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Bone Health Index (BHI): a Fracture Risk Assessment tool in Children with Osteogenesis Imperfecta
Ruggero Lanzafame1, Alistair D Calder2, Belinda Crowe3
1Paediatric Endocrinology Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK.
Insights
The Bone Health Index (BHI) shows promise for assessing fracture risk in children with Osteogenesis Imperfecta (OI). This method is more effective than bone mineral density (BMD) scans, especially for infants.
Area of Science:
- Pediatric Orthopedics
- Medical Imaging
- Skeletal Dysplasias
Background:
- Fracture risk assessment in children with Osteogenesis Imperfecta (OI) is challenging due to limitations of current tools like bone mineral density (BMD).
- BMD is often unavailable or technically difficult for children under 5 years old.
- The Bone Health Index (BHI), measuring metacarpal bone characteristics, is proposed as a potential alternative for fracture risk evaluation.
Purpose of the Study:
- To evaluate the efficacy of the Bone Health Index (BHI) in assessing fracture risk in pediatric patients with Osteogenesis Imperfecta (OI).
- To compare the performance of BHI with traditional BMD measurements in predicting fractures in young OI patients.
Main Methods:
- A cohort of 277 children with classical OI was studied, analyzing their Bone Health Index (BHI) using BoneXpert® software.
- Fracture history over two years and lateral spine X-rays were collected.
- Lumbar BMD measurements were obtained on the same day as BHI analysis where available for comparison.
Main Results:
- A 1-SD decrease in BHI SDS was significantly associated with a 5.3-fold increased odds of fracture within two years (p < 0.001).
- BHI SDS demonstrated superior discriminatory performance (AUC 0.84) compared to DXA BMD Z-score (AUC 0.60) and BMAD Z-score (AUC 0.51).
- BMD and BMAD Z-scores were not found to be independent predictors of fracture in multivariable analysis.
Conclusions:
- Lower BHI SDS values correlate with higher fracture risk in children with classical OI.
- BHI shows stronger predictive performance than DXA-derived measures in the studied subgroup.
- BHI is a potentially valuable tool for fracture risk stratification in young OI patients, particularly when DXA is not feasible, such as in infants.
Introduction:
Current tools to evaluate fracture risk in children with Osteogenesis Imperfecta (OI) are limited and bone mineral density (BMD) has limitations and is not widely available for children under 5 years. We hypothesized that the Bone Health Index (BHI), evaluating the average cortical thickness of the three middle metacarpal bones, adjusted for bone width and length, could be a useful tool in the assessment of fracture risk, particularly in infants.
Methods:
The service at Great Ormond Street Hospital (London, UK) follows a cohort of over 277 children with classical OI and keeps a detailed and accurate record of confirmed fractures. We reviewed their BHI (analysed using the latest version of BoneXpert® software) at presentation (n = 123), the lumbar BMD (n = 47) taken on the same day where available, the subsequent two years fracture history and annual lateral spine X-rays.
Results:
In multivariable logistic regression, each 1-SD decrease in BHI SDS was independently associated with a 5.3-fold higher odds of incident fracture within two years (OR 5.26, 95% CI 2.4-11.1, p < 0.001), while DXA BMD and BMAD Z-scores were not independent predictors. ROC analysis showed good discriminatory performance for BHI SDS (AUC 0.84), superior to DXA BMD Z-score (AUC 0.60) and BMAD Z-score (AUC 0.51).
Conclusions:
Our study indicates that lower BHI SDS values are associated with increased fracture risk in children with classical OI. In the available DXA subgroup, BHI demonstrated stronger discriminatory performance than DXA-derived measures. BHI may represent a clinically useful complementary tool for fracture risk stratification in young children with OI, particularly where DXA is unavailable or technically limited, including infancy.
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