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Comment on "True" and "Apparent" Bone Density Measurement In Children with GH Deficiency

Division of Endocrinology and Metabolism, University of Arkansas Medical School, Little Rock, AR 72205

The data of Baroncelli and colleagues (1) reinforce the need to relate bone mass to bone volume in the growing skeleton. They have demonstrated that growth hormone deficiency separately reduces both the size of the bones and the amount of bone within the periosteal envelope, but this important conclusion is obscured by confusing terminology. "True" bone density refers to bone as a substance or material, whereas "apparent" bone density refers to the whole bone as an organ (2 , 3). The phrase "apparent true bone density," which appears several times in the text and in the editorial flyer on the cover, is an absurdity. Also, the accumulation of cancellous and cortical bone during growth should not be referred to as "mineralization," which is the accumulation of mineral by osteoid. This process is unaffected by growth hormone deficiency, which causes not "undermineralization" but reduced net bone formation on the endosteal envelope.

Footnotes

Address correspondence to: Dr. A. Michael Parfitt, Division of Endocrinology and Metabolism, University of Arkansas Medical School, 4301 W. Markham Street, Slot 587, Little Rock, AR 72205-7199

Received December 2, 1998.

References

1. Baroncelli GI, Bertelloni S, Ceccarelli C, Saggese G. 1998 Measurement of volumetric bone mineral density accurately determines degree of lumbar undermineralization in children with growth hormone deficiency. J Clin Endocronol Metab. 83:3150–3154.[Abstract/Free Full Text]
2. Robinson RA. 1960 Chemical analysis and electron microscopy of bone. In: Rodahl K, Nicholson JT, Brown EM, eds. Bone as a tissue. New York; McGraw-Hill Book Company, 186–250.
3. Parfitt AM. 1988 The composition, structure, and remodeling of bone: A basis for the interpretation of bone mineral measurements. In: Dequeker J, Geusens P, Wahner HW, eds. Bone mineral measurements by photon absorptiometry: Methodology problems. Leuven; Leuven University Press: 9–28.

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