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Open Access Research

Factors associated with low bone density in patients referred for assessment of bone health

Lisa Swartz Topor14*, Patrice Melvin2, Courtney Giancaterino3 and Catherine M Gordon56

Author Affiliations

1 Division of Endocrinology, Boston, MA, USA

2 Program for Patient Safety and Quality, Boston, MA, USA

3 Division of Adolescent Medicine, all at Boston Children’s Hospital, Boston, MA, USA

4 Harvard Medical School, Boston, MA, USA

5 Divisions of Adolescent Medicine and Endocrinology, Hasbro Children’s Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA

6 Research Associate, Boston Children’s Hospital, Boston, MA, USA

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International Journal of Pediatric Endocrinology 2013, 2013:4  doi:10.1186/1687-9856-2013-4

Published: 6 February 2013

Abstract

Background

To identify factors that predict low bone mineral density (BMD) in pediatric patients referred for dual-energy x-ray absorptiometry assessments.

Methods

This is a retrospective cohort study of 304 children and adolescents referred for dual-energy x-ray absorptiometry assessments at a tertiary care center. Outcomes included risk factors which predicted a significant low bone density for age, defined as BMD Z-score ≤ -2.0 SD. A univariate analysis involved Chi-square, Fisher’s Exact test, and analysis of variance, and multivariate logistic regression models were constructed to determine predictors of low bone mineral density.

Results

In the multivariate logistic regression model, predictors of low bone mineral density included low body mass index Z-score (odds ratio 0.52, 95% confidence interval 0.39 – 0.69), low height Z-score (OR 0.71, 95% CI 0.57 – 0.88), vitamin D insufficiency (OR 3.97, 95% CI 2.08 – 7.59), and history of bone marrow transplant (OR 5.78, 95% CI 1.00 – 33.45).

Conclusions

Underlying health problems and associated treatments can impair bone mineral accrual. We identified risk factors most predictive of low bone mineral density in subjects referred for bone density measurement. Recognition of these factors may allow for earlier assessment to maximize bone mass in at-risk children.

Keywords:
Bone health; Low bone mineral density; Chronic disease; Vitamin D; Dual X-ray absorptiometry