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In children under two years of age, does the bone health index value differ between those with and without
Heba Shalof1, Rachel Shuyi Chong2, Alan Rigby3
1Division of Clinical Medicine, School of Medicine & Population Health, University of Sheffield, Damer Street Building, Western Bank, Sheffield S10 2TH, United Kingdom.
Insights
The bone health index (BHI) shows promise in differentiating young children with osteogenesis imperfecta (OI) from those without the condition, aiding in diagnosing low bone mineral density (BMD). Further research is needed to confirm its clinical utility.
Area of Science:
- Pediatric Radiology
- Skeletal Dysplasias
- Bone Densitometry
Background:
- Distinguishing osteogenesis imperfecta (OI) from abuse in young children with unexplained fractures is challenging.
- Current imaging modalities cannot reliably assess bone mineral density (BMD) or bone strength in children under two years old.
Purpose of the Study:
- To evaluate the sensitivity of bone health index (BHI) and BHI standard deviation scores (SDS) in differentiating children under two with and without OI.
- To explore BHI's potential as a tool for assessing bone health in pediatric patients.
Main Methods:
- Retrospective pilot study analyzing 122 radiographs from children with OI (n=33) and suspected abuse (n=89).
- Bone health index (BHI) and BHI SDS were measured using BoneXpert software.
- Statistical analyses included t-tests, Pearson's correlation, ROC curves, sensitivity, and specificity.
Main Results:
- BHI was significantly higher in children without OI (3.75) compared to those with OI (3.41) (p=0.003).
- BHI SDS was also significantly higher in the non-OI group (-0.039) versus the OI group (-0.451) (p=0.01), though both remained within the normal range (±2).
- Specific BHI cut-points showed varying sensitivity and specificity for detecting OI.
Conclusions:
- Infants without OI exhibit better volumetric BMD, indicating stronger bones.
- BHI may serve as a valuable tool to differentiate young children with low BMD from those with healthy bones.
- Established BHI cut-points can assist clinicians in assessing OI detection sensitivity and specificity, warranting further clinical utility studies.
Background:
In children with unexplained fractures who are below the age of two years, it may be difficult to distinguish those with low bone mineral density (BMD) due to conditions such as osteogenesis imperfecta (OI) from those who have been abused. Currently, no imaging modality can readily or reliably assess BMD or evaluate bone strength in this age group.
Aim:
To investigate whether bone health index (BHI) and bone health index standard deviation scores (SDS) are sufficiently sensitive to distinguish between children under two years old with and without OI.
Methods:
In this retrospective pilot study, we measured BHI and BHI SDS from 122 radiographs (33 OI, 89 suspected abuse) using BoneXpert software. Standard statistical methods (t-test, Pearson's correlation) were applied in addition to clinical diagnostics, sensitivity, specificity, and receiver operating characteristic (ROC) curves. An arbitrary level of p < 0.05 was assumed.
Results:
BHI was significantly greater in the group without OI compared to the group with OI, 3.75 and 3.41, respectively (p = 0.003). The percentage of children in the OI/non-OI groups with BHI ≤ 2.49, 2.5-2.99, 3-3.49, and ≥4 was 0 %/0 %, 27 %/7 %, 58 %/28 %, 18 %/29 %, and 12 %/36 %, respectively. While BHI SDS was significantly greater in the group without OI compared to the group with OI, -0.039 and -0.451, respectively (p = 0.01), BHI SDS was within the normal range (±2) for both groups.
Conclusion:
Although BHI SDS is lower in OI children, it remained within the normal range. Infants without OI had better volumetric bone mineral density, associated with stronger bones. This suggests BHI might be used to differentiate between young children with low BMD and those with healthy bones. Clinicians may find the cut-points established in this study useful for assessing the sensitivity and specificity of BHI in detecting OI and identifying individuals without OI. Further research is needed to assess BHI's clinical utility in this age group.
