Problems of bone analysis in childhood and adolescence

Abstract

The monitoring of bone metabolism and skeletal development during childhood and adolescence is becoming increasingly important in the prevention of osteoporosis. This is especially important in patients with chronic disorders. The predominant changes in the skeletal system during growth occur as geometric adaptation processes which lead to an increase in bone mass and bone strength. These changes can be measured with linear absorption methods (single-photon absorptiometry, dual-photon absorptiometry, dual-energy X-ray absorptiometry), computed tomographic procedures (peripheral quantitative computed tomography, quantitative computed tomography), and sonographic procedures. The aim of this review is to explain the problems of interpretation of the investigations due to growth-dependent changes. Almost all methods and their parameters, such as bone density, spongiosa density, cortical density, ultrasound transmission velocity, etc., are influenced, in varying degree, by growth-dependent skeletal changes.

A structural approach to the assessment of fracture risk in children and adolescents with chronic kidney disease

“…However, DXA summarizes the total bone mass within the projected bone area (g/cm 2 ), concealing distinct structural alterations in trabecular and cortical bone density and architecture. DXA has additional important limitations in children and adolescents, such as sparse reference data and lack of consensus regarding techniques to adjust for the confounding effect of bone size, as described by us [6] and others [7] in this journal. The following review considers the structural effects of renal osteodystrophy as it relates to fracture risk and the potential advantages and disadvantages of DXA and alternative measures of bone density, geometry, and microarchitecture, such as peripheral quantitative computed tomography (pQCT), micro-CT (μCT), and micro magnetic resonance imaging (μMRI) for fracture risk assessment.…”

Analysis of the Musculoskeletal System in Children and Adolescents Receiving Anticonvulsant Monotherapy With Valproic Acid or Carbamazepine

“…The effective radiation is approximately 0.1 Sv and thus is less than for most other densitometric techniques, such as dual-energy radiograph absorptiometry of the lumbar spine. 10 Image processing and the calculation of numerical values was done using the manufacturer's software package (version 5.10; Stratec, Pforzheim, Germany). The outer bone contour was detected at a threshold of 280 mg/cm 3 .…”

“…13,14 It therefore could be useful not only to compare bone mass results to an age-specific reference range but also to test whether bone strength (as reflected by bone mass) is adequately adapted to muscle force. 10,15 In the present cross-sectional study, we tested the hypothesis that anticonvulsant monotherapy with VPA or CBZ interfered with the adaptation of the skeletal system to the mechanical requirements during growth and development.…”

“…9 The size dependence of areal BMD often makes results difficult to interpret in the pediatric setting, because short children will have a lower areal BMD than their peers, even if their (smaller) bones are absolutely normal. 10 This problem can be overcome by using peripheral quantitative computed tomography (pQCT). Cross-sectional images of long bones are analyzed, 10 and bone size and vBMD are determined independent of each other.…”

“…10 This problem can be overcome by using peripheral quantitative computed tomography (pQCT). Cross-sectional images of long bones are analyzed, 10 and bone size and vBMD are determined independent of each other. It is possible not only to determine the total mineral mass of an entire bone cross-section but also to evaluate trabecular bone without interference from cortical bone.…”