Is the skull responsive to bone mineralisation stimuli in children?

Whole-body-less-head (WBLH) is the recommended skeletal region of interest (ROI) for dual-energy X-ray absorptiometry (DXA) assessment of bone mineral density (BMD) in children. Historically it has been suggested that the skull is less responsive than the rest of the skeleton to stimuli that affect...

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Bibliographic Details
Published in:Bone (New York, N.Y.) N.Y.), 2022-07, Vol.160, p.116415-116415, Article 116415
Main Authors: Moon, Rebecca J., D'Angelo, Stefania, Crozier, Sarah R., Godfrey, Keith M., Davies, Justin H., Cooper, Cyrus, Harvey, Nicholas C.
Format: Article
Language:English
Subjects:
Absorptiometry, Photon
Body Height
Bone Density
Bone mineral density (BMD)
Child
Children
Dual-energy X-ray absorptiometry (DXA)
Female
Humans
Lumbar Vertebrae - diagnostic imaging
Skull
Whole-body-less-head
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Summary:Whole-body-less-head (WBLH) is the recommended skeletal region of interest (ROI) for dual-energy X-ray absorptiometry (DXA) assessment of bone mineral density (BMD) in children. Historically it has been suggested that the skull is less responsive than the rest of the skeleton to stimuli that affect BMD but there are few published data to support this notion. We compared the associations of BMD with anthropometric, body composition, diet, and activity variables across various ROI. Children from the Southampton Women's Survey (SWS) mother-offspring cohort participated at age 6–7 years, including measurement of height, weight, and whole-body and lumbar spine (LS) BMD by DXA (Hologic Discovery). Physical activity was assessed by accelerometry (Actiheart) and diet by interviewer-led questionnaire. BMD was measured in the following skeletal ROI: whole-body, skull, WBLH and lower limbs (all derived from the whole-body scan) and LS. 1218 children participated. Height z-score, weight z-score, lean mass and milk intake were associated with skull BMD, but associations were weaker than observed for other ROI; for example, the association between lean mass and skull BMD was β (95% CI) 0.11 (0.08, 0.14) SD/kg, compared with 0.32 (0.30, 0.34), 0.38 (0.37, 0.40) and 0.23 (0.21, 0.25) SD/kg for whole body, WBLH and lumbar spine, respectively. Relationships with whole-body BMD were attenuated compared with WBLH. Associations between skull BMD and anthropometry, body composition and dietary variables were weaker than for other DXA sites. These findings support, and importantly provide a quantitative basis for, the recommendation that the skull should be excluded from whole-body DXA analyses in children. •Exclusion of the skull from whole body DXA scans in children has been recommended.•Associations with anthropometry were weaker for skull BMD than BMD at other sites.•Quantitative support for head exclusion from whole-body DXA scans is provided.
ISSN:8756-3282
1873-2763
DOI:10.1016/j.bone.2022.116415