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Archives de pédiatrie
Volume 26, n° 3
pages 151-157 (avril 2019)
Doi : 10.1016/j.arcped.2019.02.003
Received : 5 June 2018 ;  accepted : 3 February 2019
Research Papers

Pediatric bone evaluation with HR-pQCT: A comparison between standard and height-adjusted positioning protocols in a cohort of teenagers with chronic kidney disease
 

M. Vierge a, E. Preka a, T. Ginhoux c, R. Chapurlat b, c, d, B. Ranchin a, J. Bacchetta a, b, c, d,
a Centre de Référence des Maladies Rénales Rares, Hôpital Femme Mère Enfant, 69677 Bron, France 
b INSERM UMR 1033, Lyon, France 
c Centre d’investigation clinique, EPICIME, Lyon, France 
d Faculté de Médecine Lyon Est, Université Lyon 1, Lyon, France 

Corresponding author. Centre de Référence des Maladies Rénales Rares, Hôpital Femme Mère Enfant, Boulevard Pinel, 69677 Bron cedex, France.France
Abstract
Background

High-resolution peripheral quantitative computed tomography (HR-pQCT) evaluates different components of bone fragility. The positioning and length of the region of interest (ROI) in growing populations remain to be defined.

Methods

Using HR-pQCT at the ultradistal tibia, we compared a single-center cohort of 28 teenagers with chronic kidney disease (CKD) at a median age of 13.6 (range, 10.2–19.9) years to local age-, gender-, and puberty-matched healthy peers. Because of the potential impact of short stature, bone parameters were assessed on two different leg-length-adjusted ROIs in comparison to the standard analysis, namely the one applied in adults. The results are presented as median (range).

Results

After matching, SDS height was −0.9 (−3.3;1.6) and 0.3 (−1.4;2.0) in patients and controls, respectively (P <0.001). In younger children (e.g., prepubertal, n =11), bone texture parameters and bone strength were not different using standard analysis. However, using a height-adjusted ROI enabled better characterization of cortical bone structure. In older patients (e.g., pubertal, n =17), there were no differences for height between patients and controls: with the standard evaluation, cortical bone area and cortical thickness were significantly lower in CKD patients: 85 (50–124) vs. 108 (67–154) mm2 and 0.89 (0.46–1.31) vs 1.09 (0.60–1.62) mm, respectively (both P <0.05).

Conclusions

Adapting the ROI to leg length enables better assessment of bone structure, especially when height discrepancies exist between controls and patients. Larger cohorts are required to prospectively validate this analytic HR-pQCT technique.

The full text of this article is available in PDF format.

Keywords : HR-pQCT, Region of interest, Leg length, Positioning, Children, Chronic kidney disease




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