X-Ray densitometry as a tool for determining bone mineral density children with malabsorption syndrome: a prospective study

INTRODUCTION: Osteoporosis manifestations in the context of malabsorption syndrome result from impaired intestinal micronutrient absorption, representing a significant challenge in pediatric practice. While various modalities exist, dual-energy X-ray absorptiometry offers distinct advantages over ultrasound densitometry or quantitative computed tomography. Interpreting osteoporosis and osteoporotic fracture risk in children is particularly complex due to the often oligosymptomatic presentation and the limited availability of robust pediatric diagnostic criteria. Low-energy fractures, a major complication, significantly diminish quality of life and contribute to premature disability. Early identification of risk factors, coupled with timely prophylactic and therapeutic interventions, is crucial for improving long-term outcomes in this growing population.

OBJECTIVE: To refine the interpretive algorithm for dual-energy X-ray absorptiometry (DXA) reports in a pediatric cohort. 

MATERIALS AND METHODS: Bone mineral density (BMD) and bone mineral content (BMC) serve as the principal surrogate markers for assessing bone health. Clinical screening for osteoporosis fundamentally relies on quantifying these parameters. For this analysis, we selected DXA scan protocols for total body less head (TBLH) and the lumbar spine (L_II–L_IV). The study cohort comprised 98 pediatric patients with gastroenterological conditions. Indications for DXA evaluation included: chronic oral corticosteroid therapy (>3 months duration, >5 mg/day), delayed puberty, a history of two or more long bone fractures by age 10, prior administration of zoledronic acid, and conditions associated with intestinal malabsorption. Assessment of bone metabolism included the Z‑score and individual quantitative BMD (g/cm²).

RESULTS: When employing a rigorous, standardized acquisition protocol coupled with patient-specific interpretation of ageand sex-appropriate reference data, DXA provides clinicians with enhanced diagnostic capability. This approach facilitates accurate baseline assessment of bone mineral status and enables sensitive monitoring of longitudinal changes, thereby guiding therapeutic management in this vulnerable population.

DISCUSSION: It is important to emphasize that the examination protocol has been methodically validated in children aged 5–17 years. Nevertheless, the procedural specifics and interpretation of results in patients younger than 5 years warrant further investigation and methodological refinement to improve the accuracy of data analysis.

CONCLUSION: Adopting a personalized analytical approach minimizes the risk of overdiagnosis and allows for precise identification of the baseline value for longitudinal monitoring of bone mineral density (BMD) accumulation, including quantitative follow‑up assessments. Standardization of the analytical framework in densitometric studies not only facilitates BMD evaluation but also enables assessment of bone metabolism quality and prevention of potential complications.

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