title: Lumbar spine and total-body dual-energy X-ray absorptiometry in children with severe neurological impairment and intellectual disability: a pilot study of artefacts and disrupting factors.
abstract: BACKGROUND
  Children with severe neurological impairment and intellectual disability (ID) are susceptible for developing low bone mineral density (BMD) and fractures. BMD is generally measured with dual-energy X-ray absorptiometry (DXA).
  
  
  OBJECTIVE
  To describe the occurrence of factors that may influence the feasibility of DXA and the accuracy of DXA outcome in children with severe neurological impairment and ID.
  
  
  METHODS
  Based on literature and expert opinion, a list of disrupting factors was developed. Occurrence of these factors was assessed in 27 children who underwent DXA measurement.
  
  
  RESULTS
  Disrupting factors that occurred most frequently were movement during measurement (82%), aberrant body composition (67%), small length for age (56%) and scoliosis (37%). The number of disrupting factors per child was mean 5.3 (range 1-8). No correlation was found between DXA outcomes and the number of disrupting factors.
  
  
  CONCLUSIONS
  Factors that may negatively influence the accuracy of DXA outcome are frequently present in children with severe neurological impairment and ID. No systematic deviation of DXA outcome in coherence with the amount of disrupting factors was found, but physicians should be aware of the possible influence of disrupting factors on the accuracy of DXA.
authors.affiliation: Intellectual Disability Medicine/Department of General Practice, Erasmus University Medical Centre, PO Box 2040, 3000, CA, Rotterdam, The Netherlands. s.mergler@erasmusmc.nl
authors.forename: S
authors.initials: S
authors.lastname: Mergler
authors.forename: R
authors.initials: R
authors.lastname: Rieken
authors.forename: D
authors.initials: D
authors.lastname: Tibboel
authors.forename: H M
authors.initials: HM
authors.lastname: Evenhuis
authors.forename: R R
authors.initials: RR
authors.lastname: van Rijn
authors.forename: C
authors.initials: C
authors.lastname: Penning
mesh_terms: D015502:Absorptiometry, Photon; D000293:Adolescent; D016477:Artifacts; D015519:Bone Density; D057189:Checklist; D002648:Child; D002675:Child, Preschool; D050723:Fractures, Bone / Q000000981:diagnostic imaging* / Q000209:etiology*; D006801:Humans; D007223:Infant; D008607:Intellectual Disability / Q000150:complications*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging*; D008297:Male; D009422:Nervous System Diseases / Q000150:complications*; D010024:Osteoporosis / Q000000981:diagnostic imaging* / Q000209:etiology*; D010865:Pilot Projects; D012307:Risk Factors; D051598:Whole Body Imaging; D055815:Young Adult