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Review
. 2019 Oct-Dec;22(4):567-589.
doi: 10.1016/j.jocd.2019.07.002. Epub 2019 Jul 10.

The Utility of DXA Assessment at the Forearm, Proximal Femur, and Lateral Distal Femur, and Vertebral Fracture Assessment in the Pediatric Population: 2019 ISCD Official Position

David R Weber  1 , Alison Boyce  2 , Catherine Gordon  3 , Wolfgang Högler  4 , Heidi H Kecskemethy  5 , Madhusmita Misra  6 , Diana Swolin-Eide  7 , Peter Tebben  8 , Leanne M Ward  9 , Halley Wasserman  10 , Christopher Shuhart  11 , Babette S Zemel  12
Affiliations
Review

The Utility of DXA Assessment at the Forearm, Proximal Femur, and Lateral Distal Femur, and Vertebral Fracture Assessment in the Pediatric Population: 2019 ISCD Official Position

David R Weber et al. J Clin Densitom. 2019 Oct-Dec.

Abstract

Dual-energy X-ray absorptiometry (DXA) is widely used in the evaluation of bone fragility in children. Previous recommendations emphasized total body less head and lumbar spine DXA scans for clinical bone health assessment. However, these scan sites may not be possible or optimal for all groups of children with conditions that threaten bone health. The utility of DXA scans of the proximal femur, forearm, and radius were evaluated for adequacy of reference data, precision, ability of predict fracture, and applicability to all, or select groups of children. In addition, the strengths and limitations of vertebral fracture assessment by DXA were evaluated. The new Pediatric Positions provide guidelines on the use of these additional measures in the assessment of skeletal health in children.

Keywords: Children; DXA; Forearm; lateral distal femur; proximal femur; vertebral fracture assessment.

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Figures

Fig. 1.
Fig. 1.
Lateral distal femur scan showing the 3 regions of interest. Region (R)1 is metaphyseal and is comprised primarily of trabecular bone, R2 is metadiaphyseal and comprised of a mixture of cortical and trabecular bone, and R3 is diaphyseal which is primarily cortical bone. Reproduced from Zemel et al, (97).
Fig. 2.
Fig. 2.
Five year-old child with osteogenesis imperfecta type III. (A) Lateral spine radiograph. (B) Lateral spine DXA VFA. Both show multiple vertebral fractures at T5-11. From Diacinti D, et al, (125).
See this image and copyright information in PMC

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