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Comparative Study
. 2025 Jul 4;25(1):529.
doi: 10.1186/s12887-025-05881-5.

Comparison between dual energy X-ray absorptiometry and calcaneal quantitative ultrasound for determining bone mineral density in children living with HIV in uganda: A cross- sectional study

Eva Natukunda  1 , Alexander J Szubert  2 , Alasdair Bamford  2 , Katja Doerholt  2 , Diana M Gibb  2 , Centurio Wandera  3 , Aidah Nakalyango  3 , Anna Griffiths  2 , Lara Monkiewicz  2 , Joan J Nangiya  3 , Esther Nambi  3 , Victor Musiime  3   4 , Phillipa Musoke  4
Affiliations
Comparative Study

Comparison between dual energy X-ray absorptiometry and calcaneal quantitative ultrasound for determining bone mineral density in children living with HIV in uganda: A cross- sectional study

Eva Natukunda et al. BMC Pediatr. .

Abstract

Background: The aim of this study was to compare quantitative ultrasound (QUS) and dual energy X-ray absorptiometry (DXA) for determining bone mineral density (BMD) among children living with HIV (CLWH) who were switching to second-line antiretroviral therapy (ART).

Methods: We conducted a cross-sectional study among CLWH as a sub-study of the CHAPAS-4 trial. Total body less head (TBLH) BMD and lumbar spine (LS) BMD were determined by DXA while the sound of speed (SOS), broad band ultrasound attenuation (BUA) and bone quality index (BQI) were determined by QUS. We evaluated the correlation between the DXA and QUS measurements using spearman correlation coefficient.

Results: A total of 167 children were enrolled; the median age was 9.4 (interquartile range = 6.0-12.0) years. Eighty-five (50.9%) were male. The median weight- for- age Z- score (IQR) was - 1.29(-2.16, -0.49) and height for age Z-score was - 1.03(-1.56, 0.01). SOS was weakly correlated with TBLH BMD R = 0.35, P < 0.001), lumbar spine bone apparent density (LSBMAD) (R = 0.19, P = 0.01) and LS bone mineral content (BMC) (R = 0.31, P < 0.001). BUA was moderately correlated with TBLH BMD (R = 0.50, P < 0.001), BMC (R = 0.47, P = 0.001), and LS BMC (R = 0.43, P < 0.001) but weakly correlated with LSBMAD (R = 0.28, P < 0.001). BQI was moderately correlated with TBLH BMC (R = 0.46, P < 0.001), TBLH BMD (R = 0.46, P < 0.001) and LSBMC (R = 0.41, P < 0.001). There was weak correlation between LSBMAD and BUA (R = 0.28, P < 0.001) BQI (R = 0.29, P < 0.001). QUS Z-score was weakly correlated with TBLH BMD and (R = 0.30, P < 0.01) and no correlation with LSBMAD (R = 0.07, P = 0.35).

Conclusion: In CLWH, there was moderate correlation observed for TBLH measurements when comparing DXA to QUS, and weak correlation was found between LSBMAD and QUS measurements. There was a moderate correlation detected between the LSBMC and QUS.QUS may not be an appropriate substitute for DXA scan.

Keywords: Bone mineral density; Children; DXA scan; HIV; Quantitative ultra sound.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The CHAPAS 4 trial was approved by Joint Clinical Research Centre Institutional Review Board (Reference number JC 1417) and the sub-study was approved by the Makerere University College of Health Sciences (Reference number 2019 − 135). In addition, the main study and sub study were approved by the Uganda National Council of Science and Technology. (Reference number HS:2369). Furthermore, regulatory approval for CHAPAS 4 was obtained from the National Drug Authority (Reference number CTC 066). Parents or legal guardians provided written informed consent for study participation. In addition, children aged eight years and above provided written informed assent. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Calcaneal quantitative ultrasound device (photo taken by the authors)
Fig. 2
Fig. 2
Receiver operating characteristic (ROC) curve for QUS in detecting low BMD defined as DXA TBLH BMD or LSBMD height adjusted Z-score ≤ 2
See this image and copyright information in PMC

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