Lumbar Spine Bone Mineral Apparent Density in Children: Results From the Bone Mineral Density in Childhood Study
Lumbar Spine Bone Mineral Apparent Density in Children: Results From the Bone Mineral Density in Childhood Study
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DOI：
10.1210/jc.2018-01693
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发表时间：
2019-04-01
影响因子：
5.8
通讯作者：
Zemel, Babette S.
中科院分区：
文献类型：
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作者：
Kindler, Joseph M.;Lappe, Joan M.;Zemel, Babette S.
背景：双能 X 射线吸收测定法 (DXA) 是儿科骨骼健康评估的基石，但年龄别身高差异混淆了面积骨矿物质密度 (aBMD) 测量值的解释。为了减少身材矮小对脊柱骨密度的影响，建议使用骨矿物质表观密度 (BMAD) 和年龄别身高 Z 得分 (HAZ) 调整后的 aBMD (aBMD(HAZ))。然而，脊柱 BMAD 参考数据很少，并且 BMAD 和 aBMD (HAZ) 在骨密度中解释与高度相关的伪影的程度仍不清楚。 目的：我们制定了年龄、性别和人群血统特定的脊柱 BMAD 参考范围；比较身高调整方法以解决身材矮小的问题；设计：对先前纵向研究的数据进行二次分析。参与者：基线时 5 至 19 岁的儿童和青少年（n = 2014 年；922 名男性；22% 黑人），来自儿童骨矿物质密度研究。主要结果指标：来自 DXA 的腰椎 BMAD 和 aBMD(HAZ)。结果：脊柱 BMAD 增加与年龄呈非线性关系，并且在黑人和女性中更大（所有 P < 0.001）。为黑人和非黑人男性和女性构建了特定年龄脊柱 BMAD z 得分参考曲线。总体而言，BMAD 和 aBMD(HAZ)z 评分均减少了身材矮小的混杂影响，但两者在所有年龄范围内都没有始终保持公正。 BMAD 和 aBMD(HAZ)z 评分在 6 年多的时间里都表现强劲（r = 0.70 至 0.80；所有 P < 0.001）。结论：这项研究提供了稳健的脊柱 BMAD 参考范围，并证明 BMAD 和 aBMD(HAZ) 部分减少了身材矮小对骨密度的混杂影响。
Context: Dual-energy X-ray absorptiometry (DXA) is a cornerstone of pediatric bone health assessment, yet differences in height-for-age confound the interpretation of areal bone mineral density (aBMD) measures. To reduce the confounding of short stature on spine bone density, use of bone mineral apparent density (BMAD) and height-for-age Z-score (HAZ)adjusted aBMD (aBMD(HAZ)) are recommended. However, spine BMAD reference data are sparse, and the degree to which BMAD and aBMD(HAZ) account for height-related artifacts in bone density remains unclear.Objective: We developed age-, sex-, and population ancestryspecific spine BMAD reference ranges; compared height-adjustment methods in accounting for shorter stature; and assessed the stability of these measures over time.Design: Secondary analysis of data from a previous longitudinal study.Participants: Children and adolescents aged 5 to 19 years at baseline (n = 2014; 922 males; 22% black) from the Bone Mineral Density in Childhood Study.Main Outcome Measures: Lumbar spine BMAD and aBMD(HAZ) from DXA.Results: Spine BMAD increased nonlinearly with age and was greater in blacks and females (all P < 0.001). Age-specific spine BMAD z-score reference curves were constructed for black and nonblack males and females. Overall, both BMAD and aBMD(HAZ)z scores reduced the confounding influence of shorter stature, but neither was consistently unbiased across all age ranges. Both BMAD and aBMD(HAZ)z scores tracked strongly over 6 years (r = 0.70 to 0.80; all P < 0.001).Conclusion: This study provided robust spine BMAD reference ranges and demonstrated that BMAD and aBMD(HAZ) partially reduced the confounding influence of shorter stature on bone density.