Statistical Challenges in the Analyses of Bone Mineral Density in Pediatric Populations

Therapeutic Innovation & Regulatory Science
Phillip Dinh

Abstract

Assessing bone mineral density (BMD) by dual-energy x-ray absorptiometry (DXA) is standard in clinical practice with good precision and reproducibility. One way to analyze BMD data is through the Z-score where a subject's BMD is standardized against some reference population. This article highlights several potential problems in the calculation of the Z-score: (1) reference data are manufacturer dependent; (2) a transformation is recommended to reduce the skewness often seen in BMD data, however a transformation parameter is only available in some references using the Hologic manufacturer; (3) some reference data may be obsolete, as they were done under older scan models; (4) reference data are recommended to be interpolated to the subject's age, and linear interpolation is questionable; (5) reference data do not exist for all age groups; (6) reference data depend on the race of the subjects, and not all races are representative; and (7) reference data are limited to certain body composition. Given the limitation in the BMD Z-scores, other clinical symptoms (eg, bone fractures) or laboratory findings (eg, bone biomarkers) should be assessed in conjunction with the BMD Z-score to evaluate a subject's bone health.

References

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Citations

Jul 1, 2018·Comprehensive Reviews in Food Science and Food Safety·Keegan BurrowAlaa El-Din Bekhit

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Software Mentioned

Hologic

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