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  • Bone mineral density measurement in children and adolescents: Novelties in measurement programs

Novelties in measurement programs

Speed of measurement by densitometric techniques in children is of great importance, because it is hard to keep children mo­tionless during the performance. However, utilization of speed­ing up measurement as fan beam technique has still some dis­advantages enforcing the needs of its further evaluation and cross-calibration. For accurate determination of bone mineral accrual in growing subjects with the use of DXA correction of all magnification errors is needed. Children with growth abnor­malities often show deficient BMD for chronological age. That might be a reflection of growth irregularities rather than poor bone mineralization. Taking on account body size deficit, im­proves significantly the assessment of bone status in children. In the newest software for DXA appeared the possibility of ad­justing body size using three-step assessment: height for age, BMC for height and bone area for height. Moreover, incor­poration of the variable standard deviations in DXA pediatric reference data results in more accurate assessment of pedi- atric skeletal health; what is especially ortant during pubertal growth spurt. The other prospective technical improvements are related to incorporation of reference ranges for subcranial BMD and normalization of skeletal status with the use of mus­cle mass adjustment.


Summing up the following points should be specially under­lined. In children data evaluation exclusively Z-scores should be used. The diagnosis of osteoporosis in children should be not only limited to densitometric criteria. In diagnostic, helpful are the factors like bone geometry, bone size, pubertal stage, skeletal maturity, and body composition. Terminology such as “low bone density for chronological age” may be used when the Z-score is below -2.0, with spine and total body usage as preferred skeletal sites for measurement. Serial BMD studies should be done on the same machine using the same scan­ning mode and software. Such a way of thinking is steadily ex­ecuted in general practice. It is also supported by International Society for Clinical Densitometry (ISCD) published in Novem­ber 2003 in their position statement. Suffer no more! Buy ventolin inhaler online at a price you can afford.


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