title: Bone density assessment in a tertiary paediatric centre over 13 years: Referral patterns and limitations.
abstract: OBJECTIVE
  This study aims to examine the referral practices for the Royal Children's Hospital (RCH) bone density service over the past 13 years and to demonstrate referral patterns and possible limitations to accessing paediatric bone densitometry.
  
  
  METHODS
  All patients attending the RCH Healthy Bones Unit for bone densitometry from 1 July 1999 to 30 June 2012, aged under 18 years of age, were included. Densitometry results were downloaded directly from the Hologic scanner into an Excel document. However, the referring unit and indication for referral were collected manually from either the referral card or the hospital's scanned medical records system.
  
  
  RESULTS
  A total of 5767 bone densitometry scans were performed over the study period on 3004 patients. The majority of referrals were made by the Endocrinology department, followed by Adolescent Medicine, Gastroenterology and Neurology. Relatively few referrals were made by general paediatrics. The most common indication for bone density test overall was eating disorders, followed by steroid use, osteogenesis imperfecta and other collagen disorders and inflammatory bowel disease. The lowest lumbar spine z-scores by indication were for cerebral palsy and other causes of immobility.
  
  
  CONCLUSIONS
  Multiple childhood diseases predispose to low bone density; however, paediatric bone densitometry is still underutilised and not appropriately supported by subsidies.
authors.affiliation: The Alfred Hospital, Melbourne, Victoria, Australia.|Department of Endocrinology and Diabetes, Royal Children's Hospital, Melbourne, Victoria, Australia.
authors.forename: Alicia R
authors.initials: AR
authors.lastname: Jones
authors.affiliation: Department of Endocrinology and Diabetes, Royal Children's Hospital, Melbourne, Victoria, Australia.|Centre for Hormone Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
authors.forename: Margaret R
authors.initials: MR
authors.lastname: Zacharin
authors.affiliation: Department of Endocrinology and Diabetes, Royal Children's Hospital, Melbourne, Victoria, Australia.|Centre for Hormone Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
authors.forename: Fergus J
authors.initials: FJ
authors.lastname: Cameron
authors.affiliation: Department of Endocrinology and Diabetes, Royal Children's Hospital, Melbourne, Victoria, Australia.|Centre for Hormone Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Simm
mesh_terms: D000293:Adolescent; D001315:Australia; D015519:Bone Density; D002648:Child; D002675:Child, Preschool; D003720:Densitometry / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D010024:Osteoporosis / Q000175:diagnosis* / Q000453:epidemiology; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D062606:Tertiary Care Centers
keywords: DXA; paediatrics bone density; skeletal fragility