title: Automated radiogrammetry is a feasible method for measuring bone quality and bone maturation in severely disabled children.
abstract: BACKGROUND
  Children with severe neurological impairment and intellectual disability are prone to low bone quality and fractures.
  
  
  OBJECTIVE
  We studied the feasibility of automated radiogrammetry in assessing bone quality in this specific group of children. We measured outcome of bone quality and, because these children tend to have altered skeletal maturation, we also studied bone age.
  
  
  METHODS
  We used hand radiographs obtained in 95 children (mean age 11.4 years) presenting at outpatient paediatric clinics. We used BoneXpert software to determine bone quality, expressed as paediatric bone index and bone age.
  
  
  RESULTS
  Regarding feasibility, we successfully obtained a paediatric bone index in 60 children (63.2%). The results on bone quality showed a mean paediatric bone index standard deviation score of -1.85, significantly lower than that of healthy peers (P < 0.0001). Almost 50% of the children had severely diminished bone quality. In 64% of the children bone age diverged more than 1 year from chronological age. This mostly concerned delayed bone maturation.
  
  
  CONCLUSIONS
  Automated radiogrammetry is feasible for evaluating bone quality in children who have disabilities but not severe contractures. Bone quality in these children is severely diminished. Because bone maturation frequently deviated from chronological age, we recommend comparison to bone-age-related reference values.
authors.affiliation: Department of General Practice and Intellectual Disability Medicine, University Medical Centre, Erasmus MC, Rotterdam, The Netherlands. s.mergler@erasmusmc.nl.|Medical Department ASVZ, Care and Service Centre for People with Intellectual Disabilities, Sliedrecht, The Netherlands. s.mergler@erasmusmc.nl.
authors.forename: Sandra
authors.initials: S
authors.lastname: Mergler
authors.affiliation: Department of Paediatrics, Amphia Hospital, Breda, The Netherlands.
authors.forename: Stella A
authors.initials: SA
authors.lastname: de Man
authors.affiliation: Department of Paediatric Endocrinology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Annemieke M
authors.initials: AM
authors.lastname: Boot
authors.affiliation: Department of General Paediatrics, Sophia Children's Hospital, University Medical Centre, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Karen G C B Bindels-de
authors.initials: KG
authors.lastname: Heus
authors.affiliation: Department of Paediatrics, Beatrix Hospital, Gorinchem, The Netherlands.
authors.forename: Wim A R
authors.initials: WA
authors.lastname: Huijbers
authors.affiliation: Department of Radiology, Emma Children's Hospital/Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Rick R
authors.initials: RR
authors.lastname: van Rijn
authors.affiliation: Department of General Practice and Intellectual Disability Medicine, University Medical Centre, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Corine
authors.initials: C
authors.lastname: Penning
authors.affiliation: Department of General Practice and Intellectual Disability Medicine, University Medical Centre, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Heleen M
authors.initials: HM
authors.lastname: Evenhuis
mesh_terms: D000365:Age Determination by Skeleton / Q000379:methods; D015519:Bone Density / Q000502:physiology; D001846:Bone Development / Q000502:physiology*; D002648:Child; D003430:Cross-Sectional Studies; D019988:Children with Disabilities; D005240:Feasibility Studies; D005260:Female; D050276:Hand Bones / Q000000981:diagnostic imaging* / Q000502:physiology; D006801:Humans; D008297:Male; D009426:Netherlands; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods*; D012984:Software
keywords: Automated radiogrammetry; Bone age; Bone maturation; Bone quality; Children; Disability; Radiography