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

doi:10.1210/jc.2009-2057

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

College of Nursing

Research output: Contribution to journal › Article › peer-review

287 Scopus citations

Abstract

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 language	English (US)
Pages (from-to)	1265-1273
Number of pages	9
Journal	Journal of Clinical Endocrinology and Metabolism
Volume	95
Issue number	3
DOIs	https://doi.org/10.1210/jc.2009-2057
State	Published - Mar 2010

All Science Journal Classification (ASJC) codes

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

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10.1210/jc.2009-2057

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Zemel, B. S., Leonard, M. B., Kelly, A., Lappe, J. M., Gilsanz, V., Oberfield, S., Mahboubi, S., Shepherd, J. A., Hangartner, T. N., Frederick, M. M., Winer, K. K., & Kalkwarf, H. J. (2010). Height adjustment in assessing dual energy x-ray absorptiometry measurements of bone mass and density in children. Journal of Clinical Endocrinology and Metabolism, 95(3), 1265-1273. https://doi.org/10.1210/jc.2009-2057

Zemel, BS, Leonard, MB, Kelly, A, Lappe, JM, Gilsanz, V, Oberfield, S, Mahboubi, S, Shepherd, JA, Hangartner, TN, Frederick, MM, Winer, KK & Kalkwarf, HJ 2010, 'Height adjustment in assessing dual energy x-ray absorptiometry measurements of bone mass and density in children', Journal of Clinical Endocrinology and Metabolism, vol. 95, no. 3, pp. 1265-1273. https://doi.org/10.1210/jc.2009-2057

@article{ac88a1aab0014ef8bd65705c01f6b428,

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

abstract = "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.",

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

note = "Funding Information: This work was supported by the National Institute of Child Health and Human Development contracts NO1-HD-1-3228, -3329, -3330, -3331, -3332, and -3333 ; the General Clinical Research Center (5-MO1-RR-000240) ; the Clinical and Translational Research Center of The Children's Hospital of Philadelphia/University of Pennsylvania (UL1-RR024134) ; and the Research Institute of The Children's Hospital of Philadelphia. Funding Information: Disclosure Summary: All authors are supported by the National Institute of Child Health and Human Development contracts that supported this research. There are no further disclosures. ",

year = "2010",

month = mar,

doi = "10.1210/jc.2009-2057",

language = "English (US)",

volume = "95",

pages = "1265--1273",

journal = "Journal of Clinical Endocrinology and Metabolism",

issn = "0021-972X",

publisher = "The Endocrine Society",

number = "3",

}

TY - JOUR

T1 - Height adjustment in assessing dual energy x-ray absorptiometry measurements of bone mass and density in children

AU - Zemel, Babette S.

AU - Leonard, Mary B.

AU - Kelly, Andrea

AU - Lappe, Joan M.

AU - Gilsanz, Vicente

AU - Oberfield, Sharon

AU - Mahboubi, Soroosh

AU - Shepherd, John A.

AU - Hangartner, Thomas N.

AU - Frederick, Margaret M.

AU - Winer, Karen K.

AU - Kalkwarf, Heidi J.

N1 - Funding Information: This work was supported by the National Institute of Child Health and Human Development contracts NO1-HD-1-3228, -3329, -3330, -3331, -3332, and -3333 ; the General Clinical Research Center (5-MO1-RR-000240) ; the Clinical and Translational Research Center of The Children's Hospital of Philadelphia/University of Pennsylvania (UL1-RR024134) ; and the Research Institute of The Children's Hospital of Philadelphia. Funding Information: Disclosure Summary: All authors are supported by the National Institute of Child Health and Human Development contracts that supported this research. There are no further disclosures.

PY - 2010/3

Y1 - 2010/3

N2 - 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.

AB - 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.

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DO - 10.1210/jc.2009-2057

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AN - SCOPUS:77749246331

VL - 95

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EP - 1273

JO - Journal of Clinical Endocrinology and Metabolism

JF - Journal of Clinical Endocrinology and Metabolism

SN - 0021-972X

IS - 3

ER -

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

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