Lumbar spine bone mineral density Z-score discrepancies by dual X-ray absorptiometry do not predict vertebral fractures in children

Tasma Harindhanavudhi, Anna Petryk, Richard Jones, Amanda Regodón Wallin, James S. Hodges, Sara Van Nortwick, Bradley S. Miller, Tara L. Holm, Kyriakie Sarafoglou

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3 Scopus citations


Dual X-ray absorptiometry (DXA) remains the most common mode of bone mineral density (BMD) evaluation. In adults, presence of a lumbar spine (LS) BMD T-score discrepancy (>1 SD difference between adjacent vertebrae) can indicate a vertebral fracture. In children, however, the clinical significance of such discrepancies is unknown. We conducted a retrospective study to evaluate the association between LS DXA and LS morphology to elucidate the clinical significance of an LS BMD Z-score discrepancy. We identified 360 DXA scans performed between September 2014 and May 2016 in patients 5-18 years of age. DXA scans were cross-referenced against available LS radiographs and vertebral fracture assessment (VFA) within the 6 months preceding or following a DXA scan. After excluding 44 DXA scans because of spinal hardware, incomplete DXA, or repeat scans, 316 DXA scans were included; 81 (25.6%) had either an LS radiograph or a VFA. Twenty-five of 81 patients (30.9%) had >1 SD difference between adjacent vertebrae in LS BMD Z-score. Two of these 25 patients (8%) had a lumbar vertebral fracture documented by a spine radiograph. Of the remaining 56 patients who did not have a discrepancy >1 SD, 6 patients (11%) had a lumbar vertebral fracture. Discrepancies in LS BMD Z-scores were not associated with lumbar vertebral fractures and, in the absence of fractures, likely represented vertebral developmental variants in children whose skeletons are still growing. Therefore, it does not appear justified to recommend further imaging based solely on the results of a DXA scan without clinically meaningful indications.

Original languageEnglish (US)
Pages (from-to)980-985
Number of pages6
JournalJournal of Investigative Medicine
Issue number6
StatePublished - Aug 2018

Bibliographical note

Funding Information:
Funding Research reported in this publication was partially supported by the National Cancer Institute of the National Institutes of Health under award number R01CA181024 to KS.


  • BMD Z-scores
  • DXA
  • children
  • vertebral fracture
  • Bone mineral density

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Extramural

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