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Pediatric Reference Data for Dual X-Ray Absorptiometric Measures of Normal Bone Density in the Distal Femur

¹ Department of Orthopaedics, Campus Box 7055, University of North Carolina, Chapel Hill, NC 27599.
² Department of Pediatrics, Campus Box 7525, University of North Carolina, Chapel Hill, NC 27599.
³ School of Public Health, Campus Box 7400, University of North Carolina, Chapel Hill, NC 27599.
⁴ Department of Research, A.I. duPont Hospital for Children, 1600 Rockland Rd., Box 269, Wilmington, DE 19899.
⁵ School of Nursing, University of Pennsylvania, 420 Guardian Dr., Philadelphia, PA 19104.
⁶ Present address: Department of Gastroenterology and Nutrition, Children's Hospital, 747 Fifty-Second St., Oakland, CA 94609.
⁷ Department of Radiology, Campus Box 7510, University of North Carolina, Chapel Hill, NC 27599.
⁸ Department of Allied Health Sciences, Campus Box 7120, University of North Carolina, Chapel Hill, NC 27599.
⁹ Departments of Radiology and Pediatrics, Jefferson Medical College, 1020 Walnut St., Philadelphia, PA 19107.
¹⁰ Department of Medical Imaging, A. I. duPont Hospital for Children, Wilmington, DE 19899.

OBJECTIVE. Many children at risk for osteoporosis have substantial hip and knee contractures that prevent assessment of bone mineral density in the "usual" region, the proximal femur. As an alternative, bone density may be measured in the distal femur projected in the lateral plane. The purpose of this study was to provide normative reference data useful for interpretation of bone density measures in the distal femur of children and adolescents.

SUBJECTS AND METHODS. The study was a cross-sectional, single-observational assessment of 256 healthy children and adolescents between the ages of 3 years and 18 years 6 months (mean, 10 years 5 months). Bone mineral density was measured in the nondominant proximal femur, lumbar spine, and both distal femurs using dual X-ray absorptiometry.

RESULTS. We found that bone mineral density increases with age in the cortical, cancellous, and mixed regions of the distal femur, similar to the findings with other regional analyses of bone density. Bone density in the distal femur correlates very highly with bone density in the proximal femur and slightly less well with bone density in the lumbar spine.

CONCLUSION. In pediatric patients who have deformities, have experienced trauma, or have undergone surgical procedures that prevent reliable measures of bone density in the proximal femur, bone mineral density may be measured in the distal femur and interpreted relative to the bone mineral density findings in healthy age- and sex-matched controls.

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