Pediatric pQCT-derived tibial bone mineral density estimates: A systematic review and meta-regression

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BACKGROUND: Assessing bone mineral density (BMD) in children and adolescents is essential for detecting skeletal deficits and fracture risk. Peripheral quantitative computed tomography (pQCT) has gained increasing attention as a valuable imaging tool due to its ability to assess bone quality. Unlike dual-energy x-ray absorptiometry, pQCT provides volumetric BMD measurements and distinguishes between cortical and trabecular compartments. Despite these advantages, its clinical adoption remains limited due to the lack of reference data and standardized protocols. METHODS: A systematic search was conducted in CINAHL, Embase, PubMed, SPORTDiscus, and Web of Science from inception to November 2024. Studies reporting pQCT-derived tibial BMD in healthy children and adolescents (<19 years old) were included. Meta-regression models using natural cubic splines were applied to estimate age-specific BMD values for trabecular and cortical bone. Potential moderators, such as sex, race, reference line location, limb, and pQCT device, were evaluated to assess their influence on BMD outcomes. RESULTS: Eighty-three studies (18,531 participants) were included in this review. The meta-regression models demonstrated a non-linear relationship between BMD and age, best described using natural cubic splines. Moderator analysis indicated that sex, race, and reference line location significantly influenced cortical BMD, while trabecular BMD was affected by reference line location and pQCT device. The choice of limb assessed (dominant vs non-dominant) had minimal impact on BMD outcomes. CONCLUSION: We present pQCT-derived BMD estimates from a diverse cohort of healthy children and adolescents and identify key moderators. Our findings provide a foundation for improved understanding and future standardization, laying the groundwork for enhancing the clinical utility of pQCT.

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