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J Clin Densitom. 2014 Apr-Jun;17(2):225-42. doi: 10.1016/j.jocd.2014.01.003. Epub 2014 Mar 29.

Dual-energy X-ray absorptiometry interpretation and reporting in children and adolescents: the revised 2013 ISCD Pediatric Official Positions.

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Department of Endocrinology, Birmingham Children's Hospital, Birmingham, UK. Electronic address:
Calcium Metabolism and Osteoporosis Program, American University of Beirut, Lebanon.
Endocrinology, Department of Medicine, Stanford University, Palo Alto, CA, USA.
Department of Nutritional and Surgical Science, UCL Institute of Child Health, London, UK.
Department of Research, Nemours/A.I. duPont Hospital for Children, Wilmington, DE, USA.
Department of Biochemistry and Experimental Medicine, The Children's Memorial Health Institute, Warsaw, Poland.
Division of Adolescent Medicine, Hasbro Children's Hospital and Alpert Medical School of Brown University, Providence, RI, USA.


The International Society for Clinical Densitometry Official Revised Positions on reporting of densitometry results in children represent current expert recommendations to assist health care providers determine which skeletal sites should be measured, which, if any, adjustments should be made, reference databases to be used, and the elements to include in a dual-energy X-ray absorptiometry report. The recommended scanning sites remain the total body less head and the posterior-anterior spine. Other sites such as the proximal femur, lateral distal femur, lateral vertebral assessment, and forearm are discussed but are only recommended for specific pediatric populations. Different methods of interpreting bone density scans in children with short stature or growth delay are presented. The use of bone mineral apparent density and height-adjusted Z-scores are recommended as suitable size adjustment techniques. The validity of appropriate reference databases and technical considerations to consider when upgrading software and hardware remain unchanged. Updated reference data sets for all contemporary bone densitometers are listed. The inclusion of relevant demographic and health information, technical details of the scan, Z-scores, and the wording "low bone mass or bone density" for Z-scores less than or equal to -2.0 standard deviation are still recommended for clinical practice. The rationale and evidence for the development of the Official Positions are provided. Changes in the grading of quality of evidence, strength of recommendation, and worldwide applicability represent a change in current evidence and/or differences in opinion of the expert panelists used to validate the position statements for the 2013 Position Development Conference.


Bone mineral content; bone mineral density; children; dual-energy X-ray absorptiometry; guidelines

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