Pediatric densitometry: is the Z score adjustment necessary in all cases?
Por:
Magallares, B, Malouf, J, Codes-Méndez, H, Park, HS, Betancourt, J, Fraga, G, Quesada-Masachs, E, López-Corbeto, M, Torrent, M, Marin, A, Herrera, S, Gich, I, Boronat, S, Casademont, J, Corominas, H, Cerdá, D
Publicada:
9 abr 2025
Resumen:
Background The International Society for Clinical Densitometry recommends adjusting the bone mineral density (BMD) Z-score in children with short stature or growth delay. However, it is not clear whether height-for-age Z-score (HAZ) adjustment is required in all children. The aim of this study was to determine whether HAZ adjustment is necessary by examining variability in unadjusted and adjusted Z-scores for the main regions of interest in a large pediatric cohort.Methods We evaluated 103 patients <= 20 years of age who underwent lumbar spine and whole-body dual-energy x-ray absorptiometry (DXA) at our tertiary care hospital from 2016 to 2018. The formula proposed by Zemel was used to calculate the HAZ.Results A total of 103 participants were included (54 females; 52.4%). The mean age was 9.8 years. Height percentiles were <= 3 or >= 97 in seven (6.8%) and five (4.9%) patients. Diagnostic criteria for low bone mineral density (LBMD; BMD Z-score <= -2) were met in 8 lumbar spine scans and 10 whole-body scans. After HAZ adjustment, the prevalence of LBMD decreased from 8.2% (n=8) to 6.4% (n=6) in the lumbar spine scans and from 10.5% (n=10) to 7.2% (n=8) in the whole-body scans. Agreement between the adjusted and non-adjusted HAZ data was 0.498 for the lumbar spine and 0.557 for the whole body. The diagnostic discrepancy rate for LBMD diagnosis was 7%. After HAZ adjustment, 5% patients no longer met LBMD criteria while conversely 2% met LBMD criteria only after adjustment.Conclusions The high diagnostic discrepancy rate (7%) for LBMN in this unselected pediatric cohort underscores the value of performing HAZ adjustment of Z-scores to improve diagnostic accuracy. This divergence between adjusted and unadjusted Z-scores suggests that all pediatric patients, not only those with short stature or growth retardation, may benefit from densitometric size adjustment. This is especially true in individuals whose stature is at the upper end of the range, where size may obscure a diagnosis of LBMD.
Filiaciones:
Magallares, B:
Hosp Santa Creu i Sant Pau, Dept Rheumatol, Barcelona, Spain
Univ Dexeus Grp Quiron Salud Hosp, Dept Rheumatol, Barcelona, Spain
Inst Recerca Sant Pau IR SANT PAU, St Quinti 77-79, Barcelona, Spain
Univ Autonoma Barcelona UAB, Med Fac, Cerdanyola Del Valles, Spain
Malouf, J:
Hosp Santa Creu i Sant Pau, Dept Mineral Metab Unit Internal Med, Barcelona, Spain
Codes-Méndez, H:
Hosp Santa Creu i Sant Pau, Dept Rheumatol, Barcelona, Spain
Inst Recerca Sant Pau IR SANT PAU, St Quinti 77-79, Barcelona, Spain
Park, HS:
Hosp Santa Creu i Sant Pau, Dept Rheumatol, Barcelona, Spain
Inst Recerca Sant Pau IR SANT PAU, St Quinti 77-79, Barcelona, Spain
Univ Autonoma Barcelona UAB, Med Fac, Cerdanyola Del Valles, Spain
Betancourt, J:
Inst Recerca Sant Pau IR SANT PAU, St Quinti 77-79, Barcelona, Spain
Hosp Santa Creu i Sant Pau, Dept Pediat, Barcelona, Spain
Fraga, G:
Inst Recerca Sant Pau IR SANT PAU, St Quinti 77-79, Barcelona, Spain
Hosp Santa Creu i Sant Pau, Dept Pediat, Barcelona, Spain
Quesada-Masachs, E:
Univ Dexeus Grp Quiron Salud Hosp, Dept Rheumatol, Barcelona, Spain
Vall dHebron Barcelona Hosp, Dept Pediat Rheumatol, Barcelona, Spain
López-Corbeto, M:
Vall dHebron Barcelona Hosp, Dept Pediat Rheumatol, Barcelona, Spain
Torrent, M:
Hosp Santa Creu i Sant Pau, Dept Pediat, Barcelona, Spain
Marin, A:
Hosp Santa Creu i Sant Pau, Dept Mineral Metab Unit Internal Med, Barcelona, Spain
Herrera, S:
Inst Recerca Sant Pau IR SANT PAU, St Quinti 77-79, Barcelona, Spain
Hosp Santa Creu i Sant Pau, Dept Mineral Metab Unit Internal Med, Barcelona, Spain
Gich, I:
Inst Recerca Sant Pau IR SANT PAU, St Quinti 77-79, Barcelona, Spain
Ctr Invest Biomed Red Enfermedades Raras CIBERER, Madrid, Spain
Hosp Santa Creu i Sant Pau, Dept Clin Epidemiol & Publ Hlth, Barcelona, Spain
Boronat, S:
Inst Recerca Sant Pau IR SANT PAU, St Quinti 77-79, Barcelona, Spain
Hosp Santa Creu i Sant Pau, Dept Pediat, Barcelona, Spain
Casademont, J:
Inst Recerca Sant Pau IR SANT PAU, St Quinti 77-79, Barcelona, Spain
Univ Autonoma Barcelona UAB, Med Fac, Cerdanyola Del Valles, Spain
Hosp Santa Creu i Sant Pau, Dept Internal Med, Barcelona, Spain
Corominas, H:
Hosp Santa Creu i Sant Pau, Dept Rheumatol, Barcelona, Spain
Inst Recerca Sant Pau IR SANT PAU, St Quinti 77-79, Barcelona, Spain
Univ Autonoma Barcelona UAB, Med Fac, Cerdanyola Del Valles, Spain
Cerdá, D:
Hosp Sant Joan Despi Moises Broggi, Dept Rheumatol, Barcelona, Spain
Green Submitted, gold
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