Hand bone mineral density (BMD) in adults was found to be significantly correlated with various skeletal sites, including the total body. However, the relationships between hand and total body bone measurements have yet to be explored for children. We conducted a cross-sectional study of 892 normal Chinese children (511 males, 381 females) aged 5-14 years by measuring the BMD and bone mineral content (BMC) at the total hand, upper limb, subtotal body, and total body using dual-energy X-ray absorptiometry (DXA). We found that hand BMD and BMC increased with age for both genders. Female children had significantly higher hand BMD and BMC than males. Age explained more variance in hand BMD for females (R2=0.727) than for males (R2=0.596). For both genders, hand BMD and BMC correlated highly with age, weight, height, total body lean mass, and BMD and BMC at the upper limb, subtotal body, and total body (r=0.730-0.965, p<0.001) and moderately with body mass index and total body fat mass (r=0.525-0.701, p<0.001). Therefore, the hand DXA scan can potentially be a new tool for the clinical assessment of bone health in children.
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[Show abstract][Hide abstract] ABSTRACT: Purpose of review: Bone health and osteoporosis prevention have become areas of increasing concern for health care providers of children and adolescents. This review considers studies that examine measurement tools to evaluate bone density in a young, growing skeleton and strategies that may be employed to assist in the interpretation of this information. Also highlighted are reports that establish specific pediatric diagnoses to be associated with early bone loss.
Recent findings: An expert panel recently published recommendations regarding how to define osteoporosis in a child. Another report documented the high prevalence of errors that occur in pediatric densitometry reports, resulting in the misclassification of this diagnosis in children. Several technical reports explore algorithms or correction factors that can be used to avoid errors and enhance the interpretation of a bone density measurement in a growing child or adolescent. Other studies have focused on pediatric diagnoses such as cystic fibrosis and hemophilia, among others, that are associated with a low bone mass. Finally, recent studies have examined changes in bone density after treatment with glucocorticoids, bisphosphonates, or anticonvulsants, spurring on the debate whether the response of the pediatric skeleton to these agents differs from that seen in adults.
Summary: Controversy exists regarding the most accurate and safe measurement technique to evaluate bone mass and skeletal strength in a child. Refinement of current diagnostic tools will lead to an improved ability to assess both bone density and quality, and will afford insight into fracture risk in growing children and adolescents.
Current Opinion in Endocrinology Diabetes and Obesity 11/2005; 12(6):444-451. DOI:10.1097/01.med.0000184298.22693.ca · 3.37 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Hand bone mineral density (BMD) by DXA has mainly been used to assess bone loss in rheumatoid arthritis patients. Its use in healthy subjects is limited. The following study was conducted to determine if measurements of hand BMD could estimate ones risk of osteoporosis and predict BMD in other skeletal sites. Subjects consisted of 134 Caucasian females (57-88 yr, 46 with self-reported osteoarthritis and the rest healthy). BMD was measured in the hand, forearm, hip, spine, and total body with the Lunar DPX-MD instrument. Subjects were divided into those with osteoarthritis (OA) and those without and were examined separately, as well as together. Hand BMD correlated significantly with all skeletal sites for the whole population and for each group. Pearson r for the whole population ranged from 0.56 in the lumbar spine to 0.82 in the forearm. Subjects with OA had higher correlations for most sites. Subjects' T-scores, derived from the reference population of young normal adult women, for hip, spine, forearm, and whole body correlated highly with hand BMD. To test how accurately hand BMD could predict BMD in other skeletal sites, we generated regression models from three-fourth of our subjects (n = 102). Based on the resulting regression equations and measured hand BMD, we calculated the predicted values of the BMD in all other skeletal sites for the remaining one-fourth of the subjects (n = 32). The predictive mean square errors, calculated from the observed and predicted values for each skeletal site, were small and below the cutoff values in F-distribution. In conclusion, hand BMD has a potential to establish one's risk for osteoporosis as well as reasonably accurately predict BMD in other skeletal sites. The hand BMD measurement in general, whether a part of DXA or as a separate instrument, might have a potential to be used for mass screening and in prospective studies to determine risk of fractures.