The relationship between lean body mass and bone mineral content in paediatric health and disease
The relationship between lean body mass and bone mineral content in paediatric health and disease
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DOI：
10.1016/j.bone.2004.06.009
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发表时间：
2004-10-01
期刊：
影响因子：
4.1
通讯作者：
Shaw, NJ
中科院分区：
文献类型：
--
作者：
Crabtree, NJ;Kibirige, MS;Shaw, NJ
前言：正确解读DXA数据对疑似骨病患儿的诊断和治疗至关重要。本研究采用双能X射线骨密度仪(DXA)测量骨矿物质含量(BMC)，探讨各种因素对骨矿物质含量的影响。材料和方法：对646例5~18岁健康学龄儿童和43例慢性病儿童的腰椎和全身进行了LUNAR DPX-L DXA扫描。结果：逐步线性回归确定瘦体重(LBM)是腰椎和全身BMC的最强单一预测因子。在BMC和LBM的关系中观察到显著的性别差异，女孩从9岁的脊柱和13岁的全身每单位LBM拥有明显更多的骨。为探讨慢性疾病儿童LBM与BMC的关系，采用基于标准数据Z分计算的两阶段算法。第一阶段评估LBM的身高，第二阶段评估BMC的LBM。10例脊髓性肌萎缩症患儿身高Z评分的平均LBM为-1.8(1.4)，LBM Z评分的平均BMC为1.2(1.3)，表明他们的主要异常是肌肉质量减少(肌质疏松症)，没有骨量减少的证据。相比之下，21名成骨不全儿童的身高Z评分的平均LBM为0.4(1.7)，而LBM Z评分的平均BMC为-2.5(1.8)，表明LBM大小正常，但LBM的BMC显著降低(即骨量减少)，证实为原发性骨异常。第三组包括12名低创伤骨折的儿童，几乎没有骨量减少的证据[身高Z评分的平均LBM为-1](2.1)，但有明显的骨量减少[LBM Z评分的平均BMC为-1.9(1.5)]。结论：身高与瘦体质量、瘦体质量与骨矿含量的关系可以作为诊断儿童骨质疏松症的有用方法，以及如何利用这些关系来确定原发的异常是肌肉还是骨骼。(C)2004 Elsevier Inc.保留所有权利。
Introduction: The correct interpretation of DXA data is critical to the diagnosis and management of children with suspected bone disease. This study examines the various influences on bone mineral content (BMC), as measured by dual-energy X-ray absorptiometry (DXA). Materials and methods: Six hundred and forty-six healthy school children and forty-three children with chronic diseases, aged 5 - 18 years, had their lumbar spine and whole body measured using a Lunar DPX-L DXA scanner. Results: Stepwise linear regression identified lean body mass (LBM) as the strongest single predictor of BMC in the lurnbar spine and the total body. A significant gender difference was observed in the relationship between BMC and LBM with girls having significantly more bone per unit LBM from 9 years of age in the spine and 13 years of age in the total body. To investigate the relationship between LBM and BMC in children with chronic disease, a two-stage algorithm based upon calculation of Z scores from the normative data was applied. Stage I assessed LBM for height and stage 2 assessed BMC for LBM. Ten children with spinal muscular atrophy had a mean LBM for height Z score of - 1.8(1.4) but a mean BMC for LBM Z score of 1.2(1.3) indicating their primary abnormality was reduced muscle mass (sarcopenia) with no evidence of osteopenia. In contrast, 21 children with osteogenesis imperfecta had a mean LBM for height Z score of 0.4(1.7) but a mean BMC for LBM Z score of -2.5(1.8) indicating normal LBM for size but significantly reduced BMC for LBM (i.e. osteopenia) confirming a primary bone abnormality. A third group consisting of 12 children with low trauma fractures demonstrated little evidence of sarcopenia [mean LBM for height Z score - 1.)(2.1)] but significant osteopenia [mean BMC for LBM Z score - 1.9(1.5)]. Conclusion: The results from this study demonstrate how the relationship between height and lean body mass, and lean body mass and bone mineral content can be a useful method of diagnosing osteoporosis in children and how the relationships can be used to identify if the primary abnormality is in muscle or bone. (C) 2004 Elsevier Inc. All rights reserved.