title: Factors associated with low bone density in patients referred for assessment of bone health.
abstract: BACKGROUND
  To identify factors that predict low bone mineral density (BMD) in pediatric patients referred for dual-energy x-ray absorptiometry assessments.
  
  
  METHODS
  This is a retrospective cohort study of 304 children and adolescents referred for dual-energy x-ray absorptiometry assessments at a tertiary care center. Outcomes included risk factors which predicted a significant low bone density for age, defined as BMD Z-score ≤ -2.0 SD. A univariate analysis involved Chi-square, Fisher's Exact test, and analysis of variance, and multivariate logistic regression models were constructed to determine predictors of low bone mineral density.
  
  
  RESULTS
  In the multivariate logistic regression model, predictors of low bone mineral density included low body mass index Z-score (odds ratio 0.52, 95% confidence interval 0.39 - 0.69), low height Z-score (OR 0.71, 95% CI 0.57 - 0.88), vitamin D insufficiency (OR 3.97, 95% CI 2.08 - 7.59), and history of bone marrow transplant (OR 5.78, 95% CI 1.00 - 33.45).
  
  
  CONCLUSIONS
  Underlying health problems and associated treatments can impair bone mineral accrual. We identified risk factors most predictive of low bone mineral density in subjects referred for bone density measurement. Recognition of these factors may allow for earlier assessment to maximize bone mass in at-risk children.
authors: Division of Endocrinology, Boston, MA, USA. lisa.topor@childrens.harvard.edu.
authors: Lisa Swartz
authors: LS
authors: Topor
authors: Patrice
authors: P
authors: Melvin
authors: Courtney
authors: C
authors: Giancaterino
authors: Catherine M
authors: CM
authors: Gordon
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