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Tools for Measuring Bone in Children and Adolescents

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Bone Health Assessment in Pediatrics

Abstract

The aims of bone densitometry and what can be measured in vivo is summarised from the measures which one would ideally wish to extract (material density, compartmental mineral density and total mineral density). Although dual energy X-ray absorptiometry (DXA) is the most widely available and applied bone densitometry technique in clinical practice in adults and children, quantitative computed tomography (QCT), applied to peripheral (radius and tibia) and central (axial; lumbar spine) sites, has some advantages. These included providing a volumetric bone mineral density (BMD; mg/cm3) so is not size dependent, providing separate measures of cortical and trabecular BMD and giving additional size and shape information in the diaphyseal regions from which biomechanical parameters can be extracted. Cross-sectional area of muscle can also be measured and a ‘muscle equivalent density’ so as to explore the muscle-bone unit and the ‘mechanostat’. Peripheral QCT can be performed on dedicated peripheral or general purpose scanners; the 3D volumetric images acquired by multi-detector CT may offer advantages over 2D single slice pQCT in longitudinal studies and in children with disabilities which makes it difficult to obtain ideal positioning in DXA or pQCT on dedicated peripheral scanners. High-resolution pQCT was more recently introduced and offers the opportunity to measure cortical and trabecular bone structure in distal, peripheral skeletal sites. Magnetic resonance imaging offers opportunities to make quantitative assessment of bone size, shape and density without the use of ionising radiation, a particularly advantage in children. Tables are provided of the advantages and limitation of each technique, the reference data available and doses of ionising radiation involved. Although these techniques currently have mainly research applications they do provide complimentary information to that provided by DXA and further advance insights into the effect of diseases and therapies on the skeleton in children.

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Notes

  1. 1.

    A kappa score is a measurement of agreement between two methods when the measurements are measured on a categorical scale. The methods being tested have to rate or classify using the same scale, for example z-scores. Degree of agreement ranges from 0 to 1 with 1 being excellent, 0.8 good, etc.

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Authors and Affiliations

  1. MRC Human Nutrition Research, Cambridge, Cambridge CB1 9NL and MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, S016 6YD, UK

    Kate A. Ward Ph.D.

  2. Department of Radiology and Biomedical Imaging, UCSF, 400 Parnassus Ave, A-367, San Francisco, CA, 94143, USA

    Thomas M. Link M.D., Ph.D.

  3. Radiology & Manchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, University of Manchester, Oxford Road, Manchester, Lancashire, M13 9WL, UK

    Judith E. Adams M.B.B.S., F.R.C.R., F.R.C.P.

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  1. Kate A. Ward Ph.D.
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  2. Thomas M. Link M.D., Ph.D.
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  3. Judith E. Adams M.B.B.S., F.R.C.R., F.R.C.P.
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Correspondence to Judith E. Adams M.B.B.S., F.R.C.R., F.R.C.P. .

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  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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Ward, K.A., Link, T.M., Adams, J.E. (2016). Tools for Measuring Bone in Children and Adolescents. 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_2

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