Notice: Users may be experiencing issues with displaying some pages on stanfordhealthcare.org. We are working closely with our technical teams to resolve the issue as quickly as possible. Thank you for your patience.
 

Learn about the flu shot, COVID-19 vaccine, and our masking policy »

Stanford Health Care

The Choice of Normative Pediatric Reference Database Changes Spine Bone Mineral Density Z-Scores But Not the Relationship Between Bone Mineral Density and Prevalent Vertebral Fractures JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM Ma, J., Siminoski, K., Alos, N., Halton, J., Ho, J., Lentle, B., Matzinger, M., Shenouda, N., Atkinson, S., Barr, R., Cabral, D. A., Couch, R., Cummings, E. A., Fernandez, C. V., Grant, R. M., Rodd, C., Sbrocchi, A., Scharke, M., Rauch, F., Ward, L. M., Canadian STOPP Consortium 2015; 100 (3): 1018–27

Abstract

Our objectives were to assess the magnitude of the disparity in lumbar spine bone mineral density (LSBMD) Z-scores generated by different reference databases and to evaluate whether the relationship between LSBMD Z-scores and vertebral fractures (VF) varies by choice of database.Children with leukemia underwent LSBMD by cross-calibrated dual-energy x-ray absorptiometry, with Z-scores generated according to Hologic and Lunar databases. VF were assessed by the Genant method on spine radiographs. Logistic regression was used to assess the association between fractures and LSBMD Z-scores. Net reclassification improvement and area under the receiver operating characteristic curve were calculated to assess the predictive accuracy of LSBMD Z-scores for VF.For the 186 children from 0 to 18 years of age, 6 different age ranges were studied. The Z-scores generated for the 0 to 18 group were highly correlated (r = 0.90), but the proportion of children with LSBMD Z-scores =-2.0 among those with VF varied substantially (from 38-66%). Odds ratios (OR) for the association between LSBMD Z-score and VF were similar regardless of database (OR = 1.92, 95% confidence interval 1.44, 2.56 to OR = 2.70, 95% confidence interval 1.70, 4.28). Area under the receiver operating characteristic curve and net reclassification improvement ranged from 0.71 to 0.75 and -0.15 to 0.07, respectively.Although the use of a LSBMD Z-score threshold as part of the definition of osteoporosis in a child with VF does not appear valid, the study of relationships between BMD and VF is valid regardless of the BMD database that is used.

View details for DOI 10.1210/jc.2014-3096

View details for Web of Science ID 000353358900051

View details for PubMedID 25494661

View details for PubMedCentralID PMC4519277