Rethinking race-based interpretation in pediatric densitometry: a scoping review.

Area of Science:

• Pediatric Endocrinology
• Bone Health Research
• Health Equity

Background:

• Pediatric bone density interpretation using DXA requires reevaluation due to increasing US diversity.
• Current International Society for Clinical Densitometry guidelines recommend race-based adjustments for pediatric bone density Z-scores.
• Race-based adjustments risk reinforcing health disparities and systemic inequities in pediatric bone health.

Purpose of the Study:

• To conduct a scoping review of studies on racial and ethnic differences in bone mineral density (BMD) among healthy US children.
• To critically assess the validity and equity implications of current race-based adjustments in pediatric DXA interpretation.

Main Methods:

• A scoping review identified 54 studies meeting inclusion criteria from 3960 records across 4 databases.
• Analysis focused on the reporting of race and ethnicity and the adjustment for covariates in studies examining racial differences in pediatric BMD.
• Evaluated the impact of factors like height, lean mass, and pubertal status on reported BMD differences.

Main Results:

• Reporting of race and ethnicity in studies was inconsistent, lacking explicit definitions or concordance checks.
• Fifty percent of studies reported statistically significant racial differences in BMD, often without comprehensive covariate adjustment.
• Studies adjusting for height, lean mass, and pubertal status frequently found that racial differences in BMD attenuated or disappeared.

Conclusions:

• There is a critical need to reconsider race-based adjustments in pediatric DXA interpretation.
• Developing and validating race-neutral reference standards is essential for equitable pediatric bone health assessment.
• Biologically relevant measures like stature, body composition, and pubertal timing should inform race-neutral standards.