title: A Piece of the Puzzle: The Bone Health Index of the BoneXpert Software Reflects Cortical Bone Mineral Density in Pediatric and Adolescent Patients.
abstract: BACKGROUND
  Suspected osteopathology in chronically ill children often necessitates the assessment of bone mineral density. The most frequently used methods are dual-energy X-ray-absorption (DXA) and peripheral quantitative computed tomography (pQCT). The BoneXpert software provides an automated radiogrammatic method to assess skeletal age from digitalized X-rays of the left hand. Furthermore, the program calculates the Bone Health Index (BHI), a measure of cortical thickness and mineralization, which is obtained from indices of three metacarpal bones. In our study, we analyzed the manner in which BHI information provided by BoneXpert compares with DXA or pQCT measurements in youths.
  
  
  METHODS
  The BHI was retrospectively obtained using digitalized X-rays of the left hand and compared with the results of 203 corresponding DXA readings (Lunar Prodigy, GE Healthcare) of the lumbar vertebrae and femur as well as 117 pQCT readings (XCT 900, Stratec) of the distal radius.
  
  
  RESULTS
  The BHI values showed a strong positive correlation with the DXA readings at each and all lumbar vertebrae (L1 -L4: r = 0.73; P < 0.0001). The age-adjusted Z-score of L1 -L4 and the height-adjusted score showed a positive correlation with the BHI-SDS (standard deviation score, r = 0.23; P < 0.002 and r = 0.27; P < 0.001, respectively). Total bone mineral density, as assessed via pQCT, also positively correlated with the BHI (r = 0.39; P < 0.0001), but the trabecular values displayed only a weak correlation.
  
  
  CONCLUSIONS
  The BHI obtained using BoneXpert can be a useful parameter in the assessment of bone health in children in most cases. This technique provides observer-independent information on cortical thickness and mineralization based on X-ray imaging of the hands.
authors.affiliation: Pediatric Hematology and Oncology, Kinderklinik III, Universitätsklinikum-Essen and the University of Duisburg-Essen, Essen, Germany.
authors.forename: Michael M
authors.initials: MM
authors.lastname: Schündeln
authors.affiliation: Pediatric Endocrinology and Diabetology, Kinderklinik II, Universitätsklinikum-Essen and the University of Duisburg-Essen, Essen, Germany.
authors.forename: Laura
authors.initials: L
authors.lastname: Marschke
authors.affiliation: Pediatric Hematology and Oncology, Kinderklinik III, Universitätsklinikum-Essen and the University of Duisburg-Essen, Essen, Germany.|Pediatric Endocrinology and Diabetology, Kinderklinik II, Universitätsklinikum-Essen and the University of Duisburg-Essen, Essen, Germany.
authors.forename: Jens J
authors.initials: JJ
authors.lastname: Bauer
authors.affiliation: Pediatric Hematology and Oncology, Kinderklinik III, Universitätsklinikum-Essen and the University of Duisburg-Essen, Essen, Germany.
authors.forename: Pia K
authors.initials: PK
authors.lastname: Hauffa
authors.affiliation: Institute of Diagnostic and Interventional Radiology and Neuroradiology, Universitätsklinikum-Essen and the University of Duisburg-Essen, Essen, Germany.
authors.forename: Bernd
authors.initials: B
authors.lastname: Schweiger
authors.affiliation: Department of Endocrinology and Metabolism, Medical Center, Universitätsklinikum-Essen and the University of Duisburg-Essen, Essen, Germany.
authors.forename: Dagmar
authors.initials: D
authors.lastname: Führer-Sakel
authors.affiliation: Department of Endocrinology and Metabolism, Medical Center, Universitätsklinikum-Essen and the University of Duisburg-Essen, Essen, Germany.
authors.forename: Harald
authors.initials: H
authors.lastname: Lahner
authors.affiliation: Clinik for Nuclear Medicine, Universitätsklinikum-Essen and the University of Duisburg-Essen, Essen, Germany.
authors.forename: Thorsten D
authors.initials: TD
authors.lastname: Poeppel
authors.affiliation: Pediatric Endocrinology and Diabetology, Kinderklinik II, Universitätsklinikum-Essen and the University of Duisburg-Essen, Essen, Germany.
authors.forename: Cordula
authors.initials: C
authors.lastname: Kiewert
authors.affiliation: Pediatric Endocrinology and Diabetology, Kinderklinik II, Universitätsklinikum-Essen and the University of Duisburg-Essen, Essen, Germany.
authors.forename: Berthold P
authors.initials: BP
authors.lastname: Hauffa
authors.affiliation: Pediatric Endocrinology and Diabetology, Kinderklinik II, Universitätsklinikum-Essen and the University of Duisburg-Essen, Essen, Germany.
authors.forename: Corinna
authors.initials: C
authors.lastname: Grasemann
mesh_terms: D015502:Absorptiometry, Photon; D000293:Adolescent; D000328:Adult; D015519:Bone Density; D002648:Child; D002675:Child, Preschool; D005260:Female; D005269:Femur / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology; D006801:Humans; D008297:Male; D010024:Osteoporosis / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology; D010744:Phosphoric Monoester Hydrolases / Q000378:metabolism; D012189:Retrospective Studies; D012984:Software; D014057:Tomography, X-Ray Computed; D014807:Vitamin D / Q000378:metabolism
chemical_list: D014807:Vitamin D; D010744:Phosphoric Monoester Hydrolases