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A hip analysis protocol for pediatric bone densitometry: the Iowa Bone Development Study
Julie M Eichenberger Gilmore1, Cynthia A Pauley, Trudy L Burns
1Department of Preventive and Community Dentistry, The University of Iowa, Iowa City, IA, USA. julie-gilmore@uiowa.edu
Insights
A new protocol for pediatric proximal femur dual-energy X-ray absorptiometry (DXA) scans improves analysis stability and alignment with body size. This method offers a reproducible approach for evaluating bone density in growing children.
Area of Science:
- Pediatric Endocrinology
- Bone Densitometry
- Medical Imaging Analysis
Background:
- Pediatric proximal femur dual-energy X-ray absorptiometry (DXA) analysis faces challenges due to the evolving pediatric skeleton.
- Lack of standardized reference points complicates accurate bone density measurements in children.
Purpose of the Study:
- To develop and validate a modified, pediatric-specific proximal femur analysis protocol for DXA scans.
- To improve the precision and reliability of bone densitometry in growing pediatric populations.
Main Methods:
- The Iowa Bone Development Study (IBDS) created a custom Hologic software protocol for pediatric proximal femur DXA analysis.
- Serial DXA measurements were collected from 214 children aged 5, 8, 11, and 13 years.
- The IBDS protocol was compared against standard manufacturer (Hologic default) analysis procedures.
Main Results:
- The IBDS protocol produced lower, more stable bone area, bone mineral content (BMC), and bone mineral density (BMD) results.
- The modified protocol demonstrated better alignment with body size, indicated by higher coefficients of determination (R(2)).
- Spearman correlation coefficients for BMC and bone area were consistently higher with the IBDS protocol, especially in younger children.
Conclusions:
- The IBDS pediatric-specific proximal femur analysis protocol offers a reproducible method for evaluating DXA scans in children.
- This validated protocol enhances the accuracy and consistency of bone density assessments during childhood growth.
- The improved methodology facilitates better tracking of bone development and potential interventions in pediatric populations.
Abstract:
Pediatric proximal femur dual-energy X-ray absorptiometry (DXA) scans present analytic challenges because of the lack of standard points of reference in the growing skeleton. The Iowa Bone Development Study (IBDS) developed a modified pediatric-specific proximal femur analysis protocol using Hologic software. Serial DXA measurements were obtained for 214 children at approximate ages 5, 8, 11, and 13 yr. Standard analysis procedures as described by the manufacturer (Hologic default) were compared with the IBDS protocol. The IBDS protocol yielded lower but more stable results for bone area, bone mineral content (BMC), and bone mineral density for total hip, femoral neck, trochanter, and intertrochanter as a result of more precisely controlling the regions of interest. Linear regression models with body size, age, and gender as predictors were developed to examine variation in measurements. Coefficients of determination (R(2)) with the IBDS protocol were greater for each time point, demonstrating that the modified protocol was better aligned with body size. Similarly, Spearman correlation coefficients between total hip and hip subregions were consistently higher for BMC and bone area with the IBDS protocol with differences more notable among younger children. The IBDS protocol provides a reproducible method for evaluating pediatric proximal femur DXA scans during growth.
