Which skeletal imaging modality is best for assessing bone health in children and young adults compared to DXA? a systematic review and meta-analysis

Shalof, Heba; Dimitri, Paul; Shuweihdi, Farag; Offiah, Amaka C.

Affiliations

¹Academic Unit of Child Health, Department of Oncology and Metabolism, University of Sheffield, Damer Street Building, Western Bank, Sheffield S10 2TH, United Kingdom

²Faculty of Medicine, Omar Al-Mukhtar University, Bayda, Libya

³Department of Pediatric Endocrinology, Sheffield Children's NHS Foundation Trust, Western Bank, Sheffield, United Kingdom

⁴Leeds Institute of Health Sciences, School of medicine, University of Leeds, Leeds, United Kingdom

⁵Radiology Department, Sheffield Children's NHS Foundation Trust, Western Bank, Sheffield, United Kingdom

Abstract and keywords

Background: Skeletal imaging techniques have become clinically valuable methods for measuring and assessing bone mineral density in children and young people. Dual-energy X-ray absorptiometry (DXA) is the current reference standard for evaluating bone density, as recommended by the International Society for Clinical Densitometry (ISCD). Various bone imaging modalities, such as quantitative ultrasound (QUS), peripheral quantitative computed tomography (pQCT), high-resolution peripheral quantitative computed tomography (HR-pQCT), magnetic resonance imaging (MRI), and digital X-ray radiogrammetry (DXR) have been developed to further quantify bone health in children and adults. The purpose of this review, with meta-analysis, was to systematically research the literature to compare the various imaging methods and identify the best modality for assessing bone status in healthy papulations and children and young people with chronic disease (up to 18 years).

Methods: A systematic computerized search of Medline, PubMed, and Web of Science databases was conducted to identify English-only studies published between 1st January 1990 and 1st December 2019. In this review, clinical studies comparing imaging modalities with DXA were chosen according to the inclusion criteria. The risk of bias and quality of articles was assessed using the Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS-2). The meta-analysis to estimate the overall correlation was performed using a Fisher Z transformation of the correlation coefficient. Additionally, the diagnostic accuracy measures of different imaging methods compared with DXA were calculated.

Results: The initial search strategy identified 13,412 papers, 29 of which matched the inclusion and exclusion criteria. Of these, twenty-two papers were included in the meta-analysis. DXA was compared to QUS in 17 papers, to DXR in 7 and to pQCT in 4 papers. A single paper compared DXA, DXR, and pQCT. The meta-analysis demonstrated that the strongest correlation was between DXR and DXA, with a coefficient of 0.71 [95%CI: 0.43; 1.00, p-value < 0.001], while the correlation coefficients between QUS and DXA, and pQCT and DXA were 0.57 [95%CI: 0.25; 0.90, p-value < 0.001] and 0.57 [95%CI: 0.46; 0.67, p-value < 0.001], respectively. The overall sensitivity and specificity were statistically significant 0.71 and 0.80, respectively.

Conclusion: No current imaging modality provides a full evaluation of bone health in children and young adults, with each method having some limitations. Compared to QUS and pQCT, DXR achieved the strongest positive relationship with DXA. DXR should be further evaluated as a reliable method for assessing bone health and as a predictor of fractures in children and young people.

Keywords: Bone health; Fracture risk; Bone mineral density; Systematic review; Bone densitometry; Children; aBMD; areal bone mineral density; Ad-SoS; Amplitude dependent speed of sound; BHI; bone health index; BMAD; Bone Mineral Apparent Density; BMD; bone mineral density; BMD_FN; Bone Mineral Density _{Femoral neck}; BMD_LS; Bone Mineral Density _{Lumbar Spine}; BMD_TB; Bone Mineral Density _{Total Body}; BTT; Bone Transmission Time; BUA; broadband ultrasound attenuation; CoTh; cortical thickness; CSA; Cross-Sectional Area; CSMI; Cross-Sectional Moment of Inertia; DXA; dual-energy X-ray absorptiometry; DXR; digital X-ray radiogrammetry; FN; false negative; FP; false positive; HR-pQCT; high-resolution peripheral quantitative computed tomography; ISCD; International Society for Clinical Densitometry; MRI; magnetic resonance imaging; PA-BMD; Posteroanterior bone mineral density; pQCT; peripheral quantitative computed tomography; PRISMA; Preferred Reporting Items for Systematic Reviews and Meta-analyses; QCT; quantitative computed tomography; QUS; Quantitative bone Ultrasound; QUADAS-2; Quality Assessment Tool for Diagnostic Accuracy Studies; RE model; Random-Effects model; ROI; region of interest; SDS; Standard deviation score; SOS; Speed of Sound; TN; true negative; TP; true positive; vBMD; volumetric bone mineral density; WA-BMD; Width-adjusted bone mineral density

Links

DOI: 10.1016/j.bone.2021.116013

PubMed: 34029779

WoS: 000670351300002

History

Received: 2021-02-19

Revised: 2021-05-07

Accepted: 2021-05-14

Online: 2021-05-23

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