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Lessons Learned from Clinical Research Using QCT, pQCT, and HR-pQCT

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Bone Health Assessment in Pediatrics

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Abstract

In recent decades, three-dimensional imaging tools such as quantitative computed tomography (QCT), peripheral QCT (pQCT), and high-resolution pQCT (HR-pQCT) have advanced our understanding of the hierarchical nature of bone in the pediatric skeleton and the impact of childhood chronic diseases. We now know that gains in bone mass measured with dual energy X-ray absorptiometry are accompanied by important sex- and maturation-specific changes in bone macro- and microstructure structure in the trabecular and cortical bone compartments, all of which contribute to substantial gains in bone strength. In this chapter we summarize what is currently known about the acquisition of bone strength, structure, and density in healthy children based on QCT studies and review key determinants of bone strength acquisition. We also highlight lessons learned about the impact of childhood chronic disease and associated muscle deficits on bone strength accrual. Finally, we discuss challenges that face researchers and clinicians using these innovative tools and highlight research questions that might guide further study.

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Abbreviations

aBMD:

Areal bone mineral density (g/cm2 by DXA)

BMC:

Bone mineral content (g)

BMD:

Bone mineral density (mg/cm3 by QCT methods)

BSI:

Bone strength index (mg2/mm4 by QCT methods)

BV/TV:

Bone volume fraction

CD:

Crohn’s disease

CSA:

Cross-sectional area (cm2 by QCT methods)

DXA:

Dual energy X-ray absorptiometry

GC:

Glucocorticoid

HR-pQCT:

High-resolution pQCT

PHV:

Peak height velocity

pQCT:

Peripheral quantitative computed tomography

QCT:

Quantitative computed tomography

SSIp :

Polar strength-strain index (mm3 by QCT methods)

SSNS:

Steroid-sensitive nephrotic syndrome

TNF-α:

Tumor necrosis factor-α

2D:

Two-dimensional

3D:

Three-dimensional

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Authors and Affiliations

  1. Department of Family Practice and Centre for Hip Health and Mobility, University of British Columbia, 2635 Laurel Street, Vancouver, BC, Canada, V5Z 1M9

    Heather M. Macdonald Ph.D.

  2. Departments of Orthopaedics and Family Practice, Centre for Hip Health and Mobility, 7th Floor, 2635 Laurel Street, Vancouver, BC, Canada, V5Z 1M9

    Heather A. McKay Ph.D.

  3. Department of Pediatrics, Stanford University School of Medicine, 300 Pasteur Drive, H310, Stanford, CA, 94305, USA

    Mary B. Leonard M.D., M.S.C.E.

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  1. Heather M. Macdonald Ph.D.
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  2. Heather A. McKay Ph.D.
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  3. Mary B. Leonard M.D., M.S.C.E.
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Correspondence to Heather M. Macdonald Ph.D. .

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Editors and Affiliations

  1. UCSF Benioff Children’s Hospital Oakland, Children’s Hospital Oakland Research Institute, Oakland, California, USA

    Ellen B. Fung

  2. Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA

    Laura K. Bachrach

  3. Department of Orthopaedic Surgery, University of California, San Francisco, USA

    Aenor J. Sawyer

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Macdonald, H.M., McKay, H.A., Leonard, M.B. (2016). Lessons Learned from Clinical Research Using QCT, pQCT, and HR-pQCT. In: Fung, E., Bachrach, L., Sawyer, A. (eds) Bone Health Assessment in Pediatrics. Springer, Cham. https://doi.org/10.1007/978-3-319-30412-0_11

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