Dual-energy X-ray absorptiometry predicts bone formation in lower limb callotasis lengthening

The rate of regenerate bone mineral content (BMC) acceleration was studied using dual-energy X-ray absorptiometry (DEXA) in callotasis lengthening of the lower limb. Eleven youngsters (age range 5-17 years) undergoing callotasis lengthening for congenital, post-traumatic or post-infective conditions were studied longitudinally. Patients were initially scanned once a week until completion of the lengthening phase, and at 2-week intervals thereafter until removal of the fixator. They were subsequently followed up at regular intervals on an outpatient basis for up to 2 years after removal of the fixator (average, 14 months). The BMC accretion slopes exhibited by the patients and the rate of new bone formation allowed the identification of three groups. In the fast formation group, the rate of new bone formation was 0.3-0.6% per day. In the moderate formation group the rate of new bone formation is 0.1-0.3% per day, while in the poor formation group the rate of new bone formation is < 0.1% per day. From the analysis of time graphs, a direct correlation emerged between early bone formation and subsequent bone mineral content accretion. Measurement of BMC during callotasis lengthening in the lower limb allows precise monitoring of the process. It may prove useful to prevent complications occurring after removal of the fixator at an unduly early stage, such as plastic deformation and fracture through the regenerate bone. It may be used to predict the bone formation rate in a given patient, and to implement measures to try to influence it.