DEXA Scan Evaluation of Pediatric Sick Patients (January- May 2017) at one of the Tertiary Hospital of Central India: Management Point of View

Background: Osteoporosis can be seen in children because of chronic medical illness or medication and this must be evaluated. This evaluation results in a lower risk of fractures by early intervention and subsequent management. In the paediatric age group, the radiologist must play an important role in interpreting the DEXA (Dual Energy X-ray Absorptiometery) examination results. The role includes being a statistician, an orthopaedic specialist, and a clinical pathologist. The various factors that influence bone mineral density have been investigated and compared to the available standard database. Bone mineral density (BMD) contributes to a more detailed picture of the overall bone health. There are numerous factors that influence a child's growing skeleton. The radiologist should be familiar with the technical aspects of acquiring this information. The interpretation is always based on information other than the DEXA scan. Z-scoring and other biochemical evaluation parameters are used to diagnose osteoporosis in children. Adult T-scores differ significantly from those that of children.

Methods: Twenty pediatric patients (n=20) were subjected to DEXA examination from January to May 2017 who were referred from pediatric department. All these children were from 10-19 years age group with mixed gender. These patients were having symptoms of common ailments as that of respiratory, renal, gastrointestinal and others.

Results: Ten out of twenty cases (50%) were found to have osteopenia or osteoporosis. The sensitivity of picking up the bone density was high in estimation of lumbosacral spine as compared to the femoral neck region. One case of mal-absorption syndrome was found to have only osteopenia (10%), while others were found to have osteoporosis (90 percent). Among the later group, tuberculosis (40%) was discovered to be the most common positive ailment, followed by mal-absorption (30%), kidney disease (10%), diabetes mellitus (10%), and worm infestation (10%). Males were dominating in this group (72.7%) as compared to females (27.3%). Three (15%) were declared to be within the normal range.

Conclusion: DEXA scan Z-scoring estimation is a highly sensitive method for diagnosing osteoporosis and osteopenia in children. This is non invasive with minimal non-harmful radiation exposure. The evaluation is beneficial in chronic diseases such as tuberculosis, diabetes mellitus, malabsorption syndrome, and kidney disease in diagnosing decreased BMD. This aids in the prevention of fractures in these vulnerable patients by timely management.