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Cincinnati Children’s Hospital Medical Center (H.J.K.), Cincinnati, Ohio 45229; Children’s Hospital of Philadelphia (B.S.Z., S.M.), Philadelphia, Pennsylvania 19104; Children’s Hospital Los Angeles (V.G.), Los Angeles, California 90027; Creighton University (J.M.L.), Omaha, Nebraska 68131; Columbia University (M.H., S.O.), New York, New York 10032; University of California at San Francisco (B.F., J.A.S.), San Francisco, California 94143; Clinical Trials and Surveys Corp. (M.M.F.), Baltimore, Maryland 21210; and National Institute of Child Health and Human Development (K.W.), Bethesda, Maryland 20892
Address all correspondence and requests for reprints to: Heidi J. Kalkwarf, Ph.D., Division of General and Community Pediatrics, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, ML 7035, Cincinnati, Ohio 45229. E-mail: heidi.kalkwarf{at}cchmc.org.
Context: Low bone mass may increase risk of fracture. Several chronic medical conditions, medications, and lifestyle factors affect bone mineral accrual. Appropriate reference values are essential for identification of children with bone deficits.
Objective: Our objective was to establish reference curves for bone mineral content (BMC) and density (BMD) in children.
Design and Setting: The Bone Mineral Density in Childhood Study is an ongoing longitudinal study in which measurements are obtained annually at five clinical centers in the United States.
Participants: Participants included 1554 healthy children (761 male, 793 female), ages 6–16 yr, of all ethnicities.
Main Outcome Measures: Scans of the whole body, lumbar spine, hip, and forearm were obtained using dual-energy x-ray absorptiometry. Percentile curves based on three annual measurements were generated using the LMS statistical procedure.
Results: BMC of the whole body and lumbar spine and BMD of the whole body, lumbar spine, total hip, femoral neck, and forearm are given for specific percentiles by sex, age, and race (Black vs. non-Black). BMC and BMD were higher for Blacks at all skeletal sites (P < 0.0001). BMC and BMD increased with age, and a plateau was not evident by age 16 (girls) or age 17 (boys). The variation in BMC and BMD also increased with age.
Conclusions: Age-, race-, and sex-specific reference curves can be used to help identify children with bone deficits and for monitoring changes in bone in response to chronic diseases or therapies.
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