Pediatric data for normal distal femur bone mineral density in children aged 3 to 18 years using the lunar prodigy densitometer

Objectives: Children with compromised weight bearing and limited mobility due to neuromuscular impairments are particularly at risk for low trauma long bone fractures. Whilst dual-energy absorptiometry scan (DXA) is a useful tool to assess areal bone mineral density (aBMD) in children, several obstacles can impede proper assessment of whole body (WB) or lumbar spine (LS) aBMD in this population. Musculo-skeletal deformities and orthopaedic hardware can render measurement of aBMD at these sites uninterpretable or impossible. For example, measurement of LS aBMD in a child with a neuromuscular scoliosis may be technically infeasible and clinically invalid if orthopaedic hardware is located in the region of interest. The lateral distal femur (LDF) has been proposed as an alternative site for aBMD assessment. Furthermore, distal femur fractures are common in this population, making LDF aBMD assessment clinically relevant. There are few normative data for aBMD at the LDF in children. This study aimed to construct normative centile curves for LDF aBMD using data from healthy children aged 3-18 years using the Lunar Prodigy DXA scan. Methods: This was a cross-sectional assessment of 241 healthy Canadian children (48% males, near 89% Caucasian) ranging in age from 3-18 years. aBMD measures were completed at 3 different regions of the LDF ("region 3, 4 and 5"), LS and WB using the Lunar Prodigy Densitometer. Age was chosen as the scaling variable and sex-specific reference curves for each of the 3 LDF regions were generated using LMS-ChartMaker Pro. LDF aBMD-for-age Z-scores were calculated then compared to WB and LS aBMD and anthropometric data by correlation analysis. Linear regression and ANOVA studies were used to examine predictors associated with aBMD at the different LDF regions. Results: LDF aBMD measurements were progressively higher with older age (R2 = 0.64 Region 3; R2 = 0.77 region 4; R2 = 0.83 region 5; p-value < 0.0001 for all regions) and were highly correlated with height and weight (R2 ≥ 0.60, p-value <0.0001or all regions). Furthermore, LDF aBMD was highly correlated with WB (R2 ≥ 0.74; p-value <0.0001 for all regions) and LS aBMD measurements (R2 ≥ 0.71; p-value < 0.0001for all regions). LDF region 3 Z-scores correlated best with LS aBMD Z-scores (R2 = 0.36; p-value < 0.0001) while region 5 Z-scores correlated best with WB aBMD Z-scores (R2 ≥ 0.41; p-value < 0.0001). At each femoral region, sex differences in aBMD depended significantly on age (p-value for interaction ≤ 0.005).Conclusion: This is the first study to provide normative data for LDF aBMD in children between the ages of 3 and 18 years, using the Lunar Prodigy DXA scan.

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