Statistical Challenges in the Analyses of Bone Mineral Density in Pediatric Populations

Assessing bone mineral density (BMD) by dual-energy x-ray absorptiometry (DXA) is standard in clinical practice with good precision and reproducibility. One way to analyze BMD data is through the Z-score where a subject’s BMD is standardized against some reference population. This article highlights...

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Bibliographic Details
Published in:Therapeutic innovation & regulatory science 2015-07, Vol.49 (4), p.569-575
Main Author: Dinh, Phillip
Format: Article
Language:English
Subjects:
Adjustment
Age
Authorship
Bone density
Clinical medicine
Datasets
Drug Safety and Pharmacovigilance
Ethnicity
Nutrition research
Osteoporosis
Pediatrics
Pharmacotherapy
Pharmacy
Population
Special Populations: Analytical Report
Standard deviation
Values
Women
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Summary:Assessing bone mineral density (BMD) by dual-energy x-ray absorptiometry (DXA) is standard in clinical practice with good precision and reproducibility. One way to analyze BMD data is through the Z-score where a subject’s BMD is standardized against some reference population. This article highlights several potential problems in the calculation of the Z-score: (1) reference data are manufacturer dependent; (2) a transformation is recommended to reduce the skewness often seen in BMD data, however a transformation parameter is only available in some references using the Hologic manufacturer; (3) some reference data may be obsolete, as they were done under older scan models; (4) reference data are recommended to be interpolated to the subject’s age, and linear interpolation is questionable; (5) reference data do not exist for all age groups; (6) reference data depend on the race of the subjects, and not all races are representative; and (7) reference data are limited to certain body composition. Given the limitation in the BMD Z-scores, other clinical symptoms (eg, bone fractures) or laboratory findings (eg, bone biomarkers) should be assessed in conjunction with the BMD Z-score to evaluate a subject’s bone health.
ISSN:2168-4790
2168-4804
DOI:10.1177/2168479015570334