Guidelines for densitometry were updated in 2013 by a group of pediatric bone experts at the Pediatric Position Development Conference (PDC) of the International Society of Clinical Densitometry. Bone densitometry is a valuable part of a comprehensive bone health assessment. The limited treatment options make it all the more important to predict accurately who will have fractures and who might recover without drug therapy. The efficacy, cost-effectiveness, and safety of pharmacologic agents used to treat osteoporosis in older patients have not been fully established in pediatric patients. 6, 7 These observations have led to greater demands for diagnostic and therapeutic tools to address bone fragility in children and adolescents. 5 Vitamin D insufficiency and deficiency are widespread, calcium intake often falls below recommended levels, and physical inactivity is common among American youth, all of which may increase a child’s fracture risk. 3, 4 The documented increase of 35% to 65% in childhood fractures over the past 4 decades has raised concern that current lifestyles are compromising early bone health. 2, – 5 Children with forearm fractures have been shown to have lower bone mass, a greater percentage of body fat, and less calcium intake than their peers without a history of fracture. 1 Recurrent fractures in otherwise healthy children may also indicate underlying bone fragility. Genetic or acquired disorders can compromise gains in bone quantity and quality, leading to skeletal fragility early in life. Threats to bone health are increasingly a pediatric concern. The Pediatric Endocrine Society affirms the educational value of this publication. Ongoing research will help define the indications and best methods for assessing bone strength in children and the clinical factors that contribute to fracture risk. The terms “osteopenia” and “osteoporosis” based on bone densitometry findings alone should not be used in younger patients instead, bone mineral content or density that falls >2 SDs below expected is labeled “low for age.” Pediatric osteoporosis is defined by the Pediatric Position Development Conference by using 1 of the following criteria: ≥1 vertebral fractures occurring in the absence of local disease or high-energy trauma (without or with densitometry measurements) or low bone density for age and a significant fracture history (defined as ≥2 long bone fractures before 10 years of age or ≥3 long bone fractures before 19 years of age). The interpretation of bone densitometry results in children differs from that in older adults. The statements from this and other expert panels provide general guidance to the pediatrician, but decisions about ordering and interpreting bone densitometry still require clinical judgment. Some of these recommendations are evidence-based, whereas others reflect expert opinion, because data are sparse on many topics. The report emphasizes updated consensus statements generated at the 2013 Pediatric Position Development Conference of the International Society of Clinical Densitometry by an international panel of bone experts. This clinical report summarizes current knowledge about bone densitometry in the pediatric population, including indications for its use, interpretation of results, and risks and costs. The role of densitometry in the management of children at risk of bone fragility is less clear. In older adults, bone densitometry has been shown to predict fracture risk and reflect response to therapy. Pediatric patients with genetic and acquired chronic diseases, immobility, and inadequate nutrition may fail to achieve expected gains in bone size, mass, and strength, leaving them vulnerable to fracture. Concerns about bone health and potential fragility in children and adolescents have led to a high interest in bone densitometry.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |