Ultrasound bone measurement in healthy (n = 71) and osteopenic (n = 18) children aged 6 through 13 years of both sexes has been evaluated using the Achilles densitometer (Lunar Corporation). Measurements on the os calcis included speed of sound (SOS), broadband ultrasound attenuation (BUA), and a calculated "stiffness" index. The Achilles was adapted for children by a special positioning procedure that included the use of foot shims, and beam collimation on the receiving transducer. The precision of ultrasound results was comparable to that in adults (0.2% for SOS, 1.5% for BUA, and 1.8% for stiffness). SOS, BUA, and stiffness values increased with age in both sexes. Ultrasound measurements were correlated with bone mineral density (BMD in g/cm2) of the heel, AP spine (L2-L4), and total body by dual X-ray absorptiometry (DXA) densitometry (Lunar DPX-L). SOS, BUA, and stiffness measurements were significantly lower in osteopenic children (Z approximately -1.9 to -2.5) (P < 0.0001) than in normal age-matched controls. Total body BMD showed a higher Z-score than stiffness (-3.3 versus -2.5), but stiffness showed a greater percentage decrease (-30% versus -18%). In conclusion, ultrasound measurements of bone in children provide both good precision and discrimination of normals from osteopenic patients.
The classical method of skeletal age assessment is based on the recognition of changes in the radiographic appearance of the maturity indicators in hand-wrist radiographs by comparison with a reference atlas. The purpose of this study was the evaluation of the possibility to assess bone age using a less invasive method such as dual-energy X-ray absorptiometry (DXA). Bone ages of 50 children free of any chronic diseases (5-18 years old) and ten with multihormonal pituitary deficiency (MPD) (8-20 years old) were assessed using an Expert-XL densitometer. Hand scans and classical hand-wrist radiographs were evaluated by two independent observers for bone age by visual comparison with reference standards of skeletal development published in the atlas. The precision errors of duplicate bone age ratings were low both for radiographs (<1%) and DXA hand scans (<0.9%). A high degree of agreement between bone age ratings done by two observers was assessed by intraclass correlation coefficients. The same bone age based on radiographs and DXA hand scans was assessed in 44 of 60 cases (73.3%); in 16 cases the differences between bone age were no higher than 0.5 year. No significant difference between mean bone age based on radiographs and DXA hand scans was observed ( P>0.05). Moreover, there was a very strong correlation between bone age results ( r=0.998; r(2)=0.996; P<0.0001), indicating agreement of bone age assessments based on DXA and radiographic images. Remarkable differences (up to 3 years) between bone age and chronological age were observed in healthy subjects, probably reflecting the effect of the secular trend towards earlier maturation or alterations in pubertal development. The study indicates that evaluation of skeletal maturity using DXA images is less invasive (up to 8 micro Sv) than radiography, giving results comparable to the classical method.
The results of this study indicate that IJO is a bone disorder characterized by an imbalanced muscle-bone relationship and fractures at onset and during the acute phase and by at least a partial recovery without bone pain and new fractures. Implementation of the BH/LBM, TBBMC/LBM and SBMC/LBM ratios to the armamentarium of pediatricians diagnosing bone disorders will provide mechanically meaningful data for diagnostic purposes and, hopefully, for proper therapeutic decisions.
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