Bone Health Index (BHI): a Fracture Risk Assessment tool in Children with Osteogenesis Imperfecta

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.