March 01, 2019
2 min read

Pediatric hip DXA scans useful predictor of fracture risk

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Increased bone stress at the femoral neck in children, measured via hip DXA scan, may predict a greater susceptibility to traumatic fractures, according to findings published in Bone.

Carolina Medina-Gomez

“Although the use of hip DXA scans in a pediatric population is not recommended to asses bone health, we found in our study that data derived from these scans can be actually of use when assessing pediatric fracture risk,” Carolina Medina-Gomez, PhD, a biostatistician in the department of internal medicine at Erasmus University Medical Center in Rotterdam, the Netherlands, told Endocrine Today.On top of that, we show how information derived from these images by hip structural analysis might best capture fracture risk.”

Medina-Gomez and colleagues analyzed data from 1,840 children from the Generation R study, a prospective, prenatal cohort born between April 2002 and January 2006 (945 girls; 87.7% European). Children underwent whole-body and hip DXA scans (mean age, 6 years) to assess total-body less head bone mineral density and femoral neck BMD. The researchers used hip structural analysis to measure femur geometry and calculate femoral stress.

Parents completed questionnaires on fracture history 4 years after DXA measurements (mean age of children, 10 years).

Within the cohort, 139 children (7.6%) sustained at least one incident fracture in the 4 years after DXA measurements. Children who did not sustain a fracture had higher BMD at all skeletal sites, according to researchers.

In Cox regression analyses, researchers found that every 1 standard deviation (SD) decrease in total-body less head BMD was associated with an increase in incident fracture risk (HR = 1.35; 95% CI, 1.05-1.74), with results persisting after adjustment for sex, race, age, weight and lean mass fraction. Risk for incident fracture also rose with each 1 SD decrease in femoral neck BMD (HR = 1.31; 95% CI, 1.09-1.58) and narrow neck BMD (HR = 1.39; 95% CI, 1.14-1.68), according to researchers.

Additionally, each 1 SD increase in femoral strength was associated with an increase in incident fracture risk after adjustment for DXA-derived total-body less head BMD (HR = 1.28; 95% CI, 1.08-1.53).

Results persisted after further adjustment for previous fracture, socioeconomic status and physical activity, according to researchers.

“We think, based on our study and others, that the use of hip DXA scans in children should be re-evaluated, as at least cross-sectionally, it can in some cases be more informative than total-body scans,” Medina-Gomez said. “As the International Society for Clinical Densitometry does not recommend the use of hip scans in children, not many research institutions have that data at hand. Although our study was embedded in a powerful setting, given the number of children evaluated, it is important to replicate our findings in other studies.” – by Regina Schaffer


For more information:

Carolina Medina-Gomez, PhD, can be reached at Erasmus University Medical Center Rotterdam, Department of Internal Medicine, Genetic Laboratory, 3015 GD, Rotterdam, the Netherlands; email:

Disclosures: Medina-Gomez reports no relevant financial disclosures. One of the study authors reports he is the owner of Beck Radiological Innovations.