Bone Densitometry in Children and Adolescents

PEDIATRICS (Impact Factor: 5.47). 01/2011; 127(1):189-94. DOI: 10.1542/peds.2010-2961
Source: PubMed


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.

Full-text preview

Available from:
  • Source
    • "From refs. [2,4]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The long-term impact on bone health of lifelong HIV infection and prolonged ART in growing and developing children is not yet known. Measures of bone health in youth must be interpreted in the context of expected developmental and physiologic changes in bone mass, size, density and strength that occur from fetal through adult life. Low bone mineral density (BMD) appears to be common in perinatally HIV-infected youth, especially outside of high-income settings, but data are limited and interpretation complicated by the need for better pediatric norms. The potential negative effects of tenofovir on BMD and bone mass accrual are of particular concern as this drug may be used more widely in younger children. Emphasizing good nutrition, calcium and vitamin D sufficiency, weight-bearing exercise and avoidance of alcohol and smoking are effective and available approaches to maintain and improve bone health in all settings. More data are needed to inform therapies and monitoring for HIV-infected youth with proven bone fragility. While very limited data suggest lack of marked increase in fracture risk for youth with perinatal HIV infection, the looming concern for these children is that they may fail to attain their expected peak bone mass in early adulthood which could increase their risk for fractures and osteoporosis later in adulthood.
    Full-text · Article · Jun 2013 · Journal of the International AIDS Society
  • Source
    • "A history of recurrent fractures, particularly low-impact or atraumatic fractures, should lead the clinician to carefully consider whether a child may have reduced bone strength, and the International Society for Clinical Densitometry has recommended that a child with a history of two upper extremity or one lower extremity fractures undergo an assessment of bone density.[6869] "
    [Show abstract] [Hide abstract]
    ABSTRACT: During normal childhood and adolescence, the skeleton undergoes tremendous change. Utilizing the processes of modeling and remodeling, the skeleton acquires its adult configuration and ultimately achieves peak bone mass. Optimization of peak bone mass requires the proper interaction of environmental, dietary, hormonal, and genetic influences. A variety of acute and chronic conditions, as well as genetic polymorphisms, are associated with reduced bone density, which can lead to an increased risk of fracture both in childhood and later during adulthood. Bone densitometry has an established role in the evaluation of adults with bone disorders, and the development of suitable reference ranges for children now permits the application of this technology to younger individuals. We present a brief overview of the factors that determine bone density and the emerging role of bone densitometry in the assessment of bone mass in growing children and adolescents.
    Full-text · Article · Dec 2012
  • [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.
    No preview · Article · Aug 2011 · Pediatric Radiology
Show more