BoneXpert validated in Afghan toddlers

A new paper by Suma Uday et al reports the use of BoneXpert to study bone age and BHI in deprived Afghan children of age 1.5-2.5 y. This validates version 3 of BoneXpert, which extends the bone age range down to new-borns – the older version of BoneXpert was valid only down to 2.5 years.

This double-blind, randomised, placebo-controlled trial was performed in Kabul in 2007-2009 to evaluate the effect vitamin D3 supplementation on pneumonia. The paper is available here https://link.springer.com/content/pdf/10.1007/s00394-021-02511-5.pdf.

Seven percent of the images could not be analysed, because the hand was not placed flat on the film, or because there was an overlapping adult hand – both effects are present in this image of a boy.

To use BoneXpert in toddlers and infants, it is advised to compress the hand flat on detector with a thin plastic plate. The thumb should form an angle of at least 20 degrees to the index finger as shown in this correctly taken X-ray of a boy.

In the study, the Bone Health Index (BHI) was analysed with standard deviation scores, BHI SDS, (aka Z-scores) based on BoneXpert’s reference curves from healthy Parisian boys and girls expressed as a function of bone age. The Afghan children showed an average bone health slightly below normal.