Assessment of bone acquisition in childhood and adolescence

Availability, ease of use, relative low cost, and minimal radiation exposure have made dual-energy x-ray absorptiometry the most widely used technique worldwide to obtain bone measurements for both research and clinical purposes in pediatric populations. However, errors related to growth and maturity significantly diminish the accuracy of dual-energy x-ray absorptiometry bone measurements. Several investigators have found that dual-energy x-ray absorptiometry in children frequently leads to a misdiagnosis of osteoporosis and an underestimation of the amount of bone. In this regard, a recent official position paper by the International Society for Clinical Densitometry states that subjects <20 years of age should not be given a diagnosis of osteoporosis on the basis of dual-energy x-ray absorptiometry criteria. Nevertheless, the increased awareness that osteoporosis has its antecedents in childhood and the demand for examinations of bone acquisition and response to therapy stress the urgent need to improve the value of dual-energy x-ray absorptiometry measurements for children.