Bone Density Measurements in Children and Adolescents: Quantitative Computed Tomography versus Dual-Energy X-ray Absorptiometry

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The amount of bone that is gained during adolescence is the main contributor to peak bone mass, which is a major determinant of fracture risk in adulthood. Accordingly, osteoporosis in adults has been demonstrated to have its antecedents in childhood. Low bone density is one of the key components of osteoporosis. Because the foundation for skeletal health is established so early in life, it is crucial that clinical practitioners are able to measure and determine bone mineral density accurately. In this article, we discuss the use of quantitative computed tomography (CT) and dual-energy x-ray absorptiometry (DXA) as methods for bone density measurement in children. DXA is the most widely used technique for bone mineral measurements. It is low in cost, accessible, easy to use, and provides accurate and precise measurement of bone mass in adults. Unfortunately, DXA is unable to account for the large changes in body and skeletal size that occur during growth, limiting its use, especially in longitudinal studies. CT is able to asses both the true volume and density of bone in the axial and appendicular skeletons without significant influence from body or skeletal size, giving it a major advantage over other modalities for bone measurement in children. Although CT has a radiation exposure higher than that of DXA, the values still lie in the recommended safety range. Comparisons of bone measurements between healthy and sick children using CT and DXA are also discussed.

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