Bone health of children with intestinal failure measured by dual energy X-ray absorptiometry and digital X-ray radiogrammetry. Issue 2 (April 2018)

• Record Type: Journal Article
• Authors: Neelis, Esther; Rijnen, Noortje; Sluimer, Johanna; Olieman, Joanne; Rizopoulos, Dimitris; Wijnen, René; Rings, Edmond; de Koning, Barbara; Hulst, Jessie
• Is Part Of: Clinical nutrition. Volume 37:Issue 2(2018)
• Page Start: 687
• Page End: 694
• Publication Date: 2018-04
• Subjects: Intestinal failure -- Parenteral nutrition -- Bone mineral density -- Dual energy X-ray absorptiometry -- Digital X-ray radiogrammetry; BHI bone health index -- BMAD bone mineral apparent density -- BMD bone mineral density -- DXA dual energy X-ray absorptiometry -- DXR digital X-ray radiogrammetry -- HFA height-for-age -- IF intestinal failure -- IQR interquartile range -- LS lumbar spine -- PN parenteral nutrition -- SBS short bowel syndrome -- SD standard deviation -- SDS standard deviation score -- TB total body -- TH target height -- WFA weight-for-age -- WFH weight-for-height; Critically ill -- Nutrition -- Periodicals; Diet therapy -- Periodicals; Parenteral feeding -- Periodicals; Enteral feeding -- Periodicals; Enteral Nutrition -- Periodicals; Parenteral Nutrition -- Periodicals; Metabolism -- Periodicals; Diétothérapie -- Périodiques; Alimentation parentérale -- Périodiques; Alimentation entérale -- Périodiques; Nutrition -- Périodiques; Diet therapy; Enteral feeding; Nutrition; Parenteral feeding; Electronic journals; Periodicals; Electronic journals; 615.854
• DOI: 10.1016/j.clnu.2017.02.014
• Languages: English
• ISSNs: 0261-5614

Abstract

Summary: Background & aims: Children with intestinal failure (IF) receiving long-term parenteral nutrition (PN) are at risk of developing low bone mineral density (BMD). Next to the dual energy X-ray absorptiometry (DXA) method, digital X-ray radiogrammetry (DXR) using the BoneXpert software has become available to obtain the Bone Health Index (BHI) in hand radiographs. In this study we 1) evaluated the prevalence of low BMD in children with IF using DXA and DXR, 2) compared DXA and DXR results, and 3) aimed to identify factors associated with low BMD. Methods: A retrospective study was performed including all children with IF between 2000 and 2015 who underwent a DXA measurement and/or a hand radiograph. Z-scores of BMD total body (BMD TB) and lumbar spine (BMD LS), bone mineral apparent density (BMAD) and bone health index (BHI) were collected. A low BMD and low BHI were defined as a Z-score ≤ −2. DXA and DXR results were compared for cases in which a DXA and hand radiograph were performed within a 6 months' interval. Results: Forty-six children were included. Overall, 24.3% of the children had a low BMD at the first DXA at a median age of 6 years; correction for growth failure (n = 6) reduced this to 16.2%. Fifty percent had a low BHI at the first hand radiograph. Median DXA and BHI Z-scores were significantly lower than reference scores. Age, duration of PN and surgical IF were related to lower Z-scores at the first DXA. Paired DXA and DXR results (n = 18) were compared, resulting in a Cohen's kappa of 0.746 ('substantial') for BMD TB. Spearman's correlation coefficient for BHI and BMD TB Z-scores was 0.856 (p < 0.001). Hand radiography had a sensitivity of 90% and specificity of 86% (BMD TB). Conclusions: Up to 50% of the children had a low BMD. Children with IF have a significantly poorer bone health than the reference population, also after weaning off PN. Bone health assessment by DXA and DXR showed good agreement, especially for Z-scores ≤ −2. DXR assessment using BoneXpert software seems to be feasible for monitoring of bone health in children with IF.