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Calcif Tissue Int. 2017 May;100(5):514-527. doi: 10.1007/s00223-016-0233-4. Epub 2017 Jan 20.

Bone Density in the Obese Child: Clinical Considerations and Diagnostic Challenges.

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Division of Endocrinology and Diabetes, Monroe Carell, Jr Children's Hospital at Vanderbilt, Vanderbilt University School of Medicine, Nashville, TN, 37232, USA.
Department of Endocrinology and Diabetes, Birmingham Children's Hospital, Birmingham, UK.
Division of Gastroenterology, Hepatology and Nutrition, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, Room 1560, Philadelphia, PA, 19104, USA.


The prevalence of obesity in children has reached epidemic proportions. Concern about bone health in obese children, in part, derives from the potentially increased fracture risk associated with obesity. Additional risk factors that affect bone mineral accretion, may also contribute to obesity, such as low physical activity and nutritional factors. Consequences of obesity, such as inflammation, insulin resistance, and non-alcoholic fatty liver disease, may also affect bone mineral acquisition, especially during the adolescent years when rapid increases in bone contribute to attaining peak bone mass. Further, numerous pediatric health conditions are associated with excess adiposity, altered body composition, or endocrine disturbances that can affect bone accretion. Thus, there is a multitude of reasons for considering clinical assessment of bone health in an obese child. Multiple diagnostic challenges affect the measurement of bone density and its interpretation. These include greater precision error, difficulty in positioning, and the effects of increased lean and fat tissue on bone health outcomes. Future research is required to address these issues to improve bone health assessment in obese children.


Body composition; Children; Dual-energy X-ray absorptiometry; Fracture; Obesity; Peripheral quantitative computed tomography

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