title: Phalangeal quantitative ultrasound in 1,719 children and adolescents with bone disorders.
abstract: CONCLUSIONS
  We measured bone properties by phalangeal quantitative ultrasound in 1,719 pediatric patients with bone disorders, classifying them according to fracture status. Quantitative ultrasound discriminated fractured and nonfractured pediatric patients and enabled us to stratify fractured patients into classes according to the severity of the causative trauma (spontaneous, minimal trauma, appropriate trauma fractures).
  
  
  BACKGROUND
  The correlation between quantitative bone measurements and fractures is poorly established in pediatric patients with bone disorders. We correlated phalangeal quantitative ultrasound (QUS) and fracture history in children and adolescents with bone disorders and evaluated the ability of QUS to recognize fractured patients.
  
  
  METHODS
  Amplitude-dependent speed of sound (AD-SoS) and bone transmission time (BTT) were measured in 1,719 pediatric patients with bone disorders and related to fracture history. The patients were classified as (1) spontaneously (77), (2) minimal trauma (101), or (3) appropriate trauma fractured (206), and (4) nonfractured (1,335). The likelihood of fracture according to QUS was calculated as odds ratio per SD decrease (OR/SD), and the effectiveness in discriminating fractured patients was evaluated by receiver operating characteristic (ROC) analysis. The influence of age, sex, puberty, height, and BMI was explored by respective adjustments and multiple logistic regression.
  
  
  RESULTS
  Fractured patients showed significantly reduced AD-SoS and BTT standard deviation score (-0.32 ± 1.54 and -0.78 ± 1.49) compared to nonfractured subjects (0.43 ± 1.63 and -0.11 ± 1.34). QUS measurements paralleled the causative trauma severity, ranging from the lowest values in spontaneously fractured patients to normal values in appropriate trauma fractured subjects. The OR/SD were increasingly higher in appropriate trauma fractured, minimal trauma fractured, and spontaneously fractured patients. At ROC analysis, both parameters proved to have significant discrimination power in recognizing spontaneously and minimal trauma-fractured patients.
  
  
  CONCLUSIONS
  QUS identifies fractured pediatric patients with bone disorders, reflecting the severity of the causative trauma with a high discrimination power for fragility fractures.
authors.affiliation: Division Pediatric Endocrinology, Department of Pediatrics, University of Turin, Turin, Italy. mussa_alessandro@yahoo.it
authors.forename: A
authors.initials: A
authors.lastname: Mussa
authors.forename: F
authors.initials: F
authors.lastname: Porta
authors.forename: G
authors.initials: G
authors.lastname: Baldassarre
authors.forename: G
authors.initials: G
authors.lastname: Tuli
authors.forename: F
authors.initials: F
authors.lastname: de Terlizzi
authors.forename: P
authors.initials: P
authors.lastname: Matarazzo
authors.forename: S
authors.initials: S
authors.lastname: Einaudi
authors.forename: R
authors.initials: R
authors.lastname: Lala
authors.forename: A
authors.initials: A
authors.lastname: Corrias
mesh_terms: D000293:Adolescent; D000886:Anthropometry / Q000379:methods; D015519:Bone Density / Q000502:physiology; D001847:Bone Diseases / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D005260:Female; D050278:Finger Phalanges / Q000000981:diagnostic imaging* / Q000503:physiopathology; D050723:Fractures, Bone / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D005598:Fractures, Spontaneous / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D008297:Male; D014463:Ultrasonography; D055815:Young Adult