DXA in Children with Special Needs

While measuring and assessing bone mineral density (BMD) in the growing skeleton presents unique challenges, performing these measures in children with musculoskeletal involvement that affects positioning or who have skeletal abnormalities that affect interpretation creates additional unique challenges. Cognitive deficits seen in a variety of medical conditions can also pose challenges to acquiring valid bone density scans. This chapter addresses common scan acquisition and interpretation concerns when measuring/assessing bone density by dual-energy absorptiometry (DXA) in children with special needs. Total body, lumbar spine, forearm, and lateral distal femur regions of interest (ROI) are discussed with regard to their suitability for use in this population. Strategies and solutions for obtaining meaningful scans and for their interpretation are reviewed. Specific medical conditions that result in high risk for compromised bone density, including cerebral palsy, muscular dystrophy, spina bifida, spinal muscular atrophy, and osteogenesis imperfecta will be described with a review of current research findings. This chapter is intended to expand on the principles described in earlier chapters of this book and to highlight the special considerations required when assessing bone density in children with special needs.