Reproducibility of DXA measurements of bone mineral density and body composition in children

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Abstract
The technique of X-ray-based dual photon absorptiometry (DXA) is frequently used in children for the detection of changes in bone mass or body composition. Such changes can only be considered real if the uncertainties arising from the measurement technique are exceeded. Our objectives were twofold: (1) to determine the reproducibility of bone mineral density (BMD) measurements in children at the spine and the hip and from the whole body, as well as of whole-body measurements of mineral mass, lean body mass and fat mass in children; and (2) to estimate, from the measured precision, the time interval that needs to elapse before a statistically significant change in a DXA variable can be detected. The reproducibility of techniques for the measurement of BMD and body composition using DXA was measured in 15 young children (9 girls and 6 boys) and 17 older children (9 girls and 8 boys). Reproducibility was derived from the standard deviation of three repeated measurements of spine BMD, total hip BMD, whole-body BMD (WBBMD), whole-body bone mineral content (WBBMC), lean mass and fat mass. Technique precision was better than 0.01 g cm−2 for spine BMD and for WBBMD. Hip BMD measurements were slightly less precise, particularly in younger children (0.013 g cm−2). For body composition variables, technique precision was 13 g for WBBMC, 201 g for lean body mass and 172 g for fat mass in younger children. Technique precision for older children was 18 g, 251 g and 189 g for the corresponding variables. Predictions showed that the absence of a normal increase in WBBMC in a small-for-age girl could be established after 12 months. For spine BMD, a significant increase should be observable after 6 months for boys over the age of 11 years. For younger boys, more than 12 months has to elapse before anticipated changes can be detected with confidence. The time intervals required to elapse before decisions can be made concerning the significance of observed differences between successive measurements of BMD or body composition in children depend upon the age of the child.