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Thread: Indications for Bone Densitometry in Children

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    Default Indications for Bone Densitometry in Children

    > Dual-energy x-ray absorptiometry (DXA) of the lumbar spine and total body is the recommended test to determine bone density in children because of high availability, reproducibility, speed, low levels of radiation exposure, and availability of a pediatric reference database.

    > Children with primary bone disorders (idiopathic juvenile osteoporosis and osteogenesis imperfecta) and secondary disorders linked to an increased risk for fracture should undergo densitometry when they are first seen and before bone-active therapy is started. Secondary conditions include chronic inflammatory diseases, immobilization for long periods, endocrine or hematologic diseases, and cancer and associated treatments that adversely affect bone.

    > Children with a history of clinically significant fracture (1 lower extremity long-bone fracture, ≥ 2 upper extremity long-bone fractures, or vertebral fracture after minimal or no trauma) should undergo DXA scanning. Bone mineral density (BMD) measurement may be indicated, depending on patient age at fracture, severity of any underlying conditions, associated risk factors, exposure to ionizing radiation or drugs adversely affecting bone, exposure, family history, number of fractures, and trauma intensity, with low trauma fractures defined as those involving a fall from standing height or less.

    > In children, the lumbar spine and total body (excluding the cranium, if possible) are the preferred sites for DXA testing. Children with contractures may need to be tested at the lateral distal aspect of the femur, and those with metal hardware may need to be tested at other sites for children.

    > Although 6 months should normally elapse before densitometry testing is repeated, it might be appropriate in some cases to wait at least 1 year.

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    Low bone mineral density in adults with cystic fibrosis

    Patients with cystic fibrosis have several risk factors for the development of low bone mineral density (BMD)

    BMD was measured in the lumbar spine (L1–4) using dual energyx ray absorptiometry (DXA) and quantitative computed tomography (QCT). It was also measured in the proximal femur (total hip and femoral neck) using DXA, and in the distal and ultra distal forearm using single energy x ray absorptiometry (SXA). Biochemical markers of bone turnover, vitamin D levels, parathyroid hormone levels, and a variety of anthropometric variables were also assessed.

    Low bone density is prevalent in adult patients with cystic fibrosis. Current levels of vitamin D supplementation appear to be inadequate.

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