Journal of Clinical Densitometry
Volume 11, Issue 1 , Pages 59-74 , January 2008

Peripheral Quantitative Computed Tomography in Children and Adolescents: The 2007 ISCD Pediatric Official Positions

  • Babette Zemel

      Affiliations

    • The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
    • Corresponding Author InformationAddress correspondence to: Babette Zemel, PhD, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, 3535 Market Street, Room 1560, Philadelphia, PA 19104-4399, USA.
    • Task Force Chair.
  • ,
  • Shona Bass

      Affiliations

    • Deakin University, Melbourne, Australia
    • Task Force Member.
  • ,
  • Teresa Binkley

      Affiliations

    • South Dakota State University, Brookings, SD, USA
    • Task Force Member.
  • ,
  • Gaele Ducher

      Affiliations

    • Deakin University, Melbourne, Australia
    • Task Force Member.
  • ,
  • Heather Macdonald

      Affiliations

    • University of British Columbia, Vancouver, BC, Canada
    • Task Force Member.
  • ,
  • Heather McKay

      Affiliations

    • University of British Columbia, Vancouver, BC, Canada
    • Task Force Member.
  • ,
  • Laurie Moyer-Mileur

      Affiliations

    • University of Utah, Salt Lake City, UT, USA
    • Task Force Member.
  • ,
  • John Shepherd

      Affiliations

    • University of California at San Francisco, CA, USA
    • Task Force Member.
  • ,
  • Bonny Specker

      Affiliations

    • South Dakota State University, Brookings, SD, USA
    • Task Force Member.
  • ,
  • Kate Ward

      Affiliations

    • University of Manchester Imaging Science & Biomedical Engineering, Manchester, UK
    • Task Force Member.
  • ,
  • Didier Hans

      Affiliations

    • Geneva University Hospital, Geneva, Switzerland
    • Task Force Liaison.

Received 5 December 2007 ,Accepted 5 December 2007.

References 

  1. NIH . Osteoporosis prevention, diagnosis, and therapy. NIH Consens Statement. 2000;17(1):1–36
  2. Leonard MB, Zemel BS. Current concepts in pediatric bone disease. Pediatr Clin North Am. 2002;49(1):143–173
  3. Kontulainen S, Liu D, Manske S, et al. Analyzing cortical bone cross-sectional geometry by peripheral QCT: comparison with bone histomorphometry. J Clin Densitom. 2007;10(1):86–92
  4. Rauch F, Tutlewski B, Schoenau E. Peripheral quantitative computed tomography at the distal radius: cross-calibration between two scanners. J Musculoskelet Neuronal Interact. 2001;2(2):153–155
  5. Grampp S, Nather A, Rintelen B, et al. Peripheral quantitative CT of the forearm: scanner cross-calibration using patient data. Br J Radiol. 2000;73(867):275–277
  6. Schoenau E, Neu CM, Rauch F, et al. Gender-specific pubertal changes in volumetric cortical bone mineral density at the proximal radius. Bone. 2002;31(1):110–113
  7. Schoenau E, Neu CM, Rauch F, et al. The development of bone strength at the proximal radius during childhood and adolescence. J Clin Endocrinol Metab. 2001;86(2):613–618
  8. Neu CM, Rauch F, Manz F, et al. Modeling of cross-sectional bone size, mass and geometry at the proximal radius: a study of normal bone development using peripheral quantitative computed tomography. Osteoporos Int. 2001;12(7):538–547
  9. Neu CM, Manz F, Rauch F, et al. Bone densities and bone size at the distal radius in healthy children and adolescents: a study using peripheral quantitative computed tomography. Bone. 2001;28(2):227–232
  10. Schoenau E, Neu CM, Beck B, et al. Bone mineral content per muscle cross-sectional area as an index of the functional muscle-bone unit. J Bone Miner Res. 2002;17(6):1095–1101
  11. Ashby R, Roberts S, Adams J, et al. DXA and pQCT reference centile curves in healthy children from the United Kingdom, aged 6–17 years. J Bone Miner Res. 2006;21(Suppl 1):207
  12. Binkley TL, Specker BL, Wittig TA. Centile curves for bone densitometry measurements in healthy males and females ages 5–22 yr. J Clin Densitom. 2002;5(4):343–353
  13. Ogden CL, Kuczmarski RJ, Flegal KM, et al. Centers for Disease Control and Prevention 2000 growth charts for the United States: improvements to the 1977 National Center for Health Statistics version. Pediatrics. 2002;109(1):45–60
  14. Wang Q, Alen M, Nicholson PH, et al. Differential effects of sex hormones on peri- and endocortical bone surfaces in pubertal girls. J Clin Endocrinol Metab. 2006;91(1):277–282
  15. Wang QJ, Suominen H, Nicholson PH, et al. Influence of physical activity and maturation status on bone mass and geometry in early pubertal girls. Scand J Med Sci Sports. 2005;15(2):100–106
  16. Wang Q, Alen M, Nicholson P, et al. Growth patterns at distal radius and tibial shaft in pubertal girls: a 2-year longitudinal study. J Bone Miner Res. 2005;20(6):954–961
  17. Wang Q, Nicholson PH, Suuriniemi M, et al. Relationship of sex hormones to bone geometric properties and mineral density in early pubertal girls. J Clin Endocrinol Metab. 2004;89(4):1698–1703
  18. Suuriniemi M, Kovanen V, Mahonen A, et al. COL1A1 Sp1 polymorphism associates with bone density in early puberty. Bone. 2006;39(3):591–597
  19. Suuriniemi M, Mahonen A, Kovanen V, et al. Association between exercise and pubertal BMD is modulated by estrogen receptor alpha genotype. J Bone Miner Res. 2004;19(11):1758–1765
  20. Macdonald HM, Kontulainen SA, MacKelvie-O'Brien KJ, et al. Maturity- and sex-related changes in tibial bone geometry, strength and bone-muscle strength indices during growth: a 20-month pQCT study. Bone. 2005;36(6):1003–1011
  21. Kontulainen SA, Macdonald HM, Khan KM, et al. Examining bone surfaces across puberty: a 20-month pQCT trial. J Bone Miner Res. 2005;20(7):1202–1207
  22. Kontulainen SA, Macdonald HM, McKay HA. Change in cortical bone density and its distribution differs between boys and girls during puberty. J Clin Endocrinol Metab. 2006;91(7):2555–2561
  23. Macdonald H, Kontulainen S, Petit M, et al. Bone strength and its determinants in pre- and early pubertal boys and girls. Bone. 2006;39(3):598–608
  24. Macdonald HM, Kontulainen SA, Khan KM, et al. Is a school-based physical activity intervention effective for increasing tibial bone strength in boys and girls?. J Bone Miner Res. 2007;22(3):434–446
  25. Binkley TL, Specker BL. pQCT measurement of bone parameters in young children: validation of technique. J Clin Densitom. 2000;3(1):9–14
  26. Binkley T, Johnson J, Vogel L, et al. Bone measurements by peripheral quantitative computed tomography (pQCT) in children with cerebral palsy. J Pediatr. 2005;147(6):791–796
  27. Binkley T, Specker B. Increased periosteal circumference remains present 12 months after an exercise intervention in preschool children. Bone. 2004;35(6):1383–1388
  28. Specker B, Binkley T. Randomized trial of physical activity and calcium supplementation on bone mineral content in 3- to 5-year-old children. J Bone Miner Res. 2003;18(5):885–892
  29. Johannsen N, Binkley T, Englert V, et al. Bone response to jumping is site-specific in children: a randomized trial. Bone. 2003;33(4):533–539
  30. Specker BL, Johannsen N, Binkley T, et al. Total body bone mineral content and tibial cortical bone measures in preschool children. J Bone Miner Res. 2001;16(12):2298–2305
  31. Felin EM, Prahalad S, Askew EW, et al. Musculoskeletal abnormalities of the tibia in juvenile rheumatoid arthritis. Arthritis Rheum. 2007;56(3):984–994
  32. Ward KA, Roberts SA, Adams JE, et al. Bone geometry and density in the skeleton of pre-pubertal gymnasts and school children. Bone. 2005;36(6):1012–1018
  33. Moyer-Mileur LJ, Xie B, Ball SD, et al. Bone mass and density response to a 12-month trial of calcium and vitamin D supplement in preadolescent girls. J Musculoskelet Neuronal Interact. 2003;3(1):63–70
  34. Moyer-Mileur L, Xie B, Ball S, et al. Predictors of bone mass by peripheral quantitative computed tomography in early adolescent girls. J Clin Densitom. 2001;4(4):313–323
  35. Lee WT, Cheung CS, Tse YK, et al. Association of osteopenia with curve severity in adolescent idiopathic scoliosis: a study of 919 girls. Osteoporos Int. 2005;16(12):1924–1932
  36. Lee WT, Cheung AY, Lau J, et al. Bone densitometry: which skeletal sites are best predicted by bone mass determinants?. J Bone Miner Metab. 2004;22(5):447–455
  37. Cheng JC, Qin L, Cheung CS, et al. Generalized low areal and volumetric bone mineral density in adolescent idiopathic scoliosis. J Bone Miner Res. 2000;15(8):1587–1595
  38. Heinonen A, Sievanen H, Kannus P, et al. High-impact exercise and bones of growing girls: a 9-month controlled trial. Osteoporos Int. 2000;11(12):1010–1017
  39. Lettgen B, Hauffa B, Mohlmann C, et al. Bone mineral density in children and adolescents with juvenile diabetes: selective measurement of bone mineral density of trabecular and cortical bone using peripheral quantitative computed tomography. Horm Res. 1995;43(5):173–175
  40. Moilanen P, Nicholson PH, Karkkainen T, et al. Assessment of the tibia using ultrasonic guided waves in pubertal girls. Osteoporos Int. 2003;14(12):1020–1027
  41. Burnham JM, Shults J, Sembhi H, et al. The dysfunctional muscle-bone unit in juvenile idiopathic arthritis. J Musculoskelet Neuronal Interact. 2006;6(4):351–352
  42. Fujita T, Fujii Y, Goto B. Measurement of forearm bone in children by peripheral computed tomography. Calcif Tissue Int. 1999;64(1):34–39
  43. Haapasalo H, Kontulainen S, Sievanen H, et al. Exercise-induced bone gain is due to enlargement in bone size without a change in volumetric bone density: a peripheral quantitative computed tomography study of the upper arms of male tennis players. Bone. 2000;27(3):351–357
  44. Kontulainen S, Sievanen H, Kannus P, et al. Effect of long-term impact-loading on mass, size, and estimated strength of humerus and radius of female racquet-sports players: a peripheral quantitative computed tomography study between young and old starters and controls. J Bone Miner Res. 2003;18(2):352–359
  45. Auerbach BM, Ruff CB. Limb bone bilateral asymmetry: variability and commonality among modern humans. J Hum Evol. 2006;50(2):203–218
  46. Sievanen H, Koskue V, Rauhio A, et al. Peripheral quantitative computed tomography in human long bones: evaluation of in vitro and in vivo precision. J Bone Miner Res. 1998;13(5):871–882
  47. Jamsa T, Jalovaara P, Peng Z, et al. Comparison of three-point bending test and peripheral quantitative computed tomography analysis in the evaluation of the strength of mouse femur and tibia. Bone. 1998;23(2):155–161
  48. Ferretti JL, Capozza RF, Zanchetta JR. Mechanical validation of a tomographic (pQCT) index for noninvasive estimation of rat femur bending strength. Bone. 1996;18(2):97–102
  49. Siu WS, Qin L, Leung KS. pQCT bone strength index may serve as a better predictor than bone mineral density for long bone breaking strength. J Bone Miner Metab. 2003;21(5):316–322
  50. Muller ME, Webber CE, Bouxsein ML. Predicting the failure load of the distal radius. Osteoporos Int. 2003;14(4):345–352
  51. Ashe MC, Khan KM, Kontulainen SA, et al. Accuracy of pQCT for evaluating the aged human radius: an ashing, histomorphometry and failure load investigation. Osteoporos Int. 2006;17:1241–1251
  52. Liu D, Manske SL, Kontulainen SA, et al. Tibial geometry is associated with failure load ex vivo: a MRI, pQCT and DXA study. Osteoporos Int. 2007;18:991–997
  53. Louis O, Boulpaep F, Willnecker J, et al. Cortical mineral content of the radius assessed by peripheral QCT predicts compressive strength on biomechanical testing. Bone. 1995;16(3):375–379
  54. Lochmuller EM, Lill CA, Kuhn V, et al. Radius bone strength in bending, compression, and falling and its correlation with clinical densitometry at multiple sites. J Bone Miner Res. 2002;17(9):1629–1638
  55. Skaggs DL, Loro ML, Pitukcheewanont P, et al. Increased body weight and decreased radial cross-sectional dimensions in girls with forearm fractures. J Bone Miner Res. 2001;16(7):1337–1342
  56. Augat P, Gordon CL, Lang TF, et al. Accuracy of cortical and trabecular bone measurements with peripheral quantitative computed tomography (pQCT). Phys Med Biol. 1998;43(10):2873–2883
  57. Prevhal S, Engelke K, Kalender W. Accuracy limits for the determination of cortical width and density: the influence of object size and CT imaging parameters. Phys Med Biol. 1999;44:751–764
  58. Rittweger J, Michaelis I, Giehl M, et al. Adjusting for the partial volume effect in cortical bone analyses of pQCT images. J Musculoskelet Neuronal Interact. 2004;4(4):436–441
  59. Ward KA, Adams JE, Hangartner TN. Recommendations for thresholds for cortical bone geometry and density measurement by peripheral quantitative computed tomography. Calcif Tissue Int. 2005;77(5):275–280
  60. Rauch F, Neu C, Manz F, et al. The development of metaphyseal cortex—implications for distal radius fractures during growth. J Bone Miner Res. 2001;16(8):1547–1555
  61. Schweizer R, Martin DD, Schwarze CP, et al. Cortical bone density is normal in prepubertal children with growth hormone (GH) deficiency, but initially decreases during GH replacement due to early bone remodeling. J Clin Endocrinol Metab. 2003;88(11):5266–5272
  62. Bechtold S, Ripperger P, Dalla Pozza R, et al. Musculoskeletal and functional muscle-bone analysis in children with rheumatic disease using peripheral quantitative computed tomography. Osteoporos Int. 2005;16(7):757–763
  63. Brennan BM, Mughal Z, Roberts SA, et al. Bone mineral density in childhood survivors of acute lymphoblastic leukemia treated without cranial irradiation. J Clin Endocrinol Metab. 2005;90(2):689–694
  64. Heap J, Murray MA, Miller SC, et al. Alterations in bone characteristics associated with glycemic control in adolescents with type 1 diabetes mellitus. J Pediatr. 2004;144(1):56–62
  65. Lee DC, Gilsanz V, Wren TA. Limitations of peripheral quantitative computed tomography metaphyseal bone density measurements. J Clin Endocrinol Metab. 2007;92(11):4248–4253
  66. Rauch F, Tutlewski B, Fricke O, et al. Analysis of cancellous bone turnover by multiple slice analysis at distal radius: a study using peripheral quantitative computed tomography. J Clin Densitom. 2001;4(3):257–262
  67. Cameron N. The use and abuse of growth charts. In:  Johnston F,  Zemel B,  Eveleth PB editor. Human Growth in Context. London: Smith-Gordon; 1999;p. 65–74
  68. Leonard MB, Shults J, Elliott DM, et al. Interpretation of whole body dual-energy X-ray absorptiometry measures in children: comparison with peripheral quantitative computed tomography. Bone. 2004;34(6):1044–1052
  69. Schoenau E, Neu CM, Mokov E, et al. Influence of puberty on muscle area and cortical bone area of the forearm in boys and girls. J Clin Endocrinol Metab. 2000;85(3):1095–1098
  70. Zemel B, Kalkwarf H, Leonard M, et al. Effects of skeletal and sexual maturation on trabecular and cortical density of the peripheral skeleton. J Bone Miner Res. 2005;20(Suppl 1):59
  71. Girschick HJ, Schneider P, Kruse K, et al. Bone metabolism and bone mineral density in childhood hypophosphatasia. Bone. 1999;25(3):361–367
  72. Dyson K, Blimkie CJ, Davison KS, et al. Gymnastic training and bone density in pre-adolescent females. Med Sci Sports Exerc. 1997;29(4):443–450
  73. Rauch F, Land C, Cornibert S, et al. High and low density in the same bone: a study on children and adolescents with mild osteogenesis imperfecta. Bone. 2005;37(5):634–641
  74. Schwahn B, Mokov E, Scheidhauer K, et al. Decreased trabecular bone mineral density in patients with phenylketonuria measured by peripheral quantitative computed tomography. Acta Paediatr. 1998;87(1):61–63
  75. Ward KA, Adams JE, Freemont TJ, et al. Can bisphosphonate treatment be stopped in a growing child with skeletal fragility?. Osteoporos Int. 2007;18:1137–1140
  76. Quick JL, Ward KA, Adams JE, et al. Cortical bone geometry in asthmatic children. Arch Dis Child. 2006;91(4):346–348
  77. Matkovic V, Landoll JD, Badenhop-Stevens NE, et al. Nutrition influences skeletal development from childhood to adulthood: a study of hip, spine, and forearm in adolescent females. J Nutr. 2004;134(3):701S–705S
  78. Schonau E, Werhahn E, Schiedermaier U, et al. Influence of muscle strength on bone strength during childhood and adolescence. Horm Res. 1996;45(Suppl 1):63–66
  79. Schonau E. The development of the skeletal system in children and the influence of muscular strength. Horm Res. 1998;49(1):27–31
  80. Remer T, Boye KR, Hartmann M, et al. Adrenarche and bone modeling and remodeling at the proximal radius: weak androgens make stronger cortical bone in healthy children. J Bone Miner Res. 2003;18(8):1539–1546
  81. Ruth EM, Weber LT, Schoenau E, et al. Analysis of the functional muscle-bone unit of the forearm in pediatric renal transplant recipients. Kidney Int. 2004;66(4):1694–1706
  82. Bechtold S, Rauch F, Noelle V, et al. Musculoskeletal analyses of the forearm in young women with Turner syndrome: a study using peripheral quantitative computed tomography. J Clin Endocrinol Metab. 2001;86(12):5819–5823
  83. Muller HL, Schneider P, Bueb K, et al. Volumetric bone mineral density in patients with childhood craniopharyngioma. Exp Clin Endocrinol Diabetes. 2003;111(3):168–173
  84. Lima EM, Goodman WG, Kuizon BD, et al. Bone density measurements in pediatric patients with renal osteodystrophy. Pediatr Nephrol. 2003;18(6):554–559
  85. Schneider P, Biko J, Schlamp D, et al. Comparison of total and regional body composition in adolescent patients with anorexia nervosa and pair-matched controls. Eat Weight Disord. 1998;3(4):179–187
  86. Zemel BS, Ittenbach R, Stallings V, et al. Patterns and pitfalls in pQCT measurements of the tibia in children. J Bone Miner Res. 2002;18(Suppl 1):178
  87. Stevenson DA, Moyer-Mileur LJ, Carey JC, et al. Case-control study of the muscular compartments and osseous strength in neurofibromatosis type 1 using peripheral quantitative computed tomography. J Musculoskelet Neuronal Interact. 2005;5(2):145–149
  88. Wahner HW, Looker A, Dunn WL, et al. Quality control of bone densitometry in a national health survey (NHANES III) using three mobile examination centers. J Bone Miner Res. 1994;9(6):951–960
  89. Emaus N, Berntsen GK, Joakimsen R, et al. Bone mineral density measures in longitudinal studies: the choice of phantom is crucial for quality assessment. The Tromso study, a population-based study. Osteoporos Int. 2005;16(12):1597–1603
  90. Pearson J, Ruegsegger P, Dequeker J, et al. European semi-anthropomorphic phantom for the cross-calibration of peripheral bone densitometers: assessment of precision accuracy and stability. Bone Miner. 1994;27(2):109–120
  91. Cheng S, Lyytikainen A, Kroger H, et al. Effects of calcium, dairy product, and vitamin D supplementation on bone mass accrual and body composition in 10-12-y-old girls: a 2-y randomized trial. Am J Clin Nutr. 2005;82(5):1115–1126[quiz 1147–1148]
  92. Cheng JC, Hung VW, Lee WT, et al. Persistent osteopenia in adolescent idiopathic scoliosis—longitudinal monitoring of bone mineral density until skeletal maturity. Stud Health Technol Inform. 2006;123:47–51
  93. Rauch F, Cornibert S, Cheung M, et al. Long-bone changes after pamidronate discontinuation in children and adolescents with osteogenesis imperfecta. Bone. 2007;40:821–827
  94. Zemel BS, Paulhamus D, Dilzer C, et al. Precision of peripheral quantitative computed tomography measures of the tibia in children. J Bone Miner Res. 2004;19(Suppl 1):S232
  95. Rauch F, Schoenau E. Peripheral quantitative computed tomography of the distal radius in young subjects—new reference data and interpretation of results. J Musculoskelet Neuronal Interact. 2005;5(2):119–126

PII: S1094-6950(07)00254-5

doi: 10.1016/j.jocd.2007.12.006

Journal of Clinical Densitometry
Volume 11, Issue 1 , Pages 59-74 , January 2008