Sistema de Salut de Catalunya
Institut Català de la Salut
[Magallares B] Department of Rheumatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. Department of Rheumatology, Universitari Dexeus-Grupo Quirón Salud Hospital, Barcelona, Spain. Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain. Facultat de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain. [Malouf J] Department of Mineral Metabolism Unit - Internal Medicine, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. [Codes-Méndez H] Department of Rheumatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain. [Park HS] Department of Rheumatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain. Facultat de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain. [Betancourt J, Fraga G] Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain. Department of Pediatrics, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. [Quesada-Masachs E] Department of Rheumatology, Universitari Dexeus-Grupo Quirón Salud Hospital, Barcelona, Spain. Unitat de Reumatologia Pediàtrica, Vall d’Hebron Hospital Universitari, Barcelona, Spain. [López-Corbeto M] Unitat de Reumatologia Pediàtrica, Vall d’Hebron Hospital Universitari, Barcelona, Spain
Vall d'Hebron Barcelona Hospital Campus
2025-06-11T11:30:41Z
2025-06-11T11:30:41Z
2025-04-09
Bone mineral density; Low bone mineral mass; Pediatric densitometry
Densidad mineral ósea; Masa mineral ósea baja; Densitometría pediátrica
Densitat mineral òssia; Massa mineral òssia baixa; Densitometria pediàtrica
Background: The International Society for Clinical Densitometry recommends adjusting the bone mineral density (BMD) Z-score in children with short stature or growth delay. However, it is not clear whether height-for-age Z-score (HAZ) adjustment is required in all children. The aim of this study was to determine whether HAZ adjustment is necessary by examining variability in unadjusted and adjusted Z-scores for the main regions of interest in a large pediatric cohort. Methods: We evaluated 103 patients ≤ 20 years of age who underwent lumbar spine and whole-body dual-energy x-ray absorptiometry (DXA) at our tertiary care hospital from 2016 to 2018. The formula proposed by Zemel was used to calculate the HAZ. Results: A total of 103 participants were included (54 females; 52.4%). The mean age was 9.8 years. Height percentiles were ≤ 3 or ≥ 97 in seven (6.8%) and five (4.9%) patients. Diagnostic criteria for low bone mineral density (LBMD; BMD Z-score ≤ −2) were met in 8 lumbar spine scans and 10 whole-body scans. After HAZ adjustment, the prevalence of LBMD decreased from 8.2% (n=8) to 6.4% (n=6) in the lumbar spine scans and from 10.5% (n=10) to 7.2% (n=8) in the whole-body scans. Agreement between the adjusted and non-adjusted HAZ data was 0.498 for the lumbar spine and 0.557 for the whole body. The diagnostic discrepancy rate for LBMD diagnosis was 7%. After HAZ adjustment, 5% patients no longer met LBMD criteria while conversely 2% met LBMD criteria only after adjustment. Conclusions: The high diagnostic discrepancy rate (7%) for LBMN in this unselected pediatric cohort underscores the value of performing HAZ adjustment of Z-scores to improve diagnostic accuracy. This divergence between adjusted and unadjusted Z-scores suggests that all pediatric patients, not only those with short stature or growth retardation, may benefit from densitometric size adjustment. This is especially true in individuals whose stature is at the upper end of the range, where size may obscure a diagnosis of LBMD.
Article
Published version
English
Densitometria òssia; Trastorns del creixement; Infants; Estatura; ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Diagnosis::Diagnostic Techniques and Procedures::Diagnostic Imaging::Radiography::Absorptiometry, Photon; PHENOMENA AND PROCESSES::Musculoskeletal and Neural Physiological Phenomena::Musculoskeletal Physiological Phenomena::Bone Density; ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Diagnosis::Diagnostic Techniques and Procedures::Physical Examination::Body Constitution::Body Weights and Measures::Body Size::Body Height; NAMED GROUPS::Persons::Age Groups::Child; DISEASES::Pathological Conditions, Signs and Symptoms::Pathologic Processes::Growth Disorders; Other subheadings::Other subheadings::Other subheadings::/diagnostic imaging; TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::diagnóstico::técnicas y procedimientos diagnósticos::diagnóstico por imagen::radiografía::absorciometría fotónica; FENÓMENOS Y PROCESOS::fenómenos fisiológicos nerviosos y musculoesqueléticos::fenómenos fisiológicos musculoesqueléticos::densidad ósea; TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::diagnóstico::técnicas y procedimientos diagnósticos::exploración física::constitución corporal::pesos y medidas corporales::tamaño corporal::estatura corporal; DENOMINACIONES DE GRUPOS::personas::Grupos de Edad::niño; ENFERMEDADES::afecciones patológicas, signos y síntomas::procesos patológicos::trastornos del crecimiento; Otros calificadores::Otros calificadores::Otros calificadores::/diagnóstico por imagen
Frontiers Media
Frontiers in Endocrinology;16
https://doi.org/10.3389/fendo.2025.1587382
Attribution 4.0 International
http://creativecommons.org/licenses/by/4.0/
Articles científics - HVH [3440]
