Height adjustment in assessing dual energy x-ray absorptiometry measurements of bone mass and density in children

Babette S. Zemel, Mary B. Leonard, Andrea Kelly, Joan M. Lappe, Vicente Gilsanz, Sharon Oberfield, Soroosh Mahboubi, John A. Shepherd, Thomas N. Hangartner, Margaret M. Frederick, Karen K. Winer, Heidi J. Kalkwarf

Research output: Contribution to journalArticlepeer-review

299 Scopus citations


Context: In children, bone mineral content (BMC) and bone mineral density (BMD) measurements by dual-energy x-ray absorptiometry (DXA) are affected by height status. No consensus exists on how to adjust BMC or BMD (BMC/BMD) measurements for short or tall stature. Objective: The aim of this study was to compare various methods to adjust BMC/BMD for height in healthy children. Design: Data from the Bone Mineral Density in Childhood Study (BMDCS) were used to develop adjustment methods that were validated using an independent cross-sectional sample of healthy children from the Reference Data Project (RDP). Setting: We conducted the study in five clinical centers in the United States. Participants: We included 1546 BMDCS and 650 RDP participants (7 to 17 yr of age, 50% female). Intervention: No interventions were used. Main Outcome Measures:Wemeasured spine and whole body (WB)BMCandBMDZ-scores for age (BMC/BMD age), height age(BMC/BMD height age), height(BMC height), bone mineral apparent density (BMAD age), and height-for-age Z-score (HAZ) (BMC/BMD haz). Results: Spine and WB BMC/BMD ageZ and BMAD ageZ were positively (P <0.005; r = 0.11 to 0.64) associated with HAZ. Spine BMD haz and BMC hazZ were not associated with HAZ; WB BMC hazZ was modestly associated with HAZ (r = 0.14; P = 0.0003). All other adjustment methods were negatively associated with HAZ (P <0.005; r = -0.20 to -0.34). The deviation between adjusted and BMC/BMD age Z-scores was associated with age for most measures (P <0.005) except for BMC/BMD haz. Conclusions: Most methods to adjustBMC/BMDZ-scores for height were biased by age and/or HAZ. Adjustments using HAZ were least biased relative to HAZ and age and can be used to evaluate the effect of short or tall stature on BMC/BMD Z-scores.

Original languageEnglish (US)
Pages (from-to)1265-1273
Number of pages9
JournalJournal of Clinical Endocrinology and Metabolism
Issue number3
StatePublished - Mar 2010

All Science Journal Classification (ASJC) codes

  • Endocrinology, Diabetes and Metabolism
  • Biochemistry
  • Endocrinology
  • Clinical Biochemistry
  • Biochemistry, medical


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