Osteoporosis International

, Volume 19, Issue 2, pp 251–255 | Cite as

Which bone mass measures discriminate adolescents who have fractured from those who have not?

Original Article



This study of 415 adolescent children examined the association between four different measures of bone mass and prevalent fracture (N = 160 children). DXA measures and calcaneal ultrasound (but not radial ultrasound or metacarpal index) were associated with upper limb fracture, suggesting heel ultrasound is also a discriminator of fractures in children.


The aim of the study was to describe the association between different measures of bone mass and prevalent fracture in adolescents.


A total of 415 adolescents (150 girls and 265 boys), mean age 16.3 years were examined. Dual energy X-ray absorptiometry (DXA) measures were performed at hip, spine, radius and total body. Calcaneal bone ultrasound attenuation (BUA), speed of sound (SOS), and stiffness were assessed by a Sahara densitometer. Radial ultrasound SOS was assessed by a Sunlight 8000P machine. Metacarpal index was calculated from a left hand X-ray. Prevalent fractures were assessed by questionnaire.


A total of 160 adolescents (39%) reported at least one previous fracture (106 upper limb, 53 lower limb, one other for first fracture). Significantly lower DXA measures, heel BUA, and heel stiffness was observed in those with a history of upper limb fracture (all P < 0.05). Despite significant correlations between all the bone mass measures, radial ultrasound and metacarpal index did not discriminate those with fracture from those without. Similar associations were present for number of fractures. No bone measure was able to discriminate lower limb fracture.


Both calcaneal quantitative ultrasound and DXA are able to discriminate adolescents with a history of upper limb fracture from those without.


Bone mass Children Fracture 



This work was supported by the National Health and Medical Research Council of Australia (1996 and 2004/5), Blundstone Pty Ltd, Royal Hobart Hospital Acute Care Program, Lions Club of Australia, Coca-Cola Amatil, Tasmanian Dairy Authority and Talays (in 1996). Data collection in 1988 was supported by the Tasmanian Government. Special thanks also to Carole Goff (Research Coordinator, 1996), Jenny Cochrane (Data Manager), Denise Kaye and the staff of the Medical Imaging Department at Royal Hobart Hospital and Jack Allan.


  1. 1.
    Riggs BL, Melton LJ (1988) Osteoporosis: Etiology, Diagnosis, and Management. Raven Press, New YorkGoogle Scholar
  2. 2.
    Jones G, Cooley HM (2002) Symptomatic fracture incidence in those under 50 years of age in southern Tasmania. J Paediatr Child Health 38:278–283PubMedCrossRefGoogle Scholar
  3. 3.
    Wigg AE, Hearn TC, McCaul KA, Anderton SM, Wells VM, Krishnan J (2003) Number, incidence, and projections of distal forearm fractures admitted to hospital in Australia. J Trauma 55:87–93PubMedCrossRefGoogle Scholar
  4. 4.
    Clark EM, Ness AR, Bishop NJ, Tobias JH (2006) Association between bone mass and fractures in children: a prospective cohort study. J Bone Miner Res 21:1489–1495PubMedCrossRefGoogle Scholar
  5. 5.
    Goulding A, Cannan R, Williams SM, Gold EJ, Taylor RW, Lewis-Barned NJ (1998) Bone mineral density in girls with forearm fractures. J Bone Miner Res 13:143–148PubMedCrossRefGoogle Scholar
  6. 6.
    Goulding A, Jones IE, Taylor RW, Manning PJ, Williams SM (2000) More broken bones: a 4-year double cohort study of young girls with and without distal forearm fractures. J Bone Miner Res 15:2011–2018PubMedCrossRefGoogle Scholar
  7. 7.
    Ma D, Jones G (2003) The Association between Bone Mineral Density, Metacarpal Morphometry, and Upper Limb Fractures in Children: A Population-Based Case-Control Study. J Clin Endocrinol Metab 88:1486–1491PubMedCrossRefGoogle Scholar
  8. 8.
    Flynn J, Foley S, Jones G (2007) Can bone density assessed by DXA at age 8 predict fracture risk during puberty? An eight year prospective study. J Bone Min Res (in press)Google Scholar
  9. 9.
    Ferrari SL, Chevalley T, Bonjour JP, Rizzoli R (2006) Childhood fractures are associated with decreased bone mass gain during puberty: an early marker of persistent bone fragility? J Bone Miner Res 21:501–507PubMedCrossRefGoogle Scholar
  10. 10.
    Fielding KT, Nix DA, Bachrach LK (2003) Comparison of calcaneus ultrasound and dual X-ray absorptiometry in children at risk of osteopenia. J Clin Densitom 6:7–15PubMedCrossRefGoogle Scholar
  11. 11.
    Sundberg M, Gardsell P, Johnell O, Ornstein E, Sernbo I (1998) Comparison of qunatiative ultrasound of the calcaneus with DXA and SXA at other skeletal sites; a population based study on 280 children aged 11–16 years. Osteoporos Int 8:410–417PubMedCrossRefGoogle Scholar
  12. 12.
    Mughal M, Langton C, Utretch G, Morrison J, Specker B (1996) Comparison between BUA of the calcaneum and total body bone mineral density in children. Acta Paediatr 85:663–665PubMedGoogle Scholar
  13. 13.
    Volta C, Bagni B, Iughetti L, Rossi M, Corazzari Y, Bagni I et al (2004) Bone mass evaluated by calcaneous ultrasound and radial peripheral CT in 725 youngsters. Acta Paediatr 93:747–751PubMedCrossRefGoogle Scholar
  14. 14.
    Baroncelli G, Federico G, Bertelloni S, Sodini F, de Terlizzi F, Cadossi R et al (2003) Assessment of Bone Quality by Quantitative Ultrasound of Proximal Phalanges and Fracture rate in children and Adolescents with bone and mineral disorders. Pediatr Res 2003 54:125–136CrossRefGoogle Scholar
  15. 15.
    Schalamon J, Singer G, Schwantzer G, Nietosvaara Y (2004) Quantitative Ultrasound assessment in children with fractures. J Bone Min Res 19:1276–1279CrossRefGoogle Scholar
  16. 16.
    Dwyer T, Ponsonby AL, Newman NM, Gibbons LE (1991) Prospective cohort study of prone sleeping position and sudden infant death syndrome. Lancet 337:1244–1247PubMedCrossRefGoogle Scholar
  17. 17.
    Landin LA (1983) Fracture patterns in children. Analysis of 8,682 fractures with special reference to incidence, etiology and secular changes in a Swedish urban population 1950–1979. Acta Orthop Scand Suppl 202:1–109PubMedGoogle Scholar
  18. 18.
    Pluijm S, Graafmans WC, Bouter L, Lips P (1999) Ultrasound Measurements for the prediction of Osteoporotic Fractures in Elderly People. Osteoporos Int 9:550–556PubMedCrossRefGoogle Scholar
  19. 19.
    Thompson PW, Taylor J, Oliver R, Fisher A (1998) Quantitative ultrasound of the heel predicts wrist and osteoporosis related fractures in women age 45–74 years. J Clin Dens 1:219–226CrossRefGoogle Scholar
  20. 20.
    Manias K, McCabe D, Bishop N (2006) Fractures and recurrent fractures in children; varying effects of environmental factors as well as bone size and mass. Bone 39:652–657PubMedCrossRefGoogle Scholar
  21. 21.
    Yeh FJ, Grant AM, Williams SM, Goulding A (2006) Children who experience their first fracture at a young age have high rates of fracture. Osteoporos Int 17:267–272PubMedCrossRefGoogle Scholar
  22. 22.
    Miettinen OS (1985) Theoretical epidemiology: principles of occurrence research in medicine. John Wiley and Sons, Inc, USAGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2007

Authors and Affiliations

  1. 1.Menzies Research InstituteHobartAustralia

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