret BMD results.
Lateral distal femur scans by DXA were obtained on children, ages 1 to 18 y, from two clinical centers. Precision in young children was estimated from duplicate scans. Smoothed reference ranges for three regions of the LDF were generated. Prediction equations were developed to account for the effects of short or tall stature on BMD.
We obtained >2400 measurements on 1,245 children and generated reference ranges for three LDF BMD regions. Precision of BMD was similar (% CV of 1.33 to 2.42 %) to estimates reported at other skeletal sites. Modest sex differences were observed, with females having greater BMD than males at older ages. Children identified as Black had greater BMD than children identified as Non-Black. Height-for-age Z-scores were associated with BMD-for-age Z-scores in pre- and peri-pubertal children, and adjustment equations were generated.
This study fills substantial gaps in pediatric bone health assessment for children with musculoskeletal disorders who are at high-risk of fracture by providing smoothed reference ranges for ages 1 to 18 y and equations to estimate the impact of small body size on BMD-for-age Z-scores.
许多患有肌肉骨骼疾病的儿童骨折风险很高，而股骨远端外侧（LDF）可能是通过双能X线吸收法（DXA）测量骨密度（BMD）的唯一可行部位。需要儿科参考范围和线性生长调整来解释骨密度结果。
从两个临床中心获取了1至18岁儿童的股骨远端外侧DXA扫描图像。通过重复扫描估计幼儿的精密度。生成了LDF三个区域的平滑参考范围。开发了预测方程以考虑身材矮小或高大对骨密度的影响。
我们对1245名儿童进行了超过2400次测量，并生成了LDF骨密度三个区域的参考范围。骨密度的精密度与其他骨骼部位报告的估计值相似（变异系数为1.33%至2.42%）。观察到适度的性别差异，年龄较大时女性的骨密度高于男性。被认定为黑人的儿童比被认定为非黑人的儿童骨密度更高。青春期前和青春期儿童的年龄别身高Z评分与年龄别骨密度Z评分相关，并生成了调整方程。
本研究通过提供1至18岁的平滑参考范围以及估计小身材对年龄别骨密度Z评分影响的方程，填补了骨折高风险肌肉骨骼疾病儿童儿科骨健康评估的重大空白。
