Article

Bone Densitometry in Children and Adolescents

PEDIATRICS (Impact Factor: 5.3). 01/2011; 127(1):189-94. DOI: 10.1542/peds.2010-2961
Source: PubMed

ABSTRACT Concern for bone fragility in children and adolescents has led to increased interest in bone densitometry. Pediatric patients with genetic and acquired chronic diseases, immobility, and inadequate nutrition may fail to achieve the expected gains in bone size, mass, and strength, which leaves them vulnerable to fracture. In older adults, bone densitometry has been shown to predict fracture risk and reflect response to therapy. The role of densitometry in the management of children at risk of bone fragility is less certain. This clinical report summarizes the current knowledge about bone densitometry in the pediatric population, including indications for its use, interpretation of results, and its risks and costs. This report emphasizes consensus statements generated at the 2007 Pediatric Position Development Conference of the International Society of Clinical Densitometry by an international panel of bone experts. Some of these recommendations are evidence-based, and others reflect expert opinion, because the available data are inadequate. The statements from this and other expert panels have provided general guidance to the pediatrician, but decisions about ordering and interpreting bone densitometry still require clinical judgment. Ongoing studies will help to better define the indications and best methods for assessing bone strength in children and the clinical factors that contribute to fracture risk.

1 Follower
 · 
106 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Diagnostic imaging plays an integral role in diagnosing and managing many pediatric disorders, but there is growing concern in both the medical community and the general public about the long-term health effects of ionizing radiation in children, as well as utilization of imaging evaluation. These concerns, coupled with increasing pressure to reduce national health care spending, underscore the need for an assessment of readily available guidelines, especially evidence-based guidelines, for imaging in children. To generate a list of national medical organization-endorsed guidelines with provisions for imaging the pediatric patient. Several resources, including the National Guideline Clearinghouse (NGC) and the Web sites of major medical organizations, were searched for documents that contained specific recommendations for imaging in the pediatric population. A total of 155 guidelines from 40 medical organizations met inclusion criteria and are represented in our compendium. The compendium generated in this study can be used to direct clinical care, inform policy development and improve education of health care personnel. Additionally, the compendium can be used to identify areas of redundancy or deficiency, which may stimulate the reassessment of existing recommendations as well as the creation of new guidelines.
    Pediatric Radiology 08/2011; 42(1):82-94. DOI:10.1007/s00247-011-2211-3 · 1.65 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: VitD deficiency and bone disease are common after Tx. Prevalence and risk factors for low VitD and BMD and response to VitD therapy were investigated in pediatric renal Tx recipients. 25-hydroxy VitD levels of 71 Tx were compared to 54 healthy AA children. DXA of 44 Tx were compared to 47 AA controls. Of Tx, 59% were AA. Majority (59.1%) of Tx were VitD deficient (23.9%) or insufficient (35.2%). Prevalence of low VitD levels was double in AA (73.9%) vs. non-AA Tx (37.7%), (p = 0.003). Low VitD among Tx was associated with AA ethnicity (p < 0.01), winter (p < 0.05), older age (p < 0.05), males (p < 0.05) and time <6 months post Tx (p < 0.05). Tx with low VitD were treated with oral ergocalciferol or cholecalciferol (23 each); 13% treated with ergocalciferol vs. 82.6% treated with cholecalciferol achieved repletion (p < 0.0001). Of 36 Tx with whole body DXA, 19.5% had BMD (z < -1) after height adjustment. AA Tx had 3.4-fold higher risk of low BMD vs. controls (p < 0.05). Low VitD and BMD are prevalent in children after renal Tx. Better repletion of VitD is achieved with cholecalciferol.
    Pediatric Transplantation 09/2011; 15(8):790-7. DOI:10.1111/j.1399-3046.2011.01571.x · 1.63 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The objectives of this study were to (1) determine the prevalence of low bone mineral density (BMD) in a large prospective cohort of newly diagnosed patients with paediatric systemic lupus erythematosus (pSLE) and (2) identify risk factors associated with low BMD. Single-centre cohort study of 80 children and adolescents who underwent a dual-energy x-ray absorptiometry within 3 months of diagnosis. Low lumbar spine (LS) BMD was defined as z score ≤ -2.0. BMD was correlated with baseline demographic, clinical and laboratory markers of disease activity and biochemical markers of bone health. Risk factors of BMD were evaluated with univariable and multivariable linear and logistic regression analyses. Low BMD at any site was found in 15% of newly diagnosed pSLE patients. LS BMD was associated with body mass index (BMI) z score and corrected calcium (r(2)=0.31, p<0.0001). Hip BMD was associated with BMI z score and intact parathyroid hormone (iPTH) (r(2)=0.26, p=0.002). Higher BMI z score was protective against low BMD at any site (OR 0.35). One in six newly diagnosed pSLE patients had low BMD (at any site). Low BMI z score, low calcium and high iPTH identified children at risk for low BMD at diagnosis of pSLE.
    Annals of the rheumatic diseases 09/2011; 70(11):1991-4. DOI:10.1136/ard.2010.144311 · 9.27 Impact Factor

Preview

Download
1 Download
Available from