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Lateral femoral scan: an alternative method for assessing bone mineral density in children with cerebral palsy
H T Harcke1, A Taylor, S Bachrach
1duPont Hospital for Children, Department of Medical Imaging, P. O. Box 269, Wilmington, DE 19899, USA.
Insights
Children with cerebral palsy (CP) at high fracture risk often cannot undergo standard bone mineral density (BMD) testing. Measuring BMD at the distal femur offers a practical alternative when central DXA scans are not feasible.
Area of Science:
- Pediatrics
- Orthopedics
- Radiology
Background:
- Children with cerebral palsy (CP) face elevated fracture risks due to immobility and anticonvulsant use.
- Conventional dual-energy X-ray absorptiometry (DXA) for bone mineral density (BMD) is often challenging in CP patients.
Purpose of the Study:
- To identify a convenient alternative measurement site for BMD in children with CP.
- To assess the feasibility of measuring BMD at the distal femur.
Main Methods:
- Explored distal femur BMD measurement in the lateral projection, accommodating CP patients' preferred side-lying position.
- Conducted 92 scans on 34 children and adolescents (aged 4-19 years) with CP without sedation.
- Analyzed four femoral shaft subregions: two trabecular and two cortical.
Main Results:
- Coefficients of variation (CV %) were generally higher for opposite-side comparisons than same-side.
- Intra- and interobserver CV % were higher for cortical than trabecular regions.
- Overall CV % were comparable to those obtained from hip and spine DXA.
Conclusions:
- The distal femur is a viable peripheral site for BMD assessment in CP patients.
- This method provides a practical alternative when central DXA (whole-body, hip, spine) is not feasible for CP individuals.
Background:
Children with cerebral palsy (CP), often nonambulatory and/or on anticonvulsants, are at increased risk for fractures. Bone mineral density (BMD) measured by the conventional techniques of dual-energy X-ray absorptiometry (DXA) often cannot be reliably or easily measured in these patients.
Objective:
To find an alternative site to whole body, spine and hip that can be conveniently used to measure BMD in CP patients.
Materials And Methods:
Having observed that CP patients prefer to lie on their sides, we explored measuring BMD at the distal femur in the lateral projection. A total of 92 scans were performed without sedation in 34 children and adolescents with CP, aged 4-19 years. Four femoral shaft subregions were created: two trabecular and two cortical.
Results:
The coefficients of variation (CV %) were generally higher for opposite-side comparisons (n = 12 patients) than for same-side comparisons (n = 16 patients). For intra- and interobserver analyses, CV % were higher for cortical regions than for trabecular regions. Overall, the CV % were similar to those for hip and spine.
Conclusion:
This peripheral site in the femur should be considered as an alternative for patients with CP when whole-body, hip and spine DXA are not practical.