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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
Insights
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.
Unlabelled:
In a child, bone mineral density (BMD) may differ from an age-expected normal value, not only because of the presence of disease, but also because of deviations of height or weight from population averages. Appropriate adjustment for body size deviations simplifies interpretation of BMD measurements.
Introduction:
For children, a bone mineral density (BMD) measurement is normally expressed as a Z score. Interpretation is complicated when weight or height distinctly differ from age-matched children. We develop a procedure to allow for the influence of body size deviations upon measured BMD.
Methods:
We examined the relation between body size deviation and spine, hip and whole body BMD deviation in 179 normal children (91 girls). Expressions were developed that allowed derivation of an expected BMD based on age, gender and body size deviation. The difference between measured and expected BMD was expressed as a HAW score (Height-, Age-, Weight-adjusted score).
Results:
In a second independent sample of 26 normal children (14 girls), measured spine, total femur and whole body BMD all fell within the same single normal range after accounting for age, gender and body size deviations. When traditional Z scores and HAW scores were compared in 154 children, 17.5% showed differences of more than 1 unit and such differences were associated with height and weight deviations.
Conclusion:
For almost 1 in 5 children, body size deviations influence BMD to an extent that could alter clinical management.
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