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Size-adjustment techniques of lumbar spine dual energy X-ray absorptiometry measurements in assessing bone mineralization in children on maintenance hemodialysis

  • Nanees Salem ORCID logo EMAIL logo and Ashraf Bakr ORCID logo
Published/Copyright: July 19, 2021
Journal of Pediatric Endocrinology and Metabolism
From the journal Journal of Pediatric Endocrinology and Metabolism Volume 34 Issue 10

Abstract

Objectives

Growing skeleton is uniquely vulnerable to impaired mineralization in chronic kidney disease (CKD). Continued debate exists about the optimal method to adjust for body size when interpreting dual energy X-ray absorptiometry (DXA) scans in children with CKD given the burden of poor growth. The study aimed to evaluate the clinical usefulness of size-adjustment techniques of lumber-spine DXA measurements in assessing bone mineralization in children with kidney failure on maintenance hemodialysis (HD).

Methods

Case-control study included 93 children on maintenance HD (9–18 years; 48 males). Participants were subjected to spinal-DXA-scan to obtain areal bone mineral density (aBMD; g/cm2). Volumetric-BMD (vBMD; g/cm3) was mathematically estimated. Z-scores of aBMD for chronological age (aBMDZ-CA), aBMD adjusted for height age (aBMDZ-HA), and vBMDZ-score were calculated using mean and SD values of age subgroups of 442 healthy controls (7–18 years).

Results

In short-for-age CKD patients, aBMDZ-CA was significantly lower than vBMDZ-score, while aBMDZ-HA was significantly higher than aBMDZ-CA and vBMDZ-score. In normal height-for-age CKD patients, no significant difference between aBMDZ-scores and vBMDZ-score was detected. aBMDZ-CA was significantly lower and aBMDZ-HA was significantly higher in short-for-age compared to normal height-for-age patients without significant differences in vBMDZ-score. We observed age-related decrements in the percentage of HD patients with normal densitometric Z-scores, the effect of age was less pronounced in aBMDZ-HA than vBMDZ-score. vBMDZ-score correlated negatively with age, but not with heightZ-score.

Conclusions

Estimated vBMD seems to be a convenient size-adjustment approach of spinal-DXA measurements in assessing BMD especially in older short-for-age children with CKD. aBMDZ-CA underestimates, while aBMDZ-HA overestimates BMD in such patients.

Keywords: bone mineral density; chronic kidney disease; DXA; hemodialysis
Corresponding author: Nanees Salem, MD, Pediatric Endocrinology Unit, Department of Pediatrics, Faculty of Medicine, Mansoura University Children’s Hospital, El-Gomhoria Street, Post Office: 35516, Box 50, Mansoura 53355, Egypt, Phone: +20 1007553665, Fax: +20 50 223 4092, E-mail:

  1. Research funding: There is no external funding for this manuscript.

  2. Author contributions: Ashraf Bakr and Nanees Salem conceived the main study idea and design; Nanees Salem was involved in clinical data collection and data analysis and wrote the first draft of the manuscript; both authors were involved in data interpretation, manuscript revision, and editing, and literature search. All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: Authors have no conflicts of interest to disclose.

  4. Informed consent: Informed consent was obtained from the parents of all individual participants included in the study.

  5. Ethical approval: The study was approved by the local Ethics Committee of Mansoura Faculty of Medicine-Institutional Research Board (IRB).

  6. Permission note: All materials in the manuscript are original.

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Supplementary Material

The online version of this article offers supplementary material (https://doi.org/10.1515/jpem-2021-0081).

Received: 2021-02-04
Accepted: 2021-06-20
Published Online: 2021-07-19
Published in Print: 2021-10-26

© 2021 Walter de Gruyter GmbH, Berlin/Boston

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https://doi.org/10.1515/jpem-2021-0081
Keywords for this article
bone mineral density; chronic kidney disease; DXA; hemodialysis

Articles in the same Issue

  1. Frontmatter
  2. Review Article
  3. Stretched penile length at birth: a systematic review
  4. Original Articles
  5. Global epidemiology of mucopolysaccharidosis type III (Sanfilippo syndrome): an updated systematic review and meta-analysis
  6. Cardiometabolic risk factors in children and adolescents from southern Brazil: comparison to international reference values
  7. Association of antimullerian hormone with the size of the appendix testis, the androgen and estrogen receptors and their expression in the appendix testis, in congenital cryptorchidism
  8. The utility of serum inhibin B, anti-Müllerian hormone and insulin growth factor-1 in predicting a positive response to GnRH analogs for diagnosing central precocious puberty in girls
  9. Growth response to growth hormone (GH) treatment in children with GH deficiency (GHD) and those with idiopathic short stature (ISS) based on their pretreatment insulin-like growth factor 1 (IGFI) levels and at diagnosis and IGFI increment on treatment
  10. Association of muscle mass and fat mass on low-density-lipoprotein cholesterol and triglyceride plasma concentration in children and adolescents
  11. The effect of sickle cell anemia on the linear growth of Nigerian children
  12. Size-adjustment techniques of lumbar spine dual energy X-ray absorptiometry measurements in assessing bone mineralization in children on maintenance hemodialysis
  13. Changes in the presentation of newly diagnosed type 1 diabetes in children during the COVID-19 pandemic in a tertiary center in Southern Turkey
  14. Partial remission in children and adolescents with type 1 diabetes: an analysis based on the insulin dose-adjusted hemoglobin A1c
  15. Short Communication
  16. Anti-SARS-CoV-2 antibodies in new-onset type 1 diabetes in children during pandemic in Belgium
  17. Case Reports
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  19. Auto-destruction of the thyroid gland and coexisting glutamic acid decarboxylase mediated neurological disease in an adolescent: an unusual presentation of autoimmunity
  20. Glycogen storage disease type XII; an ultra rare cause of hemolytic anemia and rhabdomyolysis: one new case report
  21. The clinical variations and diagnostic challenges of deoxyguanosine kinase deficiency: a descriptive case series
  22. Mild phenotype in two siblings with a missense GHR variant
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