Challenges in clinical assessment of bone density and quality in children

Abstract

Purpose of review Over the past decade, it has become clear that the amount of bone gained during childhood and adolescence is an important determinant of osteoporosis in later life. This has led to a significant increase in the number of research studies performed in bone health in children, and in the clinical demand for assessment of bone density in children. The measurement of bone density in children is feasible with the accumulation of normative data for measures such as dual-energy x-ray absorptiometry. Technologies including quantitative computed tomography, peripheral quantitative computed tomography, and ultrasound, hold promise. Bone density assessment in children is more complex than in adults, however, and results interpretation is challenging. Recent findings Dual-energy x-ray absorptiometry is the most common technique used to determine bone mineral density in children. Its advantages include low radiation exposure and large amount of normative data available. The primary limitation is that areal bone mineral density is measured, which is dependent on bone size. Quantitative computed tomography and peripheral quantitative computed tomography measure volumetric bone mineral density, but there are less normative data and the scanners are not as available as dual-energy x-ray absorptiometry scanners. Ultrasound holds promise, but there are less normative data, bone size influences the results, and the interpretation is less clear than with dual-energy x-ray absorptiometry or quantitative computed tomography. Summary Understanding the techniques used to determine bone mineral density in children, and how to correctly interpret the results, will help both clinicians and researchers understand bone mass gain in children, and critically analyze the growing body of data on bone health in children.