Bone Densitometry in Children and Adolescents

Abstract

Concerns about bone health and potential fragility in children and adolescents have led to a high interest in bone densitometry. Pediatric patients with genetic and acquired chronic diseases, immobility, and inadequate nutrition may fail to achieve expected gains in bone size, mass, and strength, leaving them vulnerable to fracture. In older adults, bone densitometry has been shown to predict fracture risk and reflect response to therapy. The role of densitometry in the management of children at risk of bone fragility is less clear. This clinical report summarizes current knowledge about bone densitometry in the pediatric population, including indications for its use, interpretation of results, and risks and costs. The report emphasizes updated consensus statements generated at the 2013 Pediatric Position Development Conference of the International Society of Clinical Densitometry by an international panel of bone experts. Some of these recommendations are evidence-based, whereas others reflect expert opinion, because data are sparse on many topics. The statements from this and other expert panels provide general guidance to the pediatrician, but decisions about ordering and interpreting bone densitometry still require clinical judgment. The interpretation of bone densitometry results in children differs from that in older adults. The terms “osteopenia” and “osteoporosis” based on bone densitometry findings alone should not be used in younger patients; instead, bone mineral content or density that falls >2 SDs below expected is labeled “low for age.” Pediatric osteoporosis is defined by the Pediatric Position Development Conference by using 1 of the following criteria: ≥1 vertebral fractures occurring in the absence of local disease or high-energy trauma (without or with densitometry measurements) or low bone density for age and a significant fracture history (defined as ≥2 long bone fractures before 10 years of age or ≥3 long bone fractures before 19 years of age). Ongoing research will help define the indications and best methods for assessing bone strength in children and the clinical factors that contribute to fracture risk. The Pediatric Endocrine Society affirms the educational value of this publication.

Bone Mineral Density and Vitamin D Status in Children with Chronic Neurological Syndromes—Clinical Observations

“…Bone densitometry is part of the complex assessment of bone status in children and adolescents at increased risk of bone fracture [1] [9] [10]. This is particularly the case in patients with chronic inflammatory diseases, nutrition disorders, patients on long-term treatment with glucocorticosteroids and with markedly reduced motor activity [1] [3].…”

The Role of Exercise in Pediatric and Adolescent Cancers: A Review of Assessments and Suggestions for Clinical Implementation

“…Body composition analysis using bioelectrical impedance or DXA scanning may provide more detailed information on total body water distribution and fat versus fat-free mass components; however, due to the large variability in body composition during growth, the clinical use of these tools is questionable. Additionally, errors in interpreting DXA results may generate considerable parental concern and can result in costly and unnecessary use of pharmacologic agents and restrictions on physical activity [63]. …”

Menstrual Management for Adolescents With Disabilities

“…38 The bone-density loss appears reversible after stopping the DMPA; however, for teenagers with limited mobility, no data are available. 39 In summary, the use of DMPA in teenagers in wheelchairs can be considered for menstrual suppression after careful counseling and assessment of any contraindications to estrogen and considering whether the potential risk of decreased BMD is outweighed by the need for the suppression. The AAP and ACOG do not support the use of bonedensity screening if long-term use of DMPA seems prudent, including in adolescents with limited mobility, unless fractures have occurred.…”

“…The AAP and ACOG do not support the use of bonedensity screening if long-term use of DMPA seems prudent, including in adolescents with limited mobility, unless fractures have occurred. 36,39 Calcium and vitamin D intake may be optimized per current guidelines. 40,41 Levonorgestrel Intrauterine Device LNG-IUDs have been used extensively in adult women and, although not approved by the FDA for adolescents younger than 18 years, more recently have been advocated for use in teenagers for birth control by national organizations because of their excellent contraceptive effect.…”