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