Assessment of bone mineralization in children and adolescents

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Abstract

Bone mineral accrual during growth results in gender-, race-, and maturation-specific changes in trabecular and cortical density and dimensions. Children with chronic disease have multiple potential risk factors for impaired bone accrual. Risk factors include delayed growth and maturation, decreased weight-bearing activity, malnutrition, vitamin D deficiency, glucocorticoid therapy, impaired sex hormones and growth hormone, and increased bone resorption by inflammatory cytokines. The impact of chronic diseases may be immediate, resulting in childhood fragility fractures, or delayed, owing to suboptimal peak bone mass accrual and increased fracture risk with the inevitable bone loss during aging. Dual energy X-ray absorptiometry is, by far, the most frequent method for the assessment of bone health in children at risk. This assessment is hampered by lack of a agreement on the quantitative definition of osteopenia and osteoporosis in children, inadequate reference data, technical limitations in small children, and varied approaches to the interpretation of results in children with delayed growth and maturation. This review summarizes the expected gains in bone size, mass and strength during childhood and adolescence, the role of the bone—muscle unit, the advantages and disadvantages of the available technologies for the assessment of skeletal health in children, and possible alternative strategies for the assessment of bone healthy in children with delayed growth and maturation.