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Semin Musculoskelet Radiol 2016; 20(03): 254-268
DOI: 10.1055/s-0036-1592369
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Bone Densitometry in Children

Judith E. Adams
1   Department of Radiology, The Royal Infirmary, Manchester Academic Health Science Centre, Manchester, United Kingdom
2   Imaging Science, Institute of Population Health, Faculty of Medical and Human Sciences, University of Manchester, Manchester, United Kingdom
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Publication History

Publication Date:
14 October 2016 (online)

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Abstract

Maximizing peak bone mass in childhood is relevant to optimizing bone health in later life, so the study of the skeleton in children in health and disease is important. Dual-energy X-ray absorptiometry (DXA) is the most widely used clinical tool for the assessment of bone status in children. Technological developments in DXA enable vertebral fracture assessment at much lower ionizing radiation doses than spinal radiographs. Quantitative computed tomography remains predominantly a research tool but has some advantages over DXA in not being size dependent. High-resolution peripheral computed tomography measures trabecular and cortical bone microstructure but is technically challenging, particularly in children, and not widely available, so it is unlikely to be used in clinical practice. Other quantitative techniques (quantitative magnetic resonance imaging, digital X-ray absorptiometry, quantitative ultrasound) have been applied in children but remain research applications, and they are only covered briefly in this review.

Keywords

children - bone densitometry - dual-energy X-ray absorptiometry - quantitative computed tomography - vertebral fracture
 

  • References

  • 1 Riggs BL, Khosla S, Melton III LJ. The assembly of the adult skeleton during growth and maturation: implications for senile osteoporosis. J Clin Invest 1999; 104 (6) 671-672
    CrossrefPubMedGoogle Scholar
  • 2 Katzman DK, Bachrach LK, Carter DR, Marcus R. Clinical and anthropometric correlates of bone mineral acquisition in healthy adolescent girls. J Clin Endocrinol Metab 1991; 73 (6) 1332-1339
    CrossrefPubMedGoogle Scholar
  • 3 Bailey DA, McKay HA, Mirwald RL, Crocker PR, Faulkner RA. A six-year longitudinal study of the relationship of physical activity to bone mineral accrual in growing children: the university of Saskatchewan bone mineral accrual study. J Bone Miner Res 1999; 14 (10) 1672-1679
    CrossrefPubMedGoogle Scholar
  • 4 Zemel BS. Human biology at the interface of paediatrics: measuring bone mineral accretion during childhood. Ann Hum Biol 2012; 39 (5) 402-411
    CrossrefPubMedGoogle Scholar
  • 5 Rizzoli R, Bianchi ML, Garabédian M, McKay HA, Moreno LA. Maximizing bone mineral mass gain during growth for the prevention of fractures in the adolescents and the elderly. Bone 2010; 46 (2) 294-305
    CrossrefPubMedGoogle Scholar
  • 6 Bachrach LK. Diagnosis and treatment of pediatric osteoporosis. Curr Opin Endocrinol Diabetes Obes 2014; 21 (6) 454-460
    CrossrefPubMedGoogle Scholar
  • 7 Saraff V, Högler W. Endocrinology and adolescence: osteoporosis in children: diagnosis and management. Eur J Endocrinol 2015; 173 (6) R185-R197
    CrossrefPubMedGoogle Scholar
  • 8 Bachrach LK, Ward LM. Clinical review 1: Bisphosphonate use in childhood osteoporosis. J Clin Endocrinol Metab 2009; 94 (2) 400-409
    CrossrefPubMedGoogle Scholar
  • 9 Ward LM, Rauch F. Oral bisphosphonates for paediatric osteogenesis imperfecta?. Lancet 2013; 382 (9902) 1388-1389
    CrossrefPubMedGoogle Scholar
  • 10 Al Muderis M, Azzopardi T, Cundy P. Zebra lines of pamidronate therapy in children. J Bone Joint Surg Am 2007; 89 (7) 1511-1516
    CrossrefPubMedGoogle Scholar
  • 11 Adams JE. Advances in bone imaging for osteoporosis. Nat Rev Endocrinol 2013; 9 (1) 28-42
    PubMedGoogle Scholar
  • 12 Rauch F, Schoenau E. Changes in bone density during childhood and adolescence: an approach based on bone's biological organization. J Bone Miner Res 2001; 16 (4) 597-604
    CrossrefPubMedGoogle Scholar
  • 13 Ward KA, Mughal Z, Adams JE. Tools for measuring bone in children and adolescents. In: Sawyer AJ, Bachrach LK, Fung EB, , eds. Bone Densitometry in Growing Patients: Guidelines for Clinical Practice. New York, NY: Humana Press; 2006: 15-40
    Google Scholar
  • 14 Binkovitz LA, Henwood MJ. Pediatric DXA: technique and interpretation. Pediatr Radiol 2007; 37 (1) 21-31
    CrossrefPubMedGoogle Scholar
  • 15 Adams JE, Shaw N. Eds. A practical guide to bone densitometry in children (2004). National Osteoporosis Society, Camerton, Bath, UK. Available at: https://www.nos.org.uk/oldsite/document.doc?id=851 . Accessed April 7, 2016
    PubMedGoogle Scholar
  • 16 Dasher LG, Newton CD, Lenchik L. Dual X-ray absorptiometry in today's clinical practice. Radiol Clin North Am 2010; 48 (3) 541-560
    CrossrefPubMedGoogle Scholar
  • 17 Blake GM, Fogelman I. An update on dual-energy x-ray absorptiometry. Semin Nucl Med 2010; 40 (1) 62-73
    CrossrefPubMedGoogle Scholar
  • 18 Gordon CM, Leonard MB, Zemel BS ; International Society for Clinical Densitometry. 2013 Pediatric Position Development Conference: executive summary and reflections. J Clin Densitom 2014; 17 (2) 219-224
    CrossrefPubMedGoogle Scholar
  • 19 Crabtree NJ, Arabi A, Bachrach LK , et al; International Society for Clinical Densitometry. Dual-energy X-ray absorptiometry interpretation and reporting in children and adolescents: the revised 2013 ISCD Pediatric Official Positions. J Clin Densitom 2014; 17 (2) 225-242
    CrossrefPubMedGoogle Scholar
  • 20 Ward KA, Ashby RL, Roberts SA, Adams JE, Zulf Mughal M. UK reference data for the Hologic QDR Discovery dual-energy x ray absorptiometry scanner in healthy children and young adults aged 6-17 years. Arch Dis Child 2007; 92 (1) 53-59
    CrossrefPubMedGoogle Scholar
  • 21 Zemel BS, Stallings VA, Leonard MB , et al. Revised pediatric reference data for the lateral distal femur measured by Hologic Discovery/Delphi dual-energy X-ray absorptiometry. J Clin Densitom 2009; 12 (2) 207-218
    CrossrefPubMedGoogle Scholar
  • 22 Damilakis J, Adams JE, Guglielmi G, Link TM. Radiation exposure in X-ray-based imaging techniques used in osteoporosis. Eur Radiol 2010; 20 (11) 2707-2714
    CrossrefPubMedGoogle Scholar
  • 23 Shepherd JA, Wang L, Fan B , et al. Optimal monitoring time interval between DXA measures in children. J Bone Miner Res 2011; 26 (11) 2745-2752
    CrossrefPubMedGoogle Scholar
  • 24 Fan B, Shepherd JA, Levine MA , et al. National Health and Nutrition Examination Survey whole-body dual-energy X-ray absorptiometry reference data for GE Lunar systems. J Clin Densitom 2014; 17 (3) 344-377
    CrossrefPubMedGoogle Scholar
  • 25 Zemel BS, Kalkwarf HJ, Gilsanz V , et al. Revised reference curves for bone mineral content and areal bone mineral density according to age and sex for black and non-black children: results of the bone mineral density in childhood study. J Clin Endocrinol Metab 2011; 96 (10) 3160-3169
    CrossrefPubMedGoogle Scholar
  • 26 Fewtrell MS ; British Paediatric & Adolescent Bone Group. Bone densitometry in children assessed by dual x ray absorptiometry: uses and pitfalls. Arch Dis Child 2003; 88 (9) 795-798
    CrossrefPubMedGoogle Scholar
  • 27 Gafni RI, Baron J. Overdiagnosis of osteoporosis in children due to misinterpretation of dual-energy x-ray absorptiometry (DEXA). J Pediatr 2004; 144 (2) 253-257
    CrossrefPubMedGoogle Scholar
  • 28 Carter DR, Bouxsein ML, Marcus R. New approaches for interpreting projected bone densitometry data. J Bone Miner Res 1992; 7 (2) 137-145
    CrossrefPubMedGoogle Scholar
  • 29 Kröger H, Kotaniemi A, Vainio P, Alhava E. Bone densitometry of the spine and femur in children by dual-energy x-ray absorptiometry. Bone Miner 1992; 17 (1) 75-85
    CrossrefPubMedGoogle Scholar
  • 30 Prentice A, Parsons TJ, Cole TJ. Uncritical use of bone mineral density in absorptiometry may lead to size-related artifacts in the identification of bone mineral determinants. Am J Clin Nutr 1994; 60 (6) 837-842
    PubMedGoogle Scholar
  • 31 Mølgaard C, Thomsen BL, Prentice A, Cole TJ, Michaelsen KF. Whole body bone mineral content in healthy children and adolescents. Arch Dis Child 1997; 76 (1) 9-15
    CrossrefPubMedGoogle Scholar
  • 32 Lu PW, Cowell CT, LLoyd-Jones SA, Briody JN, Howman-Giles R. Volumetric bone mineral density in normal subjects, aged 5-27 years. J Clin Endocrinol Metab 1996; 81 (4) 1586-1590
    PubMedGoogle Scholar
  • 33 Zemel BS, Leonard MB, Kelly A , et al. Height adjustment in assessing dual energy x-ray absorptiometry measurements of bone mass and density in children. J Clin Endocrinol Metab 2010; 95 (3) 1265-1273
    CrossrefPubMedGoogle Scholar
  • 34 Crabtree NJ, Högler W, Cooper MS, Shaw NJ. Diagnostic evaluation of bone densitometric size adjustment techniques in children with and without low trauma fractures. Osteoporos Int 2013; 24 (7) 2015-2024
    CrossrefPubMedGoogle Scholar
  • 35 Högler W, Briody J, Woodhead HJ, Chan A, Cowell CT. Importance of lean mass in the interpretation of total body densitometry in children and adolescents. J Pediatr 2003; 143 (1) 81-88
    CrossrefPubMedGoogle Scholar
  • 36 Crabtree NJ, Kibirige MS, Fordham JN , et al. The relationship between lean body mass and bone mineral content in paediatric health and disease. Bone 2004; 35 (4) 965-972
    CrossrefPubMedGoogle Scholar
  • 37 Goulding A, Cannan R, Williams SM, Gold EJ, Taylor RW, Lewis-Barned NJ. Bone mineral density in girls with forearm fractures. J Bone Miner Res 1998; 13 (1) 143-148
    CrossrefPubMedGoogle Scholar
  • 38 Ma D, Jones G. The association between bone mineral density, metacarpal morphometry, and upper limb fractures in children: a population-based case-control study. J Clin Endocrinol Metab 2003; 88 (4) 1486-1491
    CrossrefPubMedGoogle Scholar
  • 39 Goulding A, Jones IE, Taylor RW, Manning PJ, Williams SM. More broken bones: a 4-year double cohort study of young girls with and without distal forearm fractures. J Bone Miner Res 2000; 15 (10) 2011-2018
    CrossrefPubMedGoogle Scholar
  • 40 Clark EM, Ness AR, Bishop NJ, Tobias JH. Association between bone mass and fractures in children: a prospective cohort study. J Bone Miner Res 2006; 21 (9) 1489-1495
    CrossrefPubMedGoogle Scholar
  • 41 Bishop N, Arundel P, Clark E , et al; International Society of Clinical Densitometry. Fracture prediction and the definition of osteoporosis in children and adolescents: the ISCD 2013 Pediatric Official Positions. J Clin Densitom 2014; 17 (2) 275-280
    CrossrefPubMedGoogle Scholar
  • 42 Rodd C, Lang B, Ramsay T , et al; Canadian Steroid-Associated Osteoporosis in the Pediatric Population (STOPP) Consortium. Incident vertebral fractures among children with rheumatic disorders 12 months after glucocorticoid initiation: a national observational study. Arthritis Care Res (Hoboken) 2012; 64 (1) 122-131
    CrossrefPubMedGoogle Scholar
  • 43 Henderson RC, Berglund LM, May R , et al. The relationship between fractures and DXA measures of BMD in the distal femur of children and adolescents with cerebral palsy or muscular dystrophy. J Bone Miner Res 2010; 25 (3) 520-526
    CrossrefPubMedGoogle Scholar
  • 44 Bianchi ML, Leonard MB, Bechtold S , et al; International Society for Clinical Densitometry. Bone health in children and adolescents with chronic diseases that may affect the skeleton: the 2013 ISCD Pediatric Official Positions. J Clin Densitom 2014; 17 (2) 281-294
    CrossrefPubMedGoogle Scholar
  • 45 Kecskemethy HH, Harcke HT. Assessment of bone health in children with disabilities. J Pediatr Rehabil Med 2014; 7 (2) 111-124
    PubMedGoogle Scholar
  • 46 Kalkwarf HJ, Abrams SA, DiMeglio LA, Koo WW, Specker BL, Weiler H ; International Society for Clinical Densitometry. Bone densitometry in infants and young children: the 2013 ISCD Pediatric Official Positions. J Clin Densitom 2014; 17 (2) 243-257
    CrossrefPubMedGoogle Scholar
  • 47 Lewiecki EM. Bone densitometry and vertebral fracture assessment. Curr Osteoporos Rep 2010; 8 (3) 123-130
    CrossrefPubMedGoogle Scholar
  • 48 Kuet KP, Charlesworth D, Peel NF. Vertebral fracture assessment scans enhance targeting of investigations and treatment within a fracture risk assessment pathway. Osteoporos Int 2013; 24 (3) 1007-1014
    CrossrefPubMedGoogle Scholar
  • 49 Högler W, Ward L. Osteoporosis in children with chronic disease. Endocr Dev 2015; 28: 176-195
    PubMedGoogle Scholar
  • 50 Lentle B, Ma J, Jaremko JL , et al. The radiology of vertebral fractures in childhood osteoporosis related to glucocorticoid administration. J Clin Densitom 2016; 19 (1) 81-88
    CrossrefPubMedGoogle Scholar
  • 51 Mäyränpää MK, Helenius I, Valta H, Mäyränpää MI, Toiviainen-Salo S, Mäkitie O. Bone densitometry in the diagnosis of vertebral fractures in children: accuracy of vertebral fracture assessment. Bone 2007; 41 (3) 353-359
    CrossrefPubMedGoogle Scholar
  • 52 Kyriakou A, Shepherd S, Mason A, Faisal Ahmed S. A critical appraisal of vertebral fracture assessment in paediatrics. Bone 2015; 81: 255-259
    CrossrefPubMedGoogle Scholar
  • 53 Diacinti D, Pisani D, D'Avanzo M , et al. Reliability of vertebral fractures assessment (VFA) in children with osteogenesis imperfecta. Calcif Tissue Int 2015; 96 (4) 307-312
    CrossrefPubMedGoogle Scholar
  • 54 Micklesfield LK, Goedecke JH, Punyanitya M, Wilson KE, Kelly TL. Dual-energy X-ray performs as well as clinical computed tomography for the measurement of visceral fat. Obesity (Silver Spring) 2012; 20 (5) 1109-1114
    CrossrefPubMedGoogle Scholar
  • 55 Bosch TA, Dengel DR, Kelly AS, Sinaiko AR, Moran A, Steinberger J. Visceral adipose tissue measured by DXA correlates with measurement by CT and is associated with cardiometabolic risk factors in children. Pediatr Obes 2015; 10 (3) 172-179
    CrossrefPubMedGoogle Scholar
  • 56 Pludowski P, Lebiedowski M, Lorenc RS. Evaluation of practical use of bone age assessments based on DXA-derived hand scans in diagnosis of skeletal status in healthy and diseased children. J Clin Densitom 2005; 8 (1) 48-56
    CrossrefPubMedGoogle Scholar
  • 57 Heppe DH, Taal HR, Ernst GD , et al. Bone age assessment by dual-energy X-ray absorptiometry in children: an alternative for X-ray?. Br J Radiol 2012; 85 (1010) 114-120
    CrossrefPubMedGoogle Scholar
  • 58 Link TM, Lang TF. Axial QCT: clinical applications and new developments. J Clin Densitom 2014; 17 (4) 438-448
    CrossrefPubMedGoogle Scholar
  • 59 Zemel BS. Quantitative computed tomography and computed tomography in children. Curr Osteoporos Rep 2011; 9 (4) 284-290
    CrossrefPubMedGoogle Scholar
  • 60 Crabtree N, Ward K. Bone densitometry: current status and future perspectives. Endocr Dev 2009; 16: 58-72
    PubMedGoogle Scholar
  • 61 Adams JE. Quantitative computed tomography. Eur J Radiol 2009; 71 (3) 415-424
    CrossrefPubMedGoogle Scholar
  • 62 Adams JE, Engelke K, Zemel BS, Ward KA ; International Society of Clinical Densitometry. Quantitative computer tomography in children and adolescents: the 2013 ISCD Pediatric Official Positions. J Clin Densitom 2014; 17 (2) 258-274
    CrossrefPubMedGoogle Scholar
  • 63 Engelke K, Adams JE, Armbrecht G , et al. Clinical use of quantitative computed tomography and peripheral quantitative computed tomography in the management of osteoporosis in adults: the 2007 ISCD Official Positions. J Clin Densitom 2008; 11 (1) 123-162
    CrossrefPubMedGoogle Scholar
  • 64 Engelke K, Libanati C, Fuerst T, Zysset P, Genant HK. Advanced CT based in vivo methods for the assessment of bone density, structure, and strength. Curr Osteoporos Rep 2013; 11 (3) 246-255
    CrossrefPubMedGoogle Scholar
  • 65 Kalender WA, Felsenberg D, Genant HK, Fischer M, Dequeker J, Reeve J. The European Spine Phantom—a tool for standardization and quality control in spinal bone mineral measurements by DXA and QCT. Eur J Radiol 1995; 20 (2) 83-92
    CrossrefPubMedGoogle Scholar
  • 66 Museyko O, Heinemann A, Krause M , et al. A low-radiation exposure protocol for 3D QCT of the spine. Osteoporos Int 2014; 25 (3) 983-992
    CrossrefPubMedGoogle Scholar
  • 67 Gilsanz V, Skaggs DL, Kovanlikaya A , et al. Differential effect of race on the axial and appendicular skeletons of children. J Clin Endocrinol Metab 1998; 83 (5) 1420-1427
    PubMedGoogle Scholar
  • 68 Marjanovic EJ, Ward KA, Adams JE. The impact of accurate positioning on measurements made by peripheral QCT in the distal radius. Osteoporos Int 2009; 20 (7) 1207-1214
    CrossrefPubMedGoogle Scholar
  • 69 Ashby RL, Ward KA, Roberts SA, Edwards L, Mughal MZ, Adams JE. A reference database for the Stratec XCT-2000 peripheral quantitative computed tomography (pQCT) scanner in healthy children and young adults aged 6-19 years. Osteoporos Int 2009; 20 (8) 1337-1346
    CrossrefPubMedGoogle Scholar
  • 70 Schoenau E, Neu CM, Beck B, Manz F, Rauch F. Bone mineral content per muscle cross-sectional area as an index of the functional muscle-bone unit. J Bone Miner Res 2002; 17 (6) 1095-1101
    CrossrefPubMedGoogle Scholar
  • 71 Engelke K, Libanati C, Liu Y , et al. Quantitative computed tomography (QCT) of the forearm using general purpose spiral whole-body CT scanners: accuracy, precision and comparison with dual-energy X-ray absorptiometry (DXA). Bone 2009; 45 (1) 110-118
    CrossrefPubMedGoogle Scholar
  • 72 Ward K, Alsop C, Caulton J, Rubin C, Adams J, Mughal Z. Low magnitude mechanical loading is osteogenic in children with disabling conditions. J Bone Miner Res 2004; 19 (3) 360-369
    CrossrefPubMedGoogle Scholar
  • 73 Ward KA, Adams JE, Hangartner TN. Recommendations for thresholds for cortical bone geometry and density measurement by peripheral quantitative computed tomography. Calcif Tissue Int 2005; 77 (5) 275-280
    CrossrefPubMedGoogle Scholar
  • 74 Hangartner TN. Thresholding technique for accurate analysis of density and geometry in QCT, pQCT and microCT images. J Musculoskelet Neuronal Interact 2007; 7 (1) 9-16
    PubMedGoogle Scholar
  • 75 Rauch F, Schoenau E. Peripheral quantitative computed tomography of the proximal radius in young subjects—new reference data and interpretation of results. J Musculoskelet Neuronal Interact 2008; 8 (3) 217-226
    PubMedGoogle Scholar
  • 76 Moyer-Mileur LJ, Quick JL, Murray MA. Peripheral quantitative computed tomography of the tibia: pediatric reference values. J Clin Densitom 2008; 11 (2) 283-294
    CrossrefPubMedGoogle Scholar
  • 77 Bass SL, Saxon L, Daly RM , et al. The effect of mechanical loading on the size and shape of bone in pre-, peri-, and postpubertal girls: a study in tennis players. J Bone Miner Res 2002; 17 (12) 2274-2280
    CrossrefPubMedGoogle Scholar
  • 78 Daly RM, Saxon L, Turner CH, Robling AG, Bass SL. The relationship between muscle size and bone geometry during growth and in response to exercise. Bone 2004; 34 (2) 281-287
    CrossrefPubMedGoogle Scholar
  • 79 McKay HA, Sievänen H, Petit MA , et al. Application of magnetic resonance imaging to evaluation of femoral neck structure in growing girls. J Clin Densitom 2004; 7 (2) 161-168
    CrossrefPubMedGoogle Scholar
  • 80 Link TM. Osteoporosis imaging: state of the art and advanced imaging. Radiology 2012; 263 (1) 3-17
    CrossrefPubMedGoogle Scholar
  • 81 Rajapakse CS, Leonard MB, Bhagat YA, Sun W, Magland JF, Wehrli FW. Micro-MR imaging-based computational biomechanics demonstrates reduction in cortical and trabecular bone strength after renal transplantation. Radiology 2012; 262 (3) 912-920
    CrossrefPubMedGoogle Scholar
  • 82 Wehrli FW. Magnetic resonance of calcified tissues. J Magn Reson 2013; 229: 35-48
    CrossrefPubMedGoogle Scholar
  • 83 Adams JE. Radiogrammetry and radiographic absorptiometry. Radiol Clin North Am 2010; 48 (3) 531-540
    CrossrefPubMedGoogle Scholar
  • 84 Dhainaut A, Hoff M, Kälvesten J, Lydersen S, Forslind K, Haugeberg G. Long-term in-vitro precision of direct digital X-ray radiogrammetry. Skeletal Radiol 2011; 40 (12) 1575-1579
    CrossrefPubMedGoogle Scholar
  • 85 Bouxsein ML, Palermo L, Yeung C, Black DM. Digital X-ray radiogrammetry predicts hip, wrist and vertebral fracture risk in elderly women: a prospective analysis from the study of osteoporotic fractures. Osteoporos Int 2002; 13 (5) 358-365
    CrossrefPubMedGoogle Scholar
  • 86 Wilczek ML, Kälvesten J, Algulin J, Beiki O, Brismar TB. Digital X-ray radiogrammetry of hand or wrist radiographs can predict hip fracture risk—a study in 5,420 women and 2,837 men. Eur Radiol 2013; 23 (5) 1383-1391
    CrossrefPubMedGoogle Scholar
  • 87 Malich A, Freesmeyer MG, Mentzel HJ , et al. Normative values of bone parameters of children and adolescents using digital computer-assisted radiogrammetry (DXR). J Clin Densitom 2003; 6 (2) 103-111
    CrossrefPubMedGoogle Scholar
  • 88 Thodberg HH, van Rijn RR, Tanaka T, Martin DD, Kreiborg S. A paediatric bone index derived by automated radiogrammetry. Osteoporos Int 2010; 21 (8) 1391-1400
    CrossrefPubMedGoogle Scholar
  • 89 Baroncelli GI. Quantitative ultrasound methods to assess bone mineral status in children: technical characteristics, performance, and clinical application. Pediatr Res 2008; 63 (3) 220-228
    CrossrefPubMedGoogle Scholar
  • 90 McDevitt H, Ahmed SF. Quantitative ultrasound assessment of bone health in the neonate. Neonatology 2007; 91 (1) 2-11
    CrossrefPubMedGoogle Scholar
  • 91 Krieg MA, Barkmann R, Gonnelli S , et al. Quantitative ultrasound in the management of osteoporosis: the 2007 ISCD Official Positions. J Clin Densitom 2008; 11 (1) 163-187
    CrossrefPubMedGoogle Scholar
  • 92 Guglielmi G, de Terlizzi F. Quantitative ultrasound in the assessment of osteoporosis. Eur J Radiol 2009; 71 (3) 425-431
    CrossrefPubMedGoogle Scholar