Pediatric DXA: clinical applications

Normal bone mineral accrual requires adequate dietary intake of calcium, vitamin D and other nutrients; hepatic and renal activation of vitamin D; normal hormone levels (thyroid, parathyroid, reproductive and growth hormones); and neuromuscular functioning with sufficient stress upon the skeleton to induce bone deposition. The presence of genetic or acquired diseases and the therapies that are used to treat them can also impact bone health. Since the introduction of clinical DXA in pediatrics in the early 1990s, there has been considerable investigation into the causes of low bone mineral density (BMD) in children. Pediatricians have also become aware of the role adequate bone mass accrual in childhood has in preventing osteoporotic fractures in late adulthood. Additionally, the availability of medications to improve BMD has increased with the development of bisphosphonates. These factors have led to the increased utilization of DXA in pediatrics. This review summarizes much of the previous research regarding BMD in children and is meant to assist radiologists and clinicians with DXA utilization and interpretation

Osteoporosis

Bone mass is determined primarily by genetic influences, but exogenous factors may also play a major role. The prevention of osteoporosis can start at childhood. Optimal achievement of peak bone mass during childhood and adolescence is important to minimize future fracture risk. Chronic inflammatory diseases can have a detrimental effect on bone mass through a variety of mechanisms. Different diagnostic methods for detecting osteoporosis (eg, dual x-ray absorptiometry, quantitative computed tomography, ultrasounds) are in use or under investigation. New treatment options are available; among these, the use of bisphosphonates seems to be the more promising approach