Reporting DXA Results for Children and Adolescents



The dual-energy X-ray absorptiometry (DXA) report fulfills the role of transmitting data clearly to the referring clinician. A timely, concise, and informative report is essential to relay the DXA findings and to avoid costly and potentially dangerous misinterpretations by physicians unfamiliar with pediatric densitometry data. A comprehensive DXA report ideally includes five elements: (1) patient demographics, (2) a brief medical history, (3) test results, (4) technical comments, and (5) interpretation and occasionally recommendations. Most often the report is focused on bone densitometry components, but may also include body composition measures. The interpretation & recommendation sections remain the most controversial. Densitometry guidelines from an international panel of experts provide recommendations to guide the imaging specialist on acquisition and interpretation of pediatric scans.


DXA Report Nomenclature Body composition Pediatrics 



Bone mineral apparent density


Bone mineral content g


Areal bone mineral density g/cm2


Volumetric bone mineral density g/cm3


Dual energy X-ray absorptiometry


International Society of Clinical Densitometry


Height for age Z-score


National Osteoporosis Foundation


Vertebral fracture assessment


World Health Organization


  1. 1.
    World Health Organization. Assessment of fracture risk and its application to screening for post-menopausal osteoporosis WHO technical report series. World Health Organ Tech Rep Ser. 1994;843:1–129.Google Scholar
  2. 2.
    Crabtree NJ, Arabi A, Bachrach LK, Fewtrell M, El-Hajj Fuleihan G, Kecskemethy HH, Jaworski M, Gordon CM. Dual-energy X-Ray absorptiometry interpretation and reporting in children and adolescents: the revised 2013 ISCD pediatric official positions. J Clin Densitom. 2014;17(2):225–42.CrossRefPubMedGoogle Scholar
  3. 3.
    Gordon CM, Bachrach LK, Carpenter TO, Crabtree N, El-Hajj Fuleihan G, Kutilek S, Lorenc RS, Tosi LL, Ward KA, Ward LM, Kalkwarf HJ. Dual energy X-ray absorptiometry interpretation and reporting in children and adolescents: the 2007 ISCD pediatric official positions. J Clin Densitom. 2008;11(1):43–58.CrossRefPubMedGoogle Scholar
  4. 4.
    Petak S, Barbu CG, Yu EW, Fielding R, Mulligan K, Sabowitz B, Wu CH, Shepherd JA. The official positions of the International Society for Clinical Densitometry: body composition analysis reporting. J Clin Densitom. 2013;16(4):508–19.CrossRefPubMedGoogle Scholar
  5. 5.
    Vokes T, Bachman D, Baim S, Binkley N, Broy S, Ferrar L, Lewiecki ME, Richmond B, Schousboe J. Vertebral fracture assessment: The 2005 ISCD official positions. J Clin Densitom. 2006;9(1):37–46.CrossRefPubMedGoogle Scholar
  6. 6.
    Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Crotty K. Low health literacy and health outcomes: an updated systematic review. Ann Intern Med. 2011;155(2):97–107.CrossRefPubMedGoogle Scholar
  7. 7.
    Edmonds SW, Solimeo SL, Lu X, Roblin DW, Saag KG, Cram P. Developing a bone mineral density test result letter to send to patients: a mixed-methods study. Patient Prefer Adherence. 2014;8:827–41.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Fewtrell MS, British Paediatric Adolescent Bone Group. Bone densitometry in children assessed by dual x-ray absorptiometry: uses and pitfalls. Arch Dis Child. 2003;88:795–8.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Fewtrell MS, Gordon I, Biassoni L, Cole TJ. Dual x-ray absorptiometry (DXA) of the lumbar spine in a clinical pediatric setting: does the method of size adjustment matter? Bone. 2005;37:413–9.CrossRefPubMedGoogle Scholar
  10. 10.
    Kuczmarski RJ, Ogden CL, Guo SS, Grummer-Strawn LM, Flegal KM, Mei Z, Wei R, Curtin LR, Roche AF, Johnson CL. 2000 CDC growth charts for the United States: methods and development. Vital Health Stat. 2002;11:1–190.Google Scholar
  11. 11.
    Freeman JV, Cole TJ, Chinn S, Jones PRM, White EM, Preece MA. Cross sectional stature and weight reference curves for the UK, 1990. Arch Dis Child. 1995;73:17–24.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Zemel BS, Leonard MB, Kelly A, Lappe JM, Gilsanz V, Oberfield S, Mahboubi S, Shepherd JA, Hangartner TN, Frederick MM, Winer KK, Kalkwarf HJ. Height adjustment in assessing dual energy x-ray absorptiometry measurements of bone mass and density in children. J Clin Endocrinol Metab. 2010;95(3):1265–73.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Heaney RP. BMD: the problem. Osteoporos Int. 2005;16:1013–5.CrossRefPubMedGoogle Scholar
  14. 14.
    Bailey DA, McKay HA, Mirwald RL, Crocker PRE, Faulkner RA. A six-year longitudinal study of the relationship of physical activity to bone mineral accrual in growing children: The University of Saskatchewan Bone Mineral Accrual Study. J Bone Miner Res. 1999;14:1672–9.CrossRefPubMedGoogle Scholar
  15. 15.
    Leonard MB, Propert KJ, Zemel BS, Stallings VA, Feldman HI. Discrepancies in pediatric bone mineral density reference data: potential for misdiagnosis of osteopenia. J Pediatr. 1999;135:182–8.CrossRefPubMedGoogle Scholar
  16. 16.
    Sherman ME, Shepard J, Frassetto L, Genant HK. Discrepancy in results between spine and hip scans of a woman with end stage renal disease. J Clin Densitom. 2002;5(1):95–8.CrossRefPubMedGoogle Scholar
  17. 17.
    Morgan SL, Lopez-Ben R, Nunnally N, Burroughs L, Fineberg N, Tubbs RS, Yester MV. “Black hole artifacts”—a new potential pitfall for DXA accuracy? J Clin Densitom. 2008;11(2):266–75.CrossRefPubMedGoogle Scholar
  18. 18.
    Watts NB, Lewiecki EM, Miller PD, Baim S. National Osteoporosis Foundation 2008 clinician’s guide to prevention and treatment of osteoporosis and the World Health Organization Fracture Risk Assessment Tool (FRAX): what they mean to the bone densitometrist and bone technologist. J Clin Densitom. 2008;11(4):473–7.CrossRefPubMedGoogle Scholar
  19. 19.
    Bishop N, Arundel P, Clark E, Dimitri P, Farr J, Jones G, Makitie O, Munns CF, Shaw N. Fracture prediction and the definition of osteoporosis in children and adolescents: the ISCD 2013 pediatric official positions. J Clin Densitom. 2014;17(2):275–80.CrossRefPubMedGoogle Scholar
  20. 20.
    Clark EM, Tobias JH, Ness AR. Association between bone density and fractures in children: a systematic review and meta-analysis. Pediatrics. 2006;117(2):e291–7.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Clark EM, Ness AR, Tobias JH. Bone fragility contributes to the risk of fracture in children, even after moderate and severe trauma. J Bone Miner Res. 2008;23(2):173–9.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Shepherd JA, Wang L, Fan B, et al. Optimal monitoring time interval between DXA measures in children. J Bone Min Res. 2011;26(11):2745–52.CrossRefGoogle Scholar
  23. 23.
    Bonnick SL. Bone densitometry in clinical practice: application and interpretation. 2nd ed. Totowa, NJ: Humana Press; 2004. p. 287–300.Google Scholar
  24. 24.
    Genant HK, Wu CY, van Kuijk C, Nevitt MC. Vertebral fracture assessment using a semi-quantitative technique. J Bone Miner Res. 1993;8(9):1137–48.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.UCSF Benioff Children’s Hospital OaklandChildren’s Hospital Oakland Research InstituteOaklandUSA

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