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Related Concept Videos

Bone Disorders01:29

Bone Disorders

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Aging and its effect on bone remodeling is the most common cause of bone disorders. In young and healthy people, bone deposition and resorption happen at an equal rate to maintain optimal bone health.
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Fractures: Bone Repair01:27

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Treatment for a fracture is based on the type of break, the bone affected, and the patient's age.
Minor fractures with no bone displacement are treated by immobilizing the fractured bone using a cast or splint. However, in the case of fractures with displaced bones, the broken bones are repositioned before immobilization to ensure successful healing without deformation and loss of function. The realignment of fractured bone ends is performed through a process called reduction. If the...
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Essential Minerals for Bone Health01:31

Essential Minerals for Bone Health

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The minerals contained in all of the food we consume are essential for our organ systems. However, certain essential minerals, such as calcium, phosphorus, magnesium, manganese, and fluoride, largely affect bone health.
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Skeleton and Calcium Homeostasis01:21

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Calcium is not only the most abundant mineral in bone but also the most abundant mineral in the human body. Calcium ions are needed for bone mineralization, tooth health, heart rate regulation and strength of contraction, blood coagulation, the contraction of smooth and skeletal muscle cells, and the regulation of nerve impulse conduction. The average calcium level in the blood is about 10 mg/dL. When the body cannot maintain this level, a person will experience hypo or hypercalcemia.
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Role of Vitamins in Maintaining Bone Health01:25

Role of Vitamins in Maintaining Bone Health

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The growth and maintenance of bone are regulated by a combination of nutritional factors, including vitamins, such as vitamin A, B12, C, D, and K.
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Vitamin A is involved in the process of bone remodeling. Retinoic acid, the active metabolite of Vitamin A, has nuclear receptors in osteoblasts and osteoclasts, which are involved in bone remodeling.
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Osteoclasts in Bone Remodeling01:31

Osteoclasts in Bone Remodeling

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Osteoclasts are cells responsible for bone resorption and remodeling. They originate from hematopoietic progenitor cells present in the bone marrow. Numerous progenitor cells fuse to form multinucleated cells, each with 10-20 nuclei. A single osteoclast has a diameter of 150 to 200 µM. These cells have ruffled borders that break down the underlying bone tissue and release minerals such as calcium into the blood in bone resorption. Osteoclasts cling to bones with their ruffled edges during...
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Updated: May 20, 2025

Scanning Skeletal Remains for Bone Mineral Density in Forensic Contexts
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Scanning Skeletal Remains for Bone Mineral Density in Forensic Contexts

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Race-neutral Pediatric Reference Ranges for Bone Mineral Density Predict Prospective Fractures in Childhood.

Babette S Zemel1,2, Karen K Winer3, Andrea Kelly2,4

  • 1Division of Gastroenterology, Hepatology and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.

The Journal of Clinical Endocrinology and Metabolism
|March 25, 2025
PubMed
Summary
This summary is machine-generated.

New race-neutral pediatric bone density reference ranges show improved fracture prediction, especially for Black children. These ranges are more representative of the U.S. population and should be considered for clinical use.

Keywords:
BMADBMDchildrenfracture

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Area of Science:

  • Pediatric Endocrinology
  • Bone Health Research
  • Biostatistics

Background:

  • Existing race-specific pediatric bone mineral density (BMD) reference ranges are widely used but their clinical utility is debated.
  • Development of race-neutral pediatric reference ranges for areal-BMD and bone mineral apparent density (BMAD) is crucial for equitable assessment.
  • Previous algorithms questioned the value of race-based clinical assessments in pediatric bone health.

Purpose of the Study:

  • To develop and validate race-neutral pediatric reference ranges for areal-BMD and BMAD.
  • To compare the predictive ability of race-specific versus race-neutral Z-scores for prospective fractures.
  • To assess the association of race-neutral Z-scores with fracture risk in children.

Main Methods:

  • Secondary analysis of the Bone Mineral Density in Childhood Study data.
  • Utilized longitudinal BMD and BMAD data from dual-energy x-ray absorptiometry scans.
  • Employed Lambda, Sigma, Mu method for race-neutral reference range creation and Cox Proportional Hazard modeling for fracture prediction.

Main Results:

  • Race-neutral BMD and BMAD Z-scores were higher for Black children and slightly lower for other groups compared to race-specific Z-scores.
  • Growth and lifestyle factors influenced these group differences.
  • A one standard deviation increase in race-neutral Z-scores correlated with a 12-18% reduction in fracture risk.

Conclusions:

  • The study presents the first race-neutral pediatric reference ranges for BMD and BMAD, representative of the U.S. population.
  • These race-neutral Z-scores demonstrate a significant association with fracture risk.
  • Thoughtful implementation of these new ranges is recommended, particularly for Black children previously assessed with race-specific ranges.