Pediatric and Whole-Body DXA Bone Densitometry Interpretation

The finding of one or more vertebral compression (crush) fractures is indicative of osteoporosis, in the absence of local disease or high-energy trauma. In such children and adolescents, measuring BMD adds to the overall assessment of bone health. The diagnosis of osteoporosis in children and adolescents should not be made on the basis of densitometric criteria alone. In the absence of vertebral compression (crush) fractures, the diagnosis of osteoporosis is indicated by the presence of both a clinically significant fracture history and BMD Z-score ≤
-2.0. A clinically significant fracture history is one or more of the following: 1) two or more long bone fractures by age 10 years; 2) three or more long bone fractures at any age up to age 19 years. A BMC/BMD Z-score > -2.0 does not preclude the possibility of skeletal fragility and increased fracture risk.
The posterior-anterior (PA) spine and total body less head (TBLH), are the preferred skeletal sites for performing BMC and areal BMD measurements in most pediatric subjects. Other sites may be useful
depending on the clinical need. Soft tissue measures in conjunction with whole body scans may be helpful in evaluating patients with chronic conditions associated with malnutrition or with muscle and skeletal deficits.