Revised reference curves for bone mineral content and areal bone mineral density according to age and sex for black and non-black children:​ results of the bone mineral density in childhood study

Zemel, Babette S.; Kalkwarf, Heidi J.; Gilsanz, Vicente; Lappe, Joan M.; Oberfield, Sharon; Shepherd, John A.; Frederick, Margaret M.; Huang, Xiangke; Lu, Ming; Mahboubi, Soroosh; Hangartner, Thomas; Winer, Karen K.

Affiliations

¹Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania 19104

²Department of General and Community Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio 45229

³Departments of Radiology and Pediatrics, Children’s Hospital Los Angeles, Los Angeles, California 90027

⁴Department of Medicine, Creighton University, Omaha, Nebraska 68178

⁵Department of Pediatrics, Columbia University, New York, New York 10032

⁶Department of Radiology, University of California at San Francisco, San Francisco, California 94143

⁷Clinical Trials and Surveys Corp., Owings Mills, Maryland 21117

⁸Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania 19104

⁹Biomedical Imaging Laboratory, Wright State University, Dayton, Ohio 45435

¹⁰Endocrinology, Nutrition, and Growth Branch Center for Research for Mothers and Children, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland 20892

Abstract

Context: Deficits in bone acquisition during growth may increase fracture risk. Assessment of bone health during childhood requires appropriate reference values relative to age, sex, and population ancestry to identify bone deficits.

Objective: The objective of this study was to provide revised and extended reference curves for bone mineral content (BMC) and areal bone mineral density (aBMD) in children.

Design: The Bone Mineral Density in Childhood Study was a multicenter longitudinal study with annual assessments for up to 7 yr.

Setting: The study was conducted at five clinical centers in the United States.

Participants: Two thousand fourteen healthy children (992 males, 22% African-Americans) aged 5-23 yr participated in the study.

Intervention: There were no interventions.

Main outcome measures: Reference percentiles for BMC and aBMD of the total body, lumbar spine, hip, and forearm were obtained using dual-energy x-ray absorptiometry for Black and non-Black children. Adjustment factors for height status were also calculated.

Results: Extended reference curves for BMC and aBMD of the total body, total body less head, lumbar spine, total hip, femoral neck, and forearm for ages 5-20 yr were constructed relative to sex and age for Black and non-Black children. Curves are similar to those previously published for 7-17 year olds. BMC and aBMD values were greater for Black vs. non-Black children at all measurement sites.

Conclusions: We provide here dual-energy x-ray absorptiometry reference data on a well-characterized cohort of 2012 children and adolescents. These reference curves provide the most robust reference values for the assessment and monitoring of bone health in children and adolescents in the literature to date.

Links

DOI: 10.1210/jc.2011-1111

PubMed: 21917867

PubMedCentral: PMC3200252

WoS: 000295879600052

History

Received: 2011-03-29

Accepted: 2011-07-12

Online: 2011-09-15

Cited Works (1)

Year	Entry
1998	Looker AC, Wahner HW, Dunn WL, Calvo MS, Harris TB, Heyse SP, Johnston CC Jr, Lindsay R. Updated data on proximal femur bone mineral levels of US adults. Osteoporos Int. 1998;8(5):468-489.

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2021	Lalayiannis AD, Fewtrell M, Biassoni L, Silva S, Goodman N, Shroff R, Crabtree NJ. Studying bone mineral density in young people: the complexity of choosing a pQCT reference database. Bone. February 2021;143:115713.
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2023	Kang M, Wu M, Crane JL. Asfotase alfa improved skeletal mineralization and fracture healing in a child with MCAHS. Bone. July 2023;172:116778.
2023	Grimbly C, Ludwig K, Wu Z, Caluseriu O, Rosolowsky E, Alexander RT, Ward LM, Rauch F. X-linked hypophosphatemia caused by a deep intronic variant in PHEX identified by PCR-based rna analysis of urine-derived cells. Bone. November 2023;176:116839.
2016	Burt LA, Liang Z, Sajobi TT, Hanley DA, Boyd SK. Sex‐ and site‐specific normative data curves for HR‐pQCT. J Bone Miner Res. November 2016;31(11):2041-2047.
2019	Monjardino T, Henriques A, Moreira C, Rodrigues T, Adubeiro N, Nogueira L, Cooper C, Santos AC, Lucas R. Gestational weight gain and offspring bone mass: different associations in healthy weight versus overweight women. J Bone Miner Res. January 2019;34(1):38-48.
2019	Kelly A, Shults J, Mostoufi‐Moab S, McCormack SE, Stallings VA, Schall JI, Kalkwarf HJ, Lappe JM, Gilsanz V, Oberfield SE, Shepherd JA, Winer KK, Leonard MB, Zemel BS. Pediatric bone mineral accrual Z‐score calculation equations and their application in childhood disease. J Bone Miner Res. January 2019;34(1):195-203.
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2021	Yau MS, Kuipers AL, Price R, Nicolas A, Tajuddin SM, Handelman SK, Arbeeva L, Chesi A, Hsu Y, Liu C, Karasik D, Zemel BS, Grant SF, Jordan JM, Jackson RD, Evans MK, Harris TB, Zmuda JM, Kiel DP. A meta‐analysis of the transferability of bone mineral density genetic loci associations from European to African ancestry populations. J Bone Miner Res. March 2021;36(3):469-479.
2022	Kalkwarf HJ, Shepherd JA, Hans D, Rodriguez EG, Kindler JM, Lappe JM, Oberfield S, Winer KK, Zemel BS. Trabecular bone score reference values for children and adolescents according to age, sex, and ancestry. J Bone Miner Res. April 2022;37(4):776-785.
2023	Halton JM, Ma J, Babyn P, Matzinger MA, Kaste SC, Scharke M, Fernandez CV, Miettunen P, Ho J, Alos N, Abish S, Barr R, Cairney E, Dix DB, Grant RM, Israels S, Lewis V, Wilson B, Atkinson S, Cabral D, Cummings E, Rodd C, Stein R, Sbrocchi AM, Jaremko JL, Koujok K, Shenouda N, Rauch F, Siminoski K, Ward LM; Canadian STOPP Consortium. Reductions in bone mineral density are apparent early in children with prevalent osteonecrosis lesions following leukemia therapy. J Bone Miner Res. August 2023;38(8):1104-1115.
2020	Zürcher SJ, Borter N, Kränzlin M, Neyer P, Meyer U, Rizzoli R, Kriemler S. Relationship between bone mineral content and bone turnover markers, sex hormones and calciotropic hormones in pre- and early pubertal children. Osteoporos Int. February 2020;31(2):335-349.
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