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Submitted on November 21, 2006
Accepted on February 14, 2007
Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Children's Hospital of Philadelphia, Philadelphia, PA; Children's Hospital Los Angeles, Los Angeles, CA; Creighton University, Omaha, NE; Columbia University, New York, NY; University of California at San Francisco, San Francisco, CA; Clinical Trials and Surveys Corp., Baltimore, MD; National Institute of Child Health and Human Development, Bethesda, MD
* To whom correspondence should be addressed. E-mail: heidi.kalkwarf{at}cchmc.org.
Context: Low bone mass may increase risk of fracture. Several chronic medical conditions, medications, and life style factors affect bone mineral accrual. Appropriate reference values are essential for identification of children with bone deficits.
Objective: To establish reference curves for bone mineral content (BMC) and density (BMD) in children.
Design: The Bone Mineral Density in Childhood Study (BMDCS) is an ongoing longitudinal study in which measurements are obtained annually.
Setting: Five clinical centers in the U.S.
Participants: 1554 healthy children (761 male, 793 female) ages 6-16 years of all ethnicies
Intervention: none
Main Outcome Measures: Scans of the total body, lumbar spine, hip and forearm were obtained using dual energy x-ray absorptiometry (DXA). Percentile curves based on 3 annual measurements were generated using the LMS statistical procedure.
Results: BMC of the total body and lumbar spine, and BMD of the total body, lumbar spine, total hip, femoral neck, and forearm are given for specific percentiles by sex, age and race (black vs. non-black). BMC and BMD were higher for blacks at all skeletal sites (p<0.0001). BMC and BMD increased with age, and a plateau was not evident by age 16 (girls) or age 17 (boys). The variation in BMC and BMD also increased with age.
Conclusions: Age, race and sex specific reference curves can be used to help identify children with bone deficits, and for monitoring changes in bone in response to chronic diseases or therapies.
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