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Published on: January 29, 2018
Accounting for body size deviations when reporting bone mineral density variables in children
1Department of Nuclear Medicine, Hamilton Health Sciences, Hamilton, ON, Canada, L8N 3Z5. webber@hhsc.ca
Summary
Body size significantly impacts bone mineral density (BMD) in children. A new Height-, Age-, Weight-adjusted (HAW) score helps accurately interpret BMD, potentially altering clinical management for nearly 20% of children.
Area of Science:
- Pediatric endocrinology
- Bone health assessment
- Growth and development
Background:
- Bone mineral density (BMD) in children is typically reported as a Z score.
- Interpreting pediatric BMD is challenging when children's height or weight deviates from age-matched norms.
- Existing methods may not adequately account for body size variations.
Purpose of the Study:
- To develop and validate a method for adjusting pediatric bone mineral density (BMD) measurements for body size deviations.
- To introduce a novel Height-, Age-, Weight-adjusted (HAW) score for more accurate BMD interpretation in children.
- To assess the clinical significance of body size influence on BMD measurements.
Main Methods:
- Examined the relationship between body size deviation and BMD at the spine, hip, and whole body in 179 normal children.
- Developed adjustment formulas based on age, gender, and body size.
- Calculated a Height-, Age-, Weight-adjusted (HAW) score to represent the difference between measured and expected BMD.
Main Results:
- In an independent validation sample, spine, femur, and whole body BMD fell within a single normal range after HAW score adjustment.
- Comparison of traditional Z scores and HAW scores in 154 children revealed differences greater than 1 unit in 17.5% of cases.
- These significant differences were associated with height and weight deviations, indicating the impact of body size.
Conclusions:
- Body size deviations significantly influence bone mineral density (BMD) measurements in children.
- The HAW score provides a more accurate assessment of pediatric BMD by accounting for height and weight.
- For approximately 1 in 5 children, these body size influences are substantial enough to potentially change clinical decisions regarding bone health.
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