title: Bone health in children and adolescents with chronic diseases that may affect the skeleton: the 2013 ISCD Pediatric Official Positions.
abstract: The aim of this Task Force was to review the use of dual-energy X-ray absorptiometry (DXA) in children and adolescents with underlying chronic diseases that pose risk factors for compromised bone health, such as inflammation, glucocorticoid therapy, or decreased mobility. The Task Force systematically analyzed more than 270 studies, with an emphasis on those published in the interval since the original 2007 Position Statements. Important developments over this period included prospective cohort studies demonstrating that DXA measures of areal bone mineral density (aBMD) predicted incident fractures and the development of robust reference data and strategies to adjust for bone size in children with growth impairment. In this report, we summarize the current literature on the relationship between DXA-based aBMD and both fracture (vertebral and non-vertebral) outcomes and non-fracture risk factors (e.g., disease characteristics, ambulatory status, and glucocorticoid exposure) in children with chronic illnesses. Most publications described the aBMD profile of children with underlying diseases, as well as the cross-sectional or longitudinal relationship between aBMD and clinically relevant non-fracture outcomes. Studies that addressed the relationship between aBMD and prevalent or incident fractures in children with chronic illnesses are now emerging. In view of these updated data, this report provides guidelines for the use of DXA-based aBMD in this setting. The initial recommendation that DXA is part of a comprehensive skeletal healthy assessment in patients with increased risk of fracture is unchanged. Although the prior guidelines recommended DXA assessment in children with chronic diseases at the time of clinical presentation with ongoing monitoring, this revised Position Statement focuses on the performance of DXA when the patient may benefit from interventions to decrease their elevated risk of a clinically significant fracture and when the DXA results will influence that management.
authors.affiliation: Experimental Laboratory for Children's Bone Metabolism Research, Istituto Auxologico Italiano IRCCS, Milano, Italy. Electronic address: ml.bianchi@auxologico.it.
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Bianchi
authors.affiliation: Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Mary B
authors.initials: MB
authors.lastname: Leonard
authors.affiliation: Department of Pediatrics, Medical University Munich, Munich, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Bechtold
authors.affiliation: Department of Endocrinology and Diabetes, Birmingham Children's Hospital, Birmingham, UK.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Högler
authors.affiliation: Department of Paediatric Medicine, Royal Manchester Children's Hospital, Manchester, UK.
authors.forename: M Zulf
authors.initials: MZ
authors.lastname: Mughal
authors.affiliation: Klinik und Poliklinik für Kinder- und Jugendmedizin, Universitätsklinik Köln, Köln, Germany.
authors.forename: Eckhart
authors.initials: E
authors.lastname: Schönau
authors.affiliation: Connecticut Children's Medical Center, Hartford, CT, USA.
authors.forename: Francisco A
authors.initials: FA
authors.lastname: Sylvester
authors.affiliation: Department of Pediatric Endocrinology, Weill Medical College of Cornell University, New York, NY, USA.
authors.forename: Maria
authors.initials: M
authors.lastname: Vogiatzi
authors.affiliation: Pediatric Oncology-Hematology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Marry M
authors.initials: MM
authors.lastname: van den Heuvel-Eibrink
authors.affiliation: Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.
authors.forename: Leanne
authors.initials: L
authors.lastname: Ward
mesh_terms: D015502:Absorptiometry, Photon; D000293:Adolescent; D015519:Bone Density; D001847:Bone Diseases / Q000175:diagnosis* / Q000453:epidemiology*; D016026:Bone Marrow Transplantation; D002547:Cerebral Palsy / Q000453:epidemiology / Q000503:physiopathology; D002648:Child; D002908:Chronic Disease / Q000453:epidemiology*; D024042:Collagen Type I / Q000235:genetics; D000090602:Collagen Type I, alpha 1 Chain; D004700:Endocrine System Diseases / Q000453:epidemiology / Q000503:physiopathology; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000453:epidemiology; D006801:Humans; D010013:Osteogenesis Imperfecta / Q000175:diagnosis / Q000453:epidemiology / Q000235:genetics / Q000503:physiopathology; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000453:epidemiology / Q000503:physiopathology; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology / Q000503:physiopathology; D012307:Risk Factors
chemical_list: D024042:Collagen Type I; D000090602:Collagen Type I, alpha 1 Chain
keywords: Bone mineral density; DXA; children; chronic disease; fractures