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Volumometric corrections of vertebral DXA scans in children with juvenile idiopathic arthritis


Authors: L. Turoňová 1;  K. Kubejová 2;  J. Vojtková 1;  K. Vorčáková 3;  E. Hyrdelová 1
Authors‘ workplace: Klinika detí a dorastu JLF UK a UNM, Martin 1;  Klinika detí a dorastu DFN, Košice 2;  Dermatovenerologická klinika JLF UK a UNM, Martin 3
Published in: Čes-slov Pediat 2017; 72 (6): 333-340.
Category: Original Papers

Overview

Objective:
To correct the changes in BMD associated with expected growth delay in children with juvenile idiopathic arthritis (JIA) by determining of volumometric DXA parameters, provided that vBMD (volumetric BMD) of a child with a chronic disease (even at delayed growth) may under certain conditions also be ideal and set the estimation of these parameters for concrete stages of puberty.

Methods:
In association with delay in growth and maturation of the skeleton the expected decrease of aBMD (areal BMD) in children with JIA was corrected by determining the BMAD (bone mineral apparent density) and WA BMD (width-adjusted BMD) vertebral DXA parameters, which have been obtained by using subsequent calculation of outputs derived from PA DXA scans (Hologic) and paired PA and lateral DXA scans (L2–L4). Outcomes were evaluated in 60 children with JIA and compared to the control group of healthy children (n=60).

Results:
Significant decrease of the mean PA BMD values in children with JIA (0.206±0.06) when compared to the control group (0.602±0.08, p<0.005) have been detected. After determining the volumetric DXA corrections, however, mean values of BMAD as well as of WA BMD parameter did not differ significantly between the JIA group and healthy controls (BMAD 0.12±0.06 in patients with JIA vs. 0.13±0.07 in the group of healthy children, p=0.73, WA BMD 0.19±0.05 in children with JIA vs. 0.20±0.07 in the control group, p=0.86). We state, that although decrease of PA BMD Z-score <-2SD in 17 (28.3%) in children with JIA has been noticed, after determining the volumetric calculations, only 8 (13.33%) JIA subjects with a significant decrease vBMD when compared to the control group have been identified, evaluated by PA scan (BMAD), as well as by pairing of PA and lateral DXA scan (WA BMD). Likewise, in comparison with Tanner stages 1–5 we state, that WA BMD seems to be more sensitive DXA parameter in association with changes of growth and sexual maturation when compared to BMAD. We also declare its sharper pace of increase during concrete Tanner stages.

Conclusion:
Reduction in BMD based solely on evaluation of PA DXA scans may in a child with a chronic illness (limiting growth) represent a diagnosis significantly overstated, often given incorrectly, ie even assuming the ideal values of vBMD.

Key words:
aBMD, BMAD, WA BMD, growth, juvenile idiopathic arthritis


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Labels
Neonatology Paediatrics General practitioner for children and adolescents
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