Does ethnicity influence bone health index in children? A pilot study

Area of Science:

• Pediatric radiology
• Bone mineral metabolism
• Quantitative radiography

Background:

• Pathological conditions can alter bone mineral content during childhood growth.
• Bone mineral content can be estimated from bone age assessments without extra cost or radiation.
• Current methods like Exton-Smith index (ESI) and BoneXpert®'s Bone Health Index (BHI) lack validation across diverse ethnic groups.

Purpose of the Study:

• To establish normative values for ESI and BHI in healthy European Caucasian and North African children residing in Europe.
• To compare the variability and trends of ESI and BHI between these ethnic groups.

Main Methods:

• Retrospective analysis of 434 children's (ages 3-15) hand and wrist radiographs.
• Automated BHI calculation using BoneXpert® software.
• Manual ESI calculation by a blinded radiologist.
• Comparison of method variability using standard deviation of the median percentage.

Main Results:

• BHI was lower in North African children compared to European Caucasians (P < 0.001).
• A significant percentage of children (13.6% girls, 15.5% boys) had BHI more than 2 SD from the mean.
• ESI exhibited higher variability than BHI, particularly in European girls aged 8-12 years.
• BHI demonstrated less than 15% variability across all ages and ethnic groups.

Conclusions:

• BHI is a dependable tool for identifying children with abnormal bone mineral content.
• BHI shows lower variability and distinct sex- and ethnicity-specific trends compared to ESI.
• BHI's reliability supports its use in diverse pediatric populations for bone health assessment.