"Which skeletal imaging modality is best for assessing bone health in children and young adults compared to DXA? A systematic review and meta-analysis"

In children under two years of age, does the bone health index value differ between those with and without osteogenesis imperfecta?

BACKGROUND

In children with unexplained fractures who are below the age of two years, it may be difficult to distinguish those with low bone mineral density (BMD) due to conditions such as osteogenesis imperfecta (OI) from those who have been abused. Currently, no imaging modality can readily or reliably assess BMD or evaluate bone strength in this age group.

AIM

To investigate whether bone health index (BHI) and bone health index standard deviation scores (SDS) are sufficiently sensitive to distinguish between children under two years old with and without OI.

METHODS

In this retrospective pilot study, we measured BHI and BHI SDS from 122 radiographs (33 OI, 89 suspected abuse) using BoneXpert software. Standard statistical methods (t-test, Pearson's correlation) were applied in addition to clinical diagnostics, sensitivity, specificity, and receiver operating characteristic (ROC) curves. An arbitrary level of p < 0.05 was assumed.

RESULTS

BHI was significantly greater in the group without OI compared to the group with OI, 3.75 and 3.41, respectively (p = 0.003). The percentage of children in the OI/non-OI groups with BHI ≤ 2.49, 2.5-2.99, 3-3.49, and ≥4 was 0 %/0 %, 27 %/7 %, 58 %/28 %, 18 %/29 %, and 12 %/36 %, respectively. While BHI SDS was significantly greater in the group without OI compared to the group with OI, -0.039 and -0.451, respectively (p = 0.01), BHI SDS was within the normal range (±2) for both groups.

CONCLUSION

Although BHI SDS is lower in OI children, it remained within the normal range. Infants without OI had better volumetric bone mineral density, associated with stronger bones. This suggests BHI might be used to differentiate between young children with low BMD and those with healthy bones. Clinicians may find the cut-points established in this study useful for assessing the sensitivity and specificity of BHI in detecting OI and identifying individuals without OI. Further research is needed to assess BHI's clinical utility in this age group.

Evaluation of the First Metacarpal Bone Head and Distal Radius Bone Architecture Using Fractal Analysis of Adolescent Hand-Wrist Radiographs

The purpose of this study was to investigate changes in bone trabecular structure during adolescence using the fractal analysis (FA) method on hand-wrist radiographs (HWRs) and to evaluate the relationship of these changes with pubertal growth stages. HWRs of healthy individuals aged 8-18 years were included (N = 600). Pubertal stages were determined by the Fishman method and divided into 10 groups (early puberty [EP], pre-peak [PRPK], peak [PK], post-peak [PTPK], late puberty [LP]). FA was performed using FIJI (ImageJ) software and the BoneJ plugin on circular regions of interest (ROIs) selected from the first metacarpal bone head and distal radius. Image processing steps were applied according to the White and Rudolph method. Differences between groups were statistically evaluated. Fractal dimension (FD) values of the distal radius (RAFAM) and metacarpal bone head (MAFAM) showed significant differences according to pubertal growth stages (p < 0.05). The highest FD value was observed in the LP group, and the lowest FD value was observed in the EP group (except MAFAM in females). FD generally increased from EP to LP in the whole population, but a significant decrease was observed in all groups during the PK period. This decrease was more pronounced in RAFAM of males. These findings suggest a potential decrease of bone mechanical properties in the PK, which is found the be more suitable for orthodontic treatment in the literature. FA on HWRs is a useful and sensitive tool for quantitatively assessing pubertal changes in trabecular bone microarchitecture. The findings demonstrate a significant decrease in FD in both bone regions during the pubertal growth spurt, particularly at the peak period. This may indicate a temporary reduction in bone mechanical strength during this critical stage and could contribute to increased distal radius fracture incidence. Clinically, the relationship between FD and pubertal stages suggests this method could serve as a valuable biomarker in orthodontic treatment planning, allowing for optimized timing of interventions. Furthermore, it may aid in pediatric fracture risk assessment, potentially leading to preventative strategies for high-risk individuals.

Proposed practice parameters for the performance of radiofrequency echographic multispectrometry (REMS) evaluations

Aims

Assessment of bone health is a multifaceted clinical process, incorporating biochemical and diagnostic tests that should be accurate and reproducible. Dual-energy X-ray absorptiometry (DXA) is the reference standard for evaluation of bone mineral density, but has known limitations. Alternatives include quantitative CT (q-CT), MRI, and peripheral quantitative ultrasound (QUS). Radiofrequency echographic multispectrometry (REMS) is a new generation of ultrasound technology used for the assessment of bone mineral density (BMD) at axial sites that is as accurate as quality-assured DXA scans. It also provides an assessment of the quality of bone architecture. This will be of direct value and significance to orthopaedic surgeons when planning surgical procedures, including fracture fixation and surgery of the hip and spine, since BMD alone is a poor predictor of fracture risk.

Methods

The various other fixed-site technologies such as high-resolution peripheral q-CT (HR-pQCT) and MRI offer no further significant prognostic advantages in terms of assessing bone structure and BMD to predict fracture risk. QUS was the only widely adopted non-fixed imaging option for bone health assessment, but it is not considered adequately accurate to provide a quantitative assessment of BMD or provide a prediction of fracture risk. In contrast, REMS has a robust evidence base that demonstrates its equivalence to DXA in determining BMD at axial sites. Fracture prediction using REMS, combining the output of fragility information and BMD, has been established as more accurate than when using BMD alone.

Conclusion

The practice parameters described in this protocol provide a framework for clinicians who provide REMS services that will, to the greatest possible extent, ensure the most accurate assessment possible from this diagnostic technology.

Bone Mineral Density Screening in People With Epilepsy and Intellectual Disability

Vitamin D measurements and dual energy x-ray absorptiometry (DXA) scans are recommended in people with intellectual disability and/or epilepsy in order to prevent bone-linked harm. The prevalence of vitamin D supplementation and bone mineral density screening were evaluated in 68 people with epilepsy and intellectual disability (EID) and 68 matched controls with epilepsy without intellectual disability. DXA scans were not performed in any of the people with EID but were performed in 11.8% of the people in the control group. People with EID had a higher vitamin D supplementation rate and were treated with more antiepileptic drugs (AEDs) and more AED combinations, including first generation AEDs. Increased awareness of bone health screening in people with epilepsy and especially EID is warranted.

The assessment of bone health in children with juvenile idiopathic arthritis; comparison of different imaging-based methods

BACKGROUND

Osteoporosis is increasingly being recognized in children, mostly secondary to systemic underlying conditions or medication. However, no imaging modality currently provides a full evaluation of bone health in children. We compared DXA, a radiographic bone health index (BHI (BoneXpert) and cone-beam CT for the assessment of low bone mass in children with juvenile idiopathic arthritis (JIA).

METHODS

Data used in the present study was drawn from a large multicentre study including 228 children aged 4-16 years, examined between 2015 and 2020. All had a radiograph of the left hand, a DXA scan and a cone-beam CT of the temporomandibular joints within four weeks of each other. For the present study, we included 120 subjects, selected based on DXA BMD and BoneXpert BHI to secure values across the whole range to be tested.

RESULTS

One hundred and twenty children (60.0% females) were included, mean age 11.6 years (SD 3.1 years). There was a strong correlation between the absolute values of BHI and BMD for both total body less head (TBLH) (r = 0.75, p < 0.001) and lumbar spine (L1-L4) (r = 0.77, p < 0.001). The correlation between BHI standard deviation score (SDS) and BMD TBLH Z-scores was weak (r = 0.34) but significant (0 = 0.001), varying from weak (r = 0.31) to moderate (r = 0.42) between the three study sites. Categorizing BHI SDS and DXA BMD Z-scores on a 0-5 scale yielded a weak agreement between the two for both TBLH and LS, with w-kappa of 0.2, increasing to 0.3 when using quadratic weights. The agreement was notably higher for one of the three study sites as compared to the two others, particularly for spine assessment, yielding a moderate kappa value of 0.4 - 0.5. For cone-beam CT, based on a 1-3 scale, 59 out of 94 left TMJ's were scored as 1 and 31 as score 2 by the first observer vs. 87 and 7 by the second observer yielding a poor agreement (kappa 0.1).

CONCLUSIONS

Categorizing DXA LS and automated radiographic Z-scores on a 0-5 scale gave a weak to moderate agreement between the two methods, indicating that a hand radiograph might provide an adjuvant tool to DXA when assessing bone health children with JIA, given thorough calibration is performed.

Osteoporosis and Bone Fragility in Children: Diagnostic and Treatment Strategies

The incidence of osteoporosis in children is increasing because of the increased survival rate of children with chronic diseases and the increased use of bone-damaging drugs. As childhood bone fragility has several etiologies, its management requires a thorough evaluation of all potentially contributing pathogenetic mechanisms. This review focuses on the main causes of primary and secondary osteoporosis and on the benefits and limits of the different radiological methods currently used in clinical practice for the study of bone quality. The therapeutic and preventive strategies currently available and the most novel diagnostic and treatment strategies are also presented. Optimal management of underlying systemic conditions is key for the treatment of bone fragility in childhood. DXA still represents the gold standard for the radiologic evaluation of bone health in children, although other imaging techniques such as computed tomography and ultrasound evaluations, as well as REMS, are increasingly studied and used. Bisphosphonate therapy is the gold standard for pharmacological treatment in both primary and secondary pediatric osteoporosis. Evidence and experience are building up relative to the use of monoclonal antibodies such as denosumab in cases of poor response to bisphosphonates in specific conditions such as osteogenesis imperfecta, juvenile Paget's disease and in some cases of secondary osteoporosis. Lifestyle interventions including adequate nutrition with adequate calcium and vitamin D intake, as well as physical activity, are recommended for prevention.

Pulsed Vibro-Acoustic Analysis Technique for Monitoring Bone Health in Preterm Infants: A Pilot Study

Despite advances in neonatal care, metabolic bone disease of prematurity (MBDP) remains a common problem in preterm infants. The development of non-invasive and affordable diagnostic approaches can be highly beneficial in the diagnosis and management of preterm infants at risk of MBDP. In this study, we present an ultrasound method called pulsed vibro-acoustic analysis to investigate the progression of bone mineralization in infants over time versus weight and postmenstrual age. The proposed pulsed vibro-acoustic analysis method is used to evaluate the vibrational characteristics of the bone. This method uses the acoustic radiation force of ultrasound to vibrate the bone. The generated acoustic waves are detected using a hydrophone placed on the skin over the tibia. The frequency of vibration and the speeds of received acoustic waves have information regarding the material property of the bone. We examined the feasibility of this method through an in vivo study consisting of 25 preterm and 10 full term infants. The pulsed vibro-acoustic data were acquired longitudinally in preterm infants with multiple visits and at a single visit in full term infants. Speed of sound and mean peak frequency of slow and fast sound waves recorded by hydrophone were used to analyze bone mineralization progress. Linear mixed model was used for statistical analysis in characterizing the mineralization progress in preterm infants compared to data from full term subjects. Significance changes in wave parameters (speed of sound and mean peak frequency) with respect to the postmenstrual age and weight in preterm infants were observed with p-values less than 0.05. Statistical significances in speed of sound measurement for both fast and slow waves were observed between preterm and full term infants, with p-values of <0.01 and 0.02, respectively. The results of this pilot study indicate the potential use of vibro-acoustic analysis for monitoring the progression of bone mineralization in preterm infants.

Adaptation and validation of an artificial intelligence based digital radiogrammetry tool for assessing bone health of indian children and youth with type-1 diabetes

BACKGROUND AND OBJECTIVES

BoneXpert (BX) is an artificial intelligence software used primarily for bone age assessment. Besides, it can also be used to screen for bone health using the digital radiogrammetry tool called bone health index (BHI) for which normative reference values available are calculated from healthy European children. Due to ethnic difference in bone geometry, in a previous study, we generated reference curves based on healthy Indian children. The objectives of this study were: 1) To assess and compare bone health of Indian children with Type 1 diabetes (T1D) using both European and Indian BHI SDS reference data and 2) To identify determinants of poor bone health in Indian children and youth with T1D by using BHI tool (based on BHI-SDS Indian reference data) of BX.

METHOD

The BHI was assessed retrospectively in 1159 subjects with T1D using digitalised left-hand x-rays and SDS were computed using European and Indian data. The demographic, anthropometric, clinical, biochemistry, dual x-ray absorptiometry (DXA) data and peripheral quantitative computed tomography (pQCT) data collection were performed using standard protocols and were extracted from hospital records.

RESULTS

The BHI correlated well with DXA and pQCT parameters in subjects with T1D. BHI-SDS calculated using Indian reference data had better correlation with height and DXA parameters. 8.6% study participants had low (less than -2) BHI-SDS (Indian), with height SDS having significant effect. Subjects with low BHI-SDS were older, shorter and had higher duration of diabetes. They also had lower IGF1 and vitamin D concentrations, bone mineral density, and trabecular density. Female gender, increased duration of illness, poor glycaemic control, and vitamin D deficiency/insufficiency were significant predictors of poor BHI-SDS.

CONCLUSION

Our study highlights the utility of digital radiogrammetry AI tool to screen for bone health of children with T1D and demonstrates and highlights the necessity of interpretation using ethnicity specific normative data.

What are the Effects of Exercise on Trabecular Microarchitecture in Older Adults? A Systematic Review and Meta-analysis of HR-pQCT Studies

The objective of this review was to determine the effects of exercise on high-resolution peripheral quantitative computed tomography (HR-pQCT) derived trabecular microarchitecture parameters in older adults. Five electronic databases were systematically searched by two independent reviewers. Inclusion criteria were adults age ≥ 50, any type of exercise as part of the intervention, and trabecular microarchitecture assessed via HR-pQCT. Data was extracted from included studies, and where suitable, included in a meta-analysis. Quality of included studies was appraised. Seven studies (397 participants) were included. All participants were postmenopausal women. Interventions included jumping, whole-body vibration, and power/plyometric training. All studies were rated as either weak or moderate quality. Meta-analysis (5 studies) showed no significant changes in any parameters when considering all exercise or sub-analysing based on type. Exercise was not found to have significant effects on trabecular microarchitecture in postmenopausal women over the age of 50. These findings should be interpreted with caution due to the small number of studies investigating few modes of exercise, their weak to moderate quality, and risk of bias. High-quality studies are needed to determine the effects of additional types of exercise in a more diverse population of older adults, including men.

Longitudinal assessment of bone health index as a measure of bone health in short-statured children before and during treatment with recombinant growth hormone

OBJECTIVES

The aim of our study was the longitudinal assessment of bone health index (BHI) in short-statured children during growth hormone (GH) treatment to estimate changes in their bone health.

METHODS

256 short-statured children (isolated GH deficiency (IGHD) n=121, multiple pituitary hormone deficiency (MPHD) n=49, intrauterine growth retardation (small for gestational age (SGA)) n=52, SHOX (short stature homeobox gene) deficiency n=9, Ullrich Turner syndrome (UTS) n=25) who started with GH between 2010 and 2018 were included. Annual bone ages (Greulich and Pyle, GP) and BHI were, retrospectively, analysed in consecutive radiographs of the left hand (BoneXpert software) from GH therapy start (T0) up to 10 years (T10) thereafter, with T max indicating the individual time point of the last available radiograph. The results are presented as the median (25 %/75 % interquartile ranges, IQR) and statistical analyses were performed using non-parametric tests as appropriate.

RESULTS

The BHI standard deviation scores (SDS) were reduced (-0.97, -1.8/-0.3) as bone ages were retarded (-1.6 years, -2.31/-0.97) in all patients before start of GH and were significantly lower in patients with growth hormone deficiency (GHD) (-1.04, -1.85/-0.56; n=170) compared to non-GHD patients (-0.79, -1.56/-0.01; n=86; p=0.022). BHI SDS increased to -0.17 (-1/0.58) after 1 year of GH (T1, 0.5-1.49, p<0.001) and to -0.20 (-1/-0.50, p<0.001) after 5.3 years (T max, 3.45/7.25).

CONCLUSIONS

BHI SDS are reduced in treatment-naive short-statured children regardless of their GH status, increase initially with GH treatment while plateauing thereafter, suggesting sustained improved bone health.

Effect of exercise modality and weight loss on changes in muscle and bone quality in older adults with obesity

BACKGROUND

Little is known about the effect of exercise modality during a dietary weight loss program on muscle size and quality, as measured by computed tomography (CT). Even less is known about how CT-derived changes in muscle track with changes in volumetric bone mineral density (vBMD) and bone strength.

METHODS

Older adults (66 ± 5 years, 64 % women) were randomized to 18-months of diet-induced weight loss (WL), WL with aerobic training (WL + AT), or WL with resistance training (WL + RT). CT-derived muscle area, radio-attenuation and intermuscular fat percentage at the trunk and mid-thigh were determined at baseline (n = 55) and 18-month follow-up (n = 22-34), and changes were adjusted for sex, baseline value, and weight lost. Lumbar spine and hip vBMD and finite element-derived bone strength were also measured.

RESULTS

After adjustment for the weight lost, muscle area losses at the trunk were -7.82 cm2 [-12.30, -3.35] for WL, -7.72 cm2 [-11.36, -4.07] for WL + AT, and -5.14 cm2 [-8.65, -1.63] for WL + RT (p < 0.001 for group differences). At the mid-thigh, decreases were -6.20 cm2 [-10.39, -2.02] for WL, -7.84 cm2 [-11.19, -4.48] for WL + AT, and -0.60 cm2 [-4.14, 2.94] for WL + RT; this difference between WL + AT and WL + RT was significant in post-hoc testing (p = 0.01). Change in trunk muscle radio-attenuation was positively associated with change in lumbar bone strength (r = 0.41, p = 0.04).

CONCLUSIONS

WL + RT better preserved muscle area and improved muscle quality more consistently than WL + AT or WL alone. More research is needed to characterize the associations between muscle and bone quality in older adults undertaking weight loss interventions.

Diagnosis, Follow-Up and Therapy for Secondary Osteoporosis in Vulnerable Children: A Narrative Review

By definition, children constitute a vulnerable population, especially when they are chronically ill and/or disabled. A characteristic of chronically ill and disabled children is that they also suffer from indirect effects of their disease, such as immobilization, chronic inflammation, reduced time outdoors in the sun, osteotoxic effects of disease-targeted therapy (like glucocorticoids), and poor nutrition. All these factors may lead to bone fragility due to secondary osteoporosis, a co-morbidity that may be overlooked in the context of serious underlying diseases. The ultimate goal of osteoporosis diagnosis and monitoring in this setting is the early identification, prevention, and treatment of low-trauma long bone and vertebral fractures; indeed, vertebral fractures are a frequently under-diagnosed manifestation of overt bone fragility in this context. Efforts to prevent first-ever fractures are also meritorious, including encouragement of weight-bearing activities, optimization of nutritional status, including calcium and vitamin D supplementation, and the diagnosis and treatment of delayed growth and puberty; however, these conservative measures may be insufficient in those at high risk. Numerous natural history studies have shown that vertebral fractures are more common than non-vertebral (i.e., long bone) fractures in at-risk children. Not surprisingly, the cornerstone of secondary osteoporosis monitoring is lateral spine imaging for the early detection of vertebral collapse. Although dual-energy x-ray absorptiometry (DXA) is the gold standard to measure bone mineral density, digital X-ray radiogrammetry may be used as a surrogate measure of bone strength if dual-energy x-ray absorptiometry is not available. In the event that preventive measures fail, treatment with bisphosphonates may be appropriate. Typically, treatment with intravenous bisphosphonates is reserved for children with overt bone fragility and limited potential for spontaneous recovery. However, there is increasing attention to very high-risk children, such as boys with Duchenne muscular dystrophy, who may benefit from bisphosphonate therapy prior to first-ever fractures (given their high fracture frequency and essentially absent potential for spontaneous recovery). This article provides a contemporary overview of the definition and diagnosis of osteoporosis in children with chronic illness, along with the approach to monitoring those at risk and the evidence for currently recommended intervention strategies.

Tibial quantitative ultrasound compared to dual-energy X-ray absorptiometry in preterm infants

OBJECTIVE

The gold standard for diagnosing metabolic bone disease in pediatrics is dual-energy x-ray absorptiometry (DXA). Bone quantitative ultrasound (QUS) has increasing applications. This study compared the relationship of DXA to QUS in preterm infants.

DESIGN

Prospective observational study of preterm infants ≤32 weeks gestation or ≤1800 grams at birth. DXA scans measuring bone mineral content (BMC) and tibial QUS scans measuring bone speed of sound (SOS) were obtained near term gestation.

RESULTS

41 infants had bone scans at mean corrected gestation 37.7 ± 2.1 weeks. BMC and SOS showed weak inverse correlation (R² 0.163, p < 0.01). BMC and SOS correlated with parameters at corrected gestational age at the time of the bone scans (p < 0.05-0.001). SOS correlated with birth gestational age (p < 0.001), not BMC.

CONCLUSIONS

A statistically significant weak inverse correlation between DXA and QUS was observed. QUS may have advantages over DXA.

Current and emerging artificial intelligence applications for pediatric musculoskeletal radiology

Artificial intelligence (AI) is playing an ever-increasing role in radiology (more so in the adult world than in pediatrics), to the extent that there are unfounded fears it will completely take over the role of the radiologist. In relation to musculoskeletal applications of AI in pediatric radiology, we are far from the time when AI will replace radiologists; even for the commonest application (bone age assessment), AI is more often employed in an AI-assist mode rather than an AI-replace or AI-extend mode. AI for bone age assessment has been in clinical use for more than a decade and is the area in which most research has been conducted. Most other potential indications in children (such as appendicular and vertebral fracture detection) remain largely in the research domain. This article reviews the areas in which AI is most prominent in relation to the pediatric musculoskeletal system, briefly summarizing the current literature and highlighting areas for future research. Pediatric radiologists are encouraged to participate as members of the research teams conducting pediatric radiology artificial intelligence research.

Association of developmental coordination disorder and low motor competence with impaired bone health: A systematic review

AIMS

Individuals with developmental coordination disorder (DCD) and low motor competence (LMC) may be at increased risk of low bone health due to their lifetime physical activity patterns. Impaired bone health increases an individual's risk of osteoporosis and fracture; therefore, it is necessary to determine whether a bone health detriment is present in this group. Accordingly, this systematic review explores the association between DCD/LMC and bone health.

METHODS AND PROCEDURES

Studies were included with assessment of bone health in a DCD/LMC population. Study bias was assessed using the JBI critical appraisal checklist. Due to heterogeneity, meta-analysis was not possible and narrative synthesis was performed with effect size and direction assessed via harvest plots.

OUTCOMES AND RESULTS

A total of 16 (15 paediatric/adolescent) studies were included. Deficits in bone measures were reported for the DCD/LMC group and were more frequent in weight-bearing sites. Critical appraisal indicated very low confidence in the results, with issues relating to indirectness and imprecision relating to comorbidities.

CONCLUSIONS AND IMPLICATIONS

Individuals with DCD or LMC are at increased risk of bone health deficits. Bone impairment locations indicate insufficient loading via physical activity as a potential cause of bone deficits. Results indicate a potential for earlier osteoporosis onset.

Vitamin D Levels in Pregnant Women Do Not Affect Neonatal Bone Strength

Vitamin D plays a key role in regulating calcium and phosphate metabolism. However, whether maternal vitamin D levels affect fetal bone strength is unclear. This study assessed correlations between maternal 25(OH)D status and neonatal bone strength 25(OH)D levels, these were measured in the maternal and infant cord blood of 81 mother−infant dyads. Bone strength was measured using a quantitative ultrasound (QUS) of tibial bone speed of sound (SOS). Maternal vitamin D intake, medical history and lifestyle were evaluated from questionnaires. Maternal 25(OH)D levels were deficient (<25 nmol/L) in 24.7%, insufficient (25−50 nmol/L) in 37% and sufficient (>50 nmol/L) in 38.3%. The maternal and cord blood 25(OH)D levels correlated (r = 0.85, p < 0.001). Cord blood levels (57.9 ± 33.5 nmol/L) were higher than the maternal blood levels (46.3 ± 23.2: p < 0.001). The mean SOS was 3042 ± 130 m/s. The neonatal SOS and 25(OH)D levels were not correlated. The mean bone SOS levels were comparable in the three maternal and cord blood 25(OH)D groups. No correlation was found between the maternal 25(OH)D levels and the neonatal anthropometrics. Although the 25(OH)D levels were higher in Jewish mothers than they were in Muslim mothers (51.1 ± 22.6 nmol/L vs. 24 ± 14.7 nmol/L, respectively: p = 0.002) and in those who took supplemental vitamin D, the bone SOS levels were comparable. In conclusion, maternal vitamin D levels correlate with cord levels but do not affect bone strength or growth parameters.

A growth area: A review of the value of clinical studies of child growth for palaeopathology

Studies of living children demonstrate that early life stress impacts linear growth outcomes. Stresses affecting linear growth may also impact later life health outcomes, including increased cardiometabolic disease risk. Palaeopathologists also assess the growth of children recovered from bioarchaeological contexts. Early life stresses are inferred to affect linear growth outcomes, and measurements of skeletal linear dimensions alongside other bioarchaeological information may indicate the types of challenges faced by past groups. In clinical settings, the impacts of stress on growing children are typically measured by examining height. Palaeopathologists are limited to examining bone dimensions directly and must grapple with incomplete pictures of childhood experiences that may affect growth. Palaeopathologists may use clinical growth studies to inform observations among past children; however, there may be issues with this approach. Here, we review the relationship between contemporary and palaeopathological studies of child and adolescent growth. We identify approaches to help bridge the gap between palaeopathological and biomedical growth studies. We advocate for: the creation of bone-specific growth reference information using medical imaging and greater examination of limb proportions; the inclusion of children from different global regions and life circumstances in contemporary bone growth studies; and greater collaboration and dialogue between palaeopathologists and clinicians as new studies are designed to assess linear growth past and present. We advocate for building stronger bridges between these fields to improve interpretations of growth patterns across human history and to potentially improve interventions for children living and growing today.

Correlation of CT Values and Bone Mineral Density in Elderly Chinese Patients with Proximal Humeral Fractures

Objective

To investigate the correlation between computed tomography (CT) values and bone mineral density (BMD) in elderly Chinese patients with proximal humeral fractures.

Methods

This was a single‐center retrospective study involving 166 elderly patients with proximal humeral fractures between January and June 2015 in our hospital. Following the inclusion and exclusion criteria, 89 patients were finally enrolled in this study. The spiral CT scanning was performed on these patients, and the CT images were obtained by using MIMICS software. The CT values in axial, coronal, and sagittal images of healthy proximal humeri were measured using a circular region of interest (ROI) by Image J. The bone mineral density (BMD) of the lumbar spine and femoral neck was measured using dual‐energy X‐ray absorptiometry (DXA). Spearman rank correlation methods were used for analysis of the association between the proximal humerus average CT value (CT_Mean) and the lumbar spine as well as femoral neck BMD in patients with proximal humeral fractures, or osteoporotic patients.

Results

Among the included 89 patients, there were 26 males and 63 females, 69% and 84% of whom were diagnosed with osteoporosis, respectively. The lumbar spine and femoral neck BMD and the CT_Mean of the proximal humerus were higher in males than females with proximal humeral fractures (P < 0.05). This gender difference was also found in the osteoporotic patient population (P < 0.05). The Spearman rank correlation method showed that the lumbar spine and femoral neck BMD was closely related to the proximal humeral CT_Mean in males (r = 0.877, P = 0.000; r = 0.832, P = 0.000; respectively) and females (r = 0.806, P = 0.000; r = 0.616, P = 0.000; respectively) with proximal humeral fractures, as well as osteoporotic male (r = 0.745, P = 0.000; r = 0.575, P = 0.000; respectively) and female (r = 0.613, P = 0.000; r = 0.629, P = 0.000; respectively) patients.

Conclusions

The CT value of the proximal humerus is a rapid and accurate method by which bone quality can be assessed in elderly patients with proximal humeral fractures. Moreover, the CT value of the proximal humerus is an alternative measurement of BMD that can guide surgeons in selecting the appropriate internal fixation material.

Maternal Diet, Nutritional Status, and Birth-Related Factors Influencing Offspring's Bone Mineral Density: A Narrative Review of Observational, Cohort, and Randomized Controlled Trials

There is growing evidence that bone health may be programmed in the first years of life. Factors during the prenatal period, especially maternal nutrition, may have an influence on offspring’s skeletal development and thus the risk of osteoporosis in further life, which is an increasing societal, health and economic burden. However, it is still inconclusive which early life factors are the most important and to what extent they may affect bone health. We searched through three databases (PubMed, Google Scholar, Cochrane Library) and after eligibility criteria were met, the results of 49 articles were analyzed. This narrative review is an overall summary of up-to-date studies on maternal diet, nutritional status, and birth-related factors that may affect offspring bone development, particularly bone mineral density (BMD). Maternal vitamin D status and diet in pregnancy, anthropometry and birth weight seem to influence BMD, however other factors such as subsequent growth may mediate these associations. Due to the ambiguity of the results in the analyzed studies, future, well-designed studies are needed to address the limitations of the present study.