Large variations occur in bone density measurements of children when using different software

Pediatric and adult osteoporosis: a contrasting mirror

Pediatric osteoporosis (PO) is a condition that is currently gaining recognition. Due to the lack of official definitions over the past few decades, the exact incidence of PO is unknown. The research does not provide a specific prevalence of PO in different world regions. However, this is expected to change with the latest 2019 guidelines proposed by the International Society of Clinical Densitometry. Although adult osteoporosis (AO) has been postulated a pediatric disease because its manifestation in adulthood is a result of the bone mass acquired during childhood, differences between PO and AO should be acknowledged. AO is defined as low bone density; however, PO is diagnosed based on existing evidence of bone fragility (vertebral fractures, pathological fractures). This is particularly relevant because unlike in adults, evidence is lacking regarding the association between low bone density and fracture risk in children. The enhanced capacity of pediatric bone for reshaping and remodeling after fracture is another difference between the two entities. This contrast has therapeutic implications because medication-free bone reconstitution is possible under certain conditions; thus, background therapy is not always recommended. In this narrative review, differences between PO and AO in definition, assessment, and medical approach were investigated.

Virtual anthropology and forensic identification using multidetector CT

Virtual anthropology is made possible by modern cross-sectional imaging. Multislice CT (MSCT) can be used for comparative bone and dental identification, reconstructive identification and lesion identification. Comparative identification, the comparison of ante- and post-mortem imaging data, can be performed on both teeth and bones. Reconstructive identification, a considerable challenge for the radiologist, identifies the deceased by determining sex, geographical origin, stature and age at death. Lesion identification combines virtual autopsy and virtual anthropology. MSCT can be useful in palaeopathology, seeking arthropathy, infection, oral pathology, trauma, tumours, haematological disorders, stress indicators or occupational stress in bones and teeth. We examine some of the possibilities offered by this new radiological subspeciality that adds a new dimension to the work of the forensic radiologist. A multidisciplinary approach is crucial and involves communication and data exchange between radiologists, forensic pathologists, anthropologists and radiographers.

Precision errors, least significant change, and monitoring time interval in pediatric measurements of bone mineral density, body composition, and mechanostat parameters by GE lunar prodigy

Dual-energy X-ray absorptiometry (DXA) method is widely used in pediatrics in the study of bone density and body composition. However, there is a limit to how precise DXA can estimate bone and body composition measures in children. The study was aimed to (1) evaluate precision errors for bone mineral density, bone mass and bone area, body composition, and mechanostat parameters, (2) assess the relationships between precision errors and anthropometric parameters, and (3) calculate a "least significant change" and "monitoring time interval" values for DXA measures in children of wide age range (5-18yr) using GE Lunar Prodigy densitometer. It is observed that absolute precision error values were different for thin and standard technical modes of DXA measures and depended on age, body weight, and height. In contrast, relative precision error values expressed in percentages were similar for thin and standard modes (except total body bone mineral density [TBBMD]) and were not related to anthropometric variables (except TBBMD). Concluding, due to stability of percentage coefficient of variation values in wide range of age, the use of precision error expressed in percentages, instead of absolute error, appeared as convenient in pediatric population.

[Ventral stabilization of the lumbar spine of a 2-year-old boy with an expandable cage : 7-year course]

This case report describes the first implantation of an expandable cage into the lumbar spine of a 2-year-old boy. Due to incomplete remission of a teratoma, it was necessary to replace the second lumbar vertebral body with an expandable cage implantation and subsequent dorsoventral stabilization. During the follow-up period with annual x-ray examinations, a loss of correction without increased pain or neurological deficits could be shown in the now 9-year-old boy.

Pediatric dual-energy X-ray absorptiometry: technique, interpretation, and clinical applications

This article reviews the dual-energy x-ray absorptiometry (DXA) technique, its interpretation, and clinical applications with emphasis on the considerations unique to pediatrics. Specifically, the use of DXA in children requires the radiologist to be a "clinical pathologist," monitoring the technical aspects of the DXA acquisition, a "statistician" knowledgeable in the concepts of Z-scores and least significant changes, and a "bone specialist," aware of the DXA findings in a large number of clinical diseases, providing the referring clinician with a meaningful context for the numeric result obtained with DXA.

Pediatric bone density and fracture

As children grow, they accumulate bone mineral, which serves as a "bone bank" for the future. Any condition that interferes with normal bone mineral accrual during childhood has the potential to reduce peak bone mass and subsequently increase future risk for fracture. In contrast to adults, for whom dual-energy x-ray absorptiometry (DXA) has become the standard clinical instrument for assessing bone mineral density and criteria have been developed to define osteopenia and osteoporosis, information for children is still limited. Numerous issues confound the interpretation of DXA-derived bone mineral density measurements in children, and clinicians often find themselves caught between the limitations of these methods and the practical issue of taking care of their pediatric patient. The explosion of treatment options for postmenopausal osteoporosis has resulted in new options for the treatment of children and adolescents. However, most of these agents have not been sufficiently well studied in children to permit the development of standardized treatment guidelines.

Pediatric DXA: technique and interpretation

This article reviews dual X-ray absorptiometry (DXA) technique and interpretation with emphasis on the considerations unique to pediatrics. Specifically, the use of DXA in children requires the radiologist to be a "clinical pathologist" monitoring the technical aspects of the DXA acquisition, a "statistician" knowledgeable in the concepts of Z-scores and least significant changes, and a "bone specialist" providing the referring clinician a meaningful context for the numeric result generated by DXA. The patient factors that most significantly influence bone mineral density are discussed and are reviewed with respect to available normative databases. The effects the growing skeleton has on the DXA result are also presented. Most important, the need for the radiologist to be actively involved in the technical and interpretive aspects of DXA is stressed. Finally, the diagnosis of osteoporosis should not be made on DXA results alone but should take into account other patient factors.

Monitoring bone mass, bone density and bone geometry in children and adolescents

The number of articles dealing with pediatric bone mass measurements has flourished during the last decade. The reasons include the awareness that bone gained early in life is an important factor in determining the risk of osteoporosis later in life and the expanding number of pediatric diseases associated with low bone mass. Dual-energy x-ray absorptiometry is the most common method for measurement of bone mineral content or bone mineral density. Quantitative computed tomography and quantitative ultrasound are the emerging techniques which offer the possibility of measuring bone mineral content, bone mineral density and quantitative ultrasound parameters that are unique to children and will be discussed in this review. The interpretation of bone mass measurements is also often difficult in growing individuals and the peculiar aspects pertaining to this problem are examined.