Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2023 Apr;58(4):1136-1144.
doi: 10.1002/ppul.26304. Epub 2023 Jan 27.

The use of DXA for early detection of pediatric cystic fibrosis-related bone disease

Christina Chadwick  1 , Renallie Arcinas  2 , Melissa Ham  3 , Rong Huang  4 , Stacie Hunter  5 , Megha Mehta  1 , Preeti Sharma  6 , Prigi Anu Varghese  6 , Kelli Williams  7 , David M Troendle  1 , Meghana Sathe  1
Affiliations
Review

The use of DXA for early detection of pediatric cystic fibrosis-related bone disease

Christina Chadwick et al. Pediatr Pulmonol. 2023 Apr.

Abstract

Background: Cystic fibrosis (CF)-related bone disease (CFBD) is seen in adults and can be associated with respiratory illness and malnutrition. There is limited and conflicting data regarding CFBD in pediatric CF. With longer life expectancy and promotion of disease prevention, pediatric CFBD demands further investigation.

Methods: Our center initiated a quality improvement (QI) project from April 2016 to December 2018 to improve CFBD screening in patients 8 years or older, per current CF Foundation (CFF) guidelines. Our team formulated a dual-energy X-ray absorptiometry (DXA) scan algorithm based upon degree of bone mineral density (BMD); shared CFBD guideline recommendations in our quarterly newsletter; and ordered scans for eligible patients at weekly review meetings. We reviewed DXA results from 141 patients after institutional review board approval and gathered data including comorbidities, genetics, anthropometric measures, medication exposure, and relevant serum studies.

Results: Fifty-three percent of our patients had normal BMD (n = 75). Seventeen patients (12%) had a Z score ≤ -2. Patients with lower BMD also had lower mean forced expiratory volume (FEV1 ) percent predicted (FEV1 %) (p < 0.001) as well as lower body mass index % (p = 0.001). Patients with lower BMD were overall older at time of DXA (p = 0.016). During study duration, 13 patients who had abnormal DXA results underwent repeat DXAs after physical therapy; 11 of the 13 showed improvement in DXA results.

Conclusions: A DXA scan is a useful screening tool and can be used to identify pediatric patients who could benefit from further therapy and interventions to preserve adequate bone health and avoid further loss. QI initiatives can lead to improved screening and diagnosis and earlier intervention such as physical therapy. Further studies are needed to better understand the utility of physical therapy in children with CF.

Keywords: bone density; imaging; physical therapy; quality improvement.

PubMed Disclaimer

Similar articles

See all similar articles

Cited by

References

REFERENCES

    1. Williams KM. Update on bone health in pediatric chronic disease. Endocrinol Metab Clin North Am. 2016;45:433-441.
    1. Rayas MS, Aris RM. Bone Disease in CF Clinical Care Guidelines. The Cystic Fibrosis Foundation; 2005. Accessed April 2019. https://www.cff.org/Care/Clinical-Care-Guidelines/Other-CF-Related-Condi...
    1. Putman MS, Anabtawi A, Le T, Tangprisha V, Sermet-Gaudelus I. Cystic fibrosis bone disease treatment: current knowledge and future directions. J Cyst Fibros. 2019;18(suppl 2):S56-S65.
    1. Cystic Fibrosis Foundation. Cystic Fibrosis Foundation Patient Registry. 2011 Annual Data Report; 2012; Bethesda, MD.
    1. Stalvey MS, Clines GA. Cystic fibrosis-related bone disease: insights into a growing problem. Curr Opin Endocrinol Diabetes Obes. 2013;20(6):547-552.

Publication types