Endocrine Abstracts (2016) 45 P9 | DOI: 10.1530/endoabs.45.P9

The use of Bone Health Index standard deviation score (BHI-SDS) in the analysis of cohorts with constitutional delay of growth (CGP), Growth Hormone deficiency (GHD), Turners syndrome (TS) and congenital adrenal hyperplasia (CAH)

Julie Park, Hussain Alsaffar, Carley Frerichs, Prashant Parvatti, Poonam Dharmaraj, Urmi Das, Mohamed Didi, Renuka Ramakrishnan, Senthil Senniappan, Laurence Abernethy & Jo Blair


Alder Hey Children’s Hospital, Liverpool, UK.


Background: BoneXpert software calculates bone health index (BHI) from 100 measurements of cortical thickness and mineralisation of three metacarpals. BHI-SDS is derived from 3,121 X-rays from 231 healthy Caucasian children, corrected for bone age (BA), estimated from the same x-ray.

BHI-SDS is new with relatively unknown clinical utility. Strong correlations between BHI and dual-energy x-ray (DXA) absorptiometry and peripheral quantitative computed CT measurements are reported.

Objective: Examine whether BHI-SDS values in children with CDG, GHD, TS and CAH are consistent with previous reports of bone health, measured using conventional methods.

Methods: Patients were identified on our database. Age, gender, and BHI-SDS were collected.

Results: See table 1 (attached)

Table 1 Table showing age, gender, BHI SDS and comparison with report using conventional methods
Age (yrs)Gender (Female:male)Mean BHI SDSReport using conventional methods
CDG7.1–17.16: 52−0.79No significant difference in CDG and controls
GHD (at diagnosis)3.7–18.831:91−1.03Lumbar spine BMD z score −2.92
GHD (+1 yr GH therapy)4.8–20.131:91−0.20Lumbar spine BMD z score −1.35
Turners Syndrome6.3–18.8−0.61Lumbar spine BMD score −0.87
CAH1.3–17.437:36−0.41Total body z score −0.76 Lumbar spine z score −0.29

Conclusion/discussion: BHI-SDS is below the mean in each group. This is consistent with trends reported from DXA studies. BHI reports a measure derived from peripheral skeleton, in contrast to DXA, which uses total skeleton or spine. This may partly account for the differences in magnitude of impairments measured in bone health derived from BA compared from DXA.

The data for CDG patients are interesting. BHI is corrected for BA. This should correct for the effect of delayed skeletal maturation. It may be interesting to repeat this measurement on completion of growth to examine any residual effect on bone health.

With the exception (CDG) these data are similar to those reported previously using conventional methods and lend support to use of BHI as a tool to identify and monitor those at risk of impaired bone health.