Pediatric bone mineral accrual Z‐score calculation equations and their application in childhood disease

Kelly, Andrea; Shults, Justine; Mostoufi‐Moab, Sogol; McCormack, Shana E.; Stallings, Virginia A.; Schall, Joan I.; Kalkwarf, Heidi J.; Lappe, Joan M.; Gilsanz, Vicente; Oberfield, Sharon E.; Shepherd, John A.; Winer, Karen K.; Leonard, Mary B.; Zemel, Babette S.

Affiliations

¹Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA

²Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA

³College of Nursing, Creighton University, Omaha, NE, USA

⁴Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

⁵Department of Pediatrics, Columbia University, New York, NY, USA

⁶Bioengineering, University of California‐San Francisco, San Francisco, CA, USA

⁷Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA

⁸Department of Pediatrics, Stanford School of Medicine, Palo Alto, CA, USA

Abstract and keywords

Annual gains in BMC and areal bone mineral density (aBMD) in children vary with age, pubertal status, height‐velocity, and lean body mass accrual (LBM velocity). Evaluating bone accrual in children with bone health‐threatening conditions requires consideration of these determinants. The objective of this study was to develop prediction equations for calculating BMC/aBMD velocity SD scores (velocity‐Z) and to evaluate bone accrual in youth with health conditions. Bone and body compositions via DXA were obtained for up to six annual intervals in healthy youth (n = 2014) enrolled in the Bone Mineral Density in Childhood Study (BMDCS) . Longitudinal statistical methods were used to develop sex‐ and pubertal‐status‐specific reference equations for calculating velocity‐Z for total body less head‐BMC and lumbar spine (LS), total hip (TotHip), femoral neck, and 1/3‐radius aBMD. Equations accounted for (1) height velocity, (2) height velocity and weight velocity, or (3) height velocity and LBM velocity. These equations were then applied to observational, single‐center, 12‐month longitudinal data from youth with cystic fibrosis (CF; n = 65), acute lymphoblastic leukemia (ALL) survivors (n = 45), or Crohn disease (CD) initiating infliximab (n = 72). Associations between BMC/aBMD‐Z change (conventional pediatric bone health monitoring method) and BMC/aBMD velocity‐Z were assessed. The BMC/aBMD velocity‐Z for CF, ALL, and CD was compared with BMDCS. Annual changes in the BMC/aBMD‐Z and the BMC/aBMD velocity‐Z were strongly correlated, but not equivalent; LS aBMD‐Z = 1 equated with LS aBMD velocity‐Z = −3. In CF, BMC/aBMD velocity‐Z was normal. In posttherapy ALL, BMC/aBMD velocity‐Z was increased, particularly at TotHip (1.01 [‐.047; 1.7], p < 0.0001). In CD, BMC/aBMD velocity‐Z was increased at all skeletal sites. LBM‐velocity adjustment attenuated these increases (eg, TotHip aBMD velocity‐Z: 1.13 [0.004; 2.34] versus 1.52 [0.3; 2.85], p < 0.0001). Methods for quantifying the BMC/aBMD velocity that account for maturation and body composition changes provide a framework for evaluating childhood bone accretion and may provide insight into mechanisms contributing to altered accrual in chronic childhood conditions.

Keywords: BONE MINERAL CONTENT/DENSITY; BONE ACCRUAL/ACCRETION; PEDIATRIC ENDOCRINOLOGY; GROWTH; PUBERTY; LEAN BODY MASS; CYSTIC FIBROSIS; CROHN'S DISEASE; ACUTE LYMPHOBLASTIC LEUKEMIA

Links

DOI: 10.1002/jbmr.3589

PubMed: 30372552

WoS: 000456724900018

History

Received: 2018-06-16

Revised: 2018-08-25

Accepted: 2018-09-10

Online: 2018-09-26

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