Archives of Osteoporosis

, 14:98 | Cite as

Analysis of volumetric BMD in people with Down syndrome using DXA-based 3D modeling

  • Marta García Hoyos
  • Ludovic Humbert
  • Zaida Salmón
  • José A. Riancho
  • Carmen ValeroEmail author
Original Article



We analyzed volumetric bone mineral density, by 3D analysis, in 76 people with Down syndrome and 76 controls. People with Down syndrome, particularly men, have a lower hip volumetric bone mineral density than the general population. Besides, volumetric bone mineral density declines more rapidly in Down syndrome.


People with Down syndrome (DS) have a lower areal bone mineral density (aBMD) estimated by dual-energy X-ray absorptiometry (DXA). However, they have smaller-sized bones, which could influence the measurements. Therefore, our objective was to determine volumetric BMD in these patients.

Materials and methods

We included 76 outpatients with DS and 76 control healthy volunteers matched for age and sex distribution. Clinical data were obtained with a standardized interview and physical exam, including age, sex, height, weight, and body mass index (BMI). aBMD was measured by dual-energy X-ray at the femoral neck (FN) and total hip (TH). The 3D-SHAPER® software (version 2.8, Galgo Medical, Barcelona, Spain) was used to derive 3D analysis from participants’ hip DXA scans.


DS femurs had a similar 3D geometry, compared with the femurs of controls. However, 3D analysis showed that participants with DS had smaller cortical thickness (1.84 mm ± 0.17 vs. 2.02 ± 0.20 mm; p < 0.0001), cortical vBMD (777 ± 49 mg/cm3 vs. 809 ± 43 mg/cm3; p < 0.0001), and cortical sBMD (143 ± 19 mg/cm2 vs. 164 ± 22 mg/cm2; p < 0.0001). After adjustment for age and BMI, all 3D measurements remained lower in DS than in controls. These differences were more marked in men than in women. vBMD decreased with age in controls and DS, but the decline was greater in DS for all 3D parameters.


People with DS, particularly men, have a lower hip vBMD than the general population. Besides, vBMD declines more rapidly in DS.


Volumetric Bone mineral density 3D modeling Osteoporosis Down 


Compliance with ethical standards

The study protocol was approved by the Institutional Review Board and all patients gave written informed consent.

Conflict of interest

L. Humbert is stockholder and employee of Galgo Medical. Marta García Hoyos, José A. Riancho, and Carmen Valero declare that they have no conflicts of interest.


  1. 1.
    Roizen NJ, Patterson D (2003) Down’s syndrome. Lancet. 361:1281–1289CrossRefGoogle Scholar
  2. 2.
    García-Hoyos M, Riancho JA, Valero C (2017) Bone health in Down syndrome. Med Clin (Barc) 149:78–82CrossRefGoogle Scholar
  3. 3.
    Angelopoulou N, Souftas V, Sakadamis A, Mandroukas K (1999) Bone mineral density in adults with Down’s syndrome. Eur Radiol 9:648–651CrossRefGoogle Scholar
  4. 4.
    Angelopoulou N, Matziari C, Tsimaras V, Sakadamis A, Souftas V, Mandroukas K (2000) Bone mineral density and muscle strength in young men with mental retardation (with and without Down syndrome). Calcif Tissue Int 66:176–180CrossRefGoogle Scholar
  5. 5.
    Guijarro M, Valero C, Paule B, Gonzalez-Macias J, Riancho JA (2008) Bone mass in young adults with Down syndrome. J Intellect Disabil Res 52:182–189CrossRefGoogle Scholar
  6. 6.
    García-Hoyos M, García-Unzueta MT, de Luis D, Valero C, Riancho JA (2017) Diverging results of areal and volumetric bone mineral density in Down syndrome. Osteoporos Int 28:965–972CrossRefGoogle Scholar
  7. 7.
    Katzman DK, Bachrach LK, Carter DR, Marcus R (1991) Clinical and anthropometric correlates of bone mineral acquisition in healthy adolescent girls. J Clin Endocrinol Metab 73:1332–1339CrossRefGoogle Scholar
  8. 8.
    Humbert L, Martelli Y, Fonolla R, Steghofer M, Di Gregorio S, Malouf J, Romera J, Barquero LM (2017) 3D-DXA: Assessing the femoral shape, the trabecular macrostructure and the cortex in 3D from DXA images. IEEE Trans Med Imaging 36:27–39CrossRefGoogle Scholar
  9. 9.
    Clotet J, Martelli Y, Di Gregorio S, Del Río Barquero LM, Humbert L (2018) Structural parameters of the proximal femur by 3-dimensional dual-energy X-ray absorptiometry software: comparison with quantitative computed tomography. J Clin Densitom 21:550–562CrossRefGoogle Scholar
  10. 10.
    Langsetmo L, Peters KW, Burghardt AJ, Ensrud KE, Fink HA, Cawthon PM, Cauley JA, Schousboe JT, Barrett-Connor E, Orwoll ES, Osteoporotic Fractures in Men (MrOS) Study Research Group (2018) Volumetric bone mineral density and failure load of distal limbs predict incident clinical fracture independent HR-pQCT BMD and failure load predicts incident clinical fracture of FRAX and clinical risk factors among older men. J Bone Miner Res 33:1302–1311CrossRefGoogle Scholar
  11. 11.
    Sornay-Rendu E, Boutroy S, Duboeuf F, Chapurlat RD (2017) Bone microarchitecture assessed by HR-pQCT as predictor of fracture risk in postmenopausal women: The OFELY Study. J Bone Miner Res 32:1243–1251CrossRefGoogle Scholar
  12. 12.
    Torres GHF, Guzman LFE, Alvarenga JC, Lopes NHM, Pereira RMR (2019) Association of moderate/severe vertebral fractures with reduced trabecular volumetric bone density in older women and reduced areal femoral neck bone density in older men from the community: A cross-sectional study (SPAH). Maturitas. 120:61–67CrossRefGoogle Scholar
  13. 13.
    Kral R, Osima M, Borgen TT, Vestgaard R, Richardsen E, Bjørnerem Å (2017) Increased cortical porosity and reduced cortical thickness of the proximal femur are associated with nonvertebral fracture independent of fracture risk assessment tool and Garvan estimates in postmenopausal women. PLoS One 12:e0185363CrossRefGoogle Scholar
  14. 14.
    Borggrefe J, de Buhr T, Shrestha S, Marshall LM, Orwoll E, Peters K, Black DM, Glüer CC (2016) Osteoporotic Fractures in Men (MrOS) Study Research Group. Association of 3D geometric measures derived from quantitative computed tomography with hip fracture risk in older men. J Bone Miner Res 31:1550–1558CrossRefGoogle Scholar
  15. 15.
    Humbert L, Hazrati Marangalou J, Del Río Barquero LM, van Lenthe GH, van Rietbergen B (2016) Technical note: cortical thickness and density estimation from clinical CT using a prior thickness-density relationship. Med Phys 43:1945–1954CrossRefGoogle Scholar
  16. 16.
    Humbert L, Winzenrieth R, Di Gregorio S, Thomas T, Vico L, Malouf J, Del Río Barquero LM (2018) 3D Analysis of cortical and trabecular bone from hip DXA: precision and trend assessment interval in postmenopausal women in press. J Clin Densitom 22:214–218CrossRefGoogle Scholar
  17. 17.
    Costa R, De Miguel R, García C, de Asúa DR, Castañeda S, Moldenhauer F, Suárez C (2017) Bone mass assessment in a cohort of adults with down syndrome: a cross-sectional study. Intellect Dev Disabil 55:315–324CrossRefGoogle Scholar
  18. 18.
    Costa R, Gullón A, De Miguel R, de Asúa DR, Bautista A, García C, Suarez C, Castañeda S, Moldenhauer F (2018) Bone mineral density distribution curves in spanish adults with Down syndrome. J Clin Densitom 21:493–500CrossRefGoogle Scholar
  19. 19.
    Coelho-Junior HJ, Villani ER, Calvani R, Carfì A, Picca A, Landi F, Bernabei R, Onder G, Marzetti E (2019) Sarcopenia-related parameters in adults with Down syndrome: a cross-sectional exploratory study. Exp Gerontol 119:93–99CrossRefGoogle Scholar
  20. 20.
    Sakadamis A, Angelopoulou N, Matziari C, Papameletiou V, Souftas V (2002) Bone mass, gonadal function and biochemical assessment in young men with trisomy 21. Eur J Obstet Gynecol Reprod Biol 100:208–221CrossRefGoogle Scholar
  21. 21.
    Blazek JD, Abeysekera I, Li J, Roper RJ (2015) Rescue of the abnormal skeletal phenotype in Ts65Dn Down syndrome mice using genetic and therapeutic modulation of trisomic Dyrk1a. Hum Mol Genet 24:5687–5696CrossRefGoogle Scholar
  22. 22.
    Wu J (2013) Bone mass and density in preadolescent boys with and without Down syndrome. Osteoporos Int 24:2847–2854CrossRefGoogle Scholar
  23. 23.
    González-Agüero A, Vicente-Rodríguez G, Moreno L, Casajús J (2011) Bone mass in male and female children and adolescents with Down syndrome. Osteoporos Int 22:2151–2157CrossRefGoogle Scholar
  24. 24.
    Riancho JA, Valero C, Hernandez JL, Olmos JM, Paule B, Zarrabeitia A, Gonzalez-Macias J (2007) Biomechanical indices of the femoral neck estimated from the standard DXA output: age- and sex-related differences. J Clin Densitom 10:39–45CrossRefGoogle Scholar
  25. 25.
    Carfì A, Liperoti R, Fusco D, Giovannini S, Brandi V, Vetrano DL, Meloni E, Mascia D, Villani ER, Manes Gravina E, Bernabei R, Onder G (2017) Bone mineral density in adults with Down syndrome. Osteoporos Int 28:2929–2934CrossRefGoogle Scholar
  26. 26.
    Tang JYM, Luo H, Wong GHY, Lau MMY, Joe GM, Tse MA, Ip P, Wong ICK, Lum TYS (2019) Bone mineral density from early to middle adulthood in persons with Down syndrome. J Intellect Disabil Res 18Google Scholar
  27. 27.
    Woolf SK, Gross RH (2003) Posterior acetabular wall deficiency in Down syndrome. J Pediatr Orthop 23:708–713CrossRefGoogle Scholar
  28. 28.
    Bulat E, Maranho DA, Kalish LA, Millis MB, Kim YJ, Novais EN (2017) Acetabular global insufficiency in patients with Down syndrome and hip-related symptoms: a matched-cohort study. J Bone Joint Surg Am 99:1760–1768CrossRefGoogle Scholar
  29. 29.
    Abousamra O, Bayhan IA, Rogers KJ, Miller F (2016) Hip instability in Down syndrome: a focus on acetabular retroversion. J Pediatr Orthop 36:499–504CrossRefGoogle Scholar
  30. 30.
    Tannenbaum TN, Lipworth L, Baker S (1989) Risk of fractures in an intermediate care facility for persons with mental retardation. Am J Ment Retard 93:444–51. 52PubMedGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2019

Authors and Affiliations

  • Marta García Hoyos
    • 1
  • Ludovic Humbert
    • 2
  • Zaida Salmón
    • 1
  • José A. Riancho
    • 1
  • Carmen Valero
    • 1
    Email author
  1. 1.Department of Internal Medicine, University Hospital Marqués de ValdecillaUniversity of Cantabria, IDIVALSantanderSpain
  2. 2.Galgo MedicalBarcelonaSpain

Personalised recommendations