Archives of Osteoporosis

, 13:117 | Cite as

Individualized evaluation of lumbar bone mineral density and bone mineral apparent density in children and adolescents

  • Ibrahim DuranEmail author
  • K. Martakis
  • M. Rehberg
  • O. Semler
  • E. Schoenau
Original Article



Lumbar spine bone mineral density (LS-BMD) assessed by dual-energy X-ray absorptiometry (DXA) is used in children to evaluate bone health. LS-BMD results in children are influenced significantly by height and BMI. An adjustment for these parameters may improve the clinical use of the method.


DXA evaluation is considered useful in children to assess bone health. For this purpose, lumbar spine bone mineral density (LS-BMD) and bone mineral apparent density (LS-BMAD) are often used. The aim of the study was to estimate the effect of height and BMI on LS-BMD and LS-BMAD in children and adolescents and to develop a method to adjust individual results for these factors.


As part of the National Health and Nutrition Examination Survey (NHANES) study, between the years 2005 and 2010 lumbar DXA scans on randomly selected Americans from 8 to 20 years of age were carried out. From all eligible DXA scans, three major US ethnic groups were evaluated (Non-Hispanic Whites, Non-Hispanic Blacks, and Mexican Americans) for further statistical analysis. The relationship between height as well as BMI for age Z-scores and age-adjusted LS-BMD and LS-BMAD Z-scores was analyzed.


For the statistical analysis, the DXA scans of 1799 non-Hispanic White children (823 females), of 1696 non-Hispanic Black children (817 females), and of 1839 Mexican American children (884 females) were eligible. The statistical analysis showed that taller and heavier children had significantly (p < 0.001) higher age-adjusted LS-BMD Z-scores than shorter and lighter children. But on LS-BMAD, only BMI and not height had a significant influence.


LS-BMD results in children were influenced significantly by their height and BMI, the LS-BMAD results were only influenced by their BMI. For the first time, the proposed method adjusts LS-BMD and LS-BMAD to BMI. An adjustment of the LS-BMD and LS-BMAD results to these factors might improve the clinical significance of an individual result.


Lumbar spine bone mineral density Lumbar spine bone mineral apparent density Children Adolescents Dual-energy X-ray absorptiometry Reference values 



BMI for age Z-score


Bone mineral apparent density


Bone mineral density


Body mass index


Center of disease control and prevention


Dual-energy X-ray absorptiometry


Height for age Z-score


International Society of Clinical Densitometry


Lumbar spine


National Health and Nutrition Examination Survey


Total body less head



This research received no specific grant from any funding agency in the public, commercial, or non-profit sectors.

Compliance with ethical standards

Conflicts of interest


Supplementary material

11657_2018_532_Fig7_ESM.png (357 kb)
Fig. 1

Nomograms for non-Hispanic White children. The application of the nomograms is explained in Fig. 6. (PNG 356 kb)

11657_2018_532_MOESM1_ESM.tiff (552 kb)
High Resolution Image (TIFF 551 kb)
11657_2018_532_Fig8_ESM.png (358 kb)
Fig. 2

Nomograms for non-Hispanic Black children. The application of the nomograms is explained in Fig. 6. (PNG 358 kb)

11657_2018_532_MOESM2_ESM.tiff (554 kb)
High Resolution Image (TIFF 554 kb)
11657_2018_532_Fig9_ESM.png (364 kb)
Fig. 3

Nomograms for American Mexican children. The application of the nomograms is explained in Fig. 6. (PNG 364 kb)

11657_2018_532_MOESM3_ESM.tiff (555 kb)
High Resolution Image (TIFF 554 kb)
11657_2018_532_MOESM4_ESM.docx (104 kb)
ESM 4 (DOCX 103 kb)


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2018

Authors and Affiliations

  • Ibrahim Duran
    • 1
    Email author
  • K. Martakis
    • 2
    • 3
  • M. Rehberg
    • 2
  • O. Semler
    • 2
    • 4
  • E. Schoenau
    • 1
    • 2
  1. 1.Center of Prevention and Rehabilitation, UniRehaUniversity of CologneCologneGermany
  2. 2.Children’s and Adolescents’ HospitalUniversity of CologneCologneGermany
  3. 3.Department of International Health, School CAPHRI, Care and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands
  4. 4.Center for Rare Skeletal Diseases in ChildhoodUniversity of CologneCologneGermany

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