Background: Bone densitometry by DXA is now considered routine part of clinical management of children at risk of osteoporosis. Data on activity of a paediatric DXA service would be helpful for service planning but are currently lacking.
Aim: A survey of referrals to the service and size-adjusted total body (TB) and lumbar spine (LS) bone mineral content for bone-area standard deviation scores (BMC for BA SDS) were obtained from the local database.
Results: From 20022009, 2089 DXA scans (57% male) were performed (median/yr=261, range 239286), most were from gastroenterology (24.4%) and metabolic bone (19%) clinics. Total referral was 251 for 2009, with a decline in renal referrals, and increase in haematology and respiratory referrals. By clinical condition, 21% had IBD, 12% osteogenesis imperferta, 10% chronic kidney disease, 11% cancer-related, 5% poor mobility, 5% glucocorticoids, 5% arthritis, 4% cystic fibrosis, 3% hypogonadal, and 25% other miscellaneous concerns. Low BMC was more prevalent at LS than TB (1.7%, 0.2% respectively in ≤−2.0SDS category, and 15.4%, 1.8% respectively in −1.0 to −1.9SDS category). Boys were 5.4 times more likely than girls to have LS ≤−2.0SDS. By indication, lowest BMC values are summarised below
|BMC SDS||Enteropathy (%)||OI (%)||Metabolic disorder (%)||Hypogon (%)||Liver disease (%)||Poor mobility (%)||Renal (%)|
|−1.0 to −1.9||15.4||27.6||5.7||16.9||6.3||21||13.6|
Conclusion: DXA scans are performed for many conditions associated with osteoporosis. Referrals for secondary osteoporosis may depend on clinical awareness about bone health as well as variations in clinical practice and need careful monitoring.