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Assessment of Bone Health in the Young Athlete

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Abstract

Assessment of bone health in the young athlete requires a detailed history, comprehensive physical examination, and targeted investigative studies. Imaging modalities currently available are all only surrogate measures for assessing fracture risk, and each method has advantages and limitations. For clinical use, dual energy X-ray absorptiometry (DXA) remains the preferred method because of its availability, precision, and low dose of radiation. However, DXA measures two-dimensional areal bone mineral density (aBMD), not three-dimensional volumetric BMD (vBMD), and underestimates true BMD in small subjects. When DXA is used in athletes younger than 20 years of age, Z-scores should be used instead of T-scores, and the diagnosis of osteoporosis should not be made on bone densitometry criteria alone. Fracture rate depends not only on bone mass and density, but also on geometry, microstructure, and strength. High resolution peripheral QCT (HR-pQCT) measures three-dimensional vBMD of an extremity and can also evaluate bone geometry, microarchitecture and strength. Use of HR-pQCT, while currently still limited to research, shows great promise for clinical use, especially in athletes who are more likely to sustain a fracture of an extremity than of the spine or hip. Markers of bone formation and resorption can be used to assess dynamic changes in bone health in response to specific interventions.

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Abbreviations

aBMD:

Areal bone mineral density

BMC:

Bone mineral content

BMD:

Bone mineral density

DXA:

Dual energy X-ray absorptiometry

FEA:

Finite element analysis

HR-pQCT:

High resolution peripheral quantitative computed tomography

vBMD:

Volumetric bone mineral density

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Author information

Authors and Affiliations

  1. Department of Pediatrics, Division of Adolescent Medicine, Stanford University School of Medicine, 770 Welch Road, Suite 433, Palo Alto, CA, 94304, USA

    Neville H. Golden MD

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  1. Neville H. Golden MD
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Correspondence to Neville H. Golden MD .

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Editors and Affiliations

  1. Hasbro Children's Hospital, Providence, Rhode Island, USA

    Catherine M. Gordon

  2. Brigham and Women's Hospital, Boston, Massachusetts, USA

    Meryl S. LeBoff

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Golden, N.H. (2015). Assessment of Bone Health in the Young Athlete. In: Gordon, C., LeBoff, M. (eds) The Female Athlete Triad. Springer, Boston, MA. https://doi.org/10.1007/978-1-4899-7525-6_5

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  • DOI: https://doi.org/10.1007/978-1-4899-7525-6_5

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