Abstract
Specific approaches are needed in indication and interpretation of bone density measurement in pediatric population. Changes in body size and body composition during growth have essential impact on the bone developement.
Therefore, it is important to correlate bone density to anthropometric data. Dual Energy X-ray absorptiometry (DXA), the most widely used technique nowadays, assess the areal bone density.
The limitation of DXA is the underestimation of bone density in children with short stature. In contrast, quantitative CT (QCT) assesses volumetric bone density.
QCT results are not influenced by body height and therefore of great privilege particularly in pediatric osteology. This method also allows distinguishing the cortical and the trabecular bone density.
QCT also assess bone geometric parameters that serve as the basis for calculation of bone strength indices that correlate well to fracture load assessed ex vivo. Micro-CT, high resolution-pQCT and micro-MR are able to assess bone microarchitecture, thus making fracture prediction even more accurate.
Quantitative ultrasound (QUS) is radiation free technique, but its clinical utility is not clear yet. When assessing individual risk of fracture, other factors such as muscle strength, neurological status or personal, pharmacological and fracture history are of consideration.