Fracture study from Birmingham

Bone Health Index is significantly lower in children with vertebral fractures than in children without.

 Dr. Nicola Crabtree (Birmingham Women’s and Children’s NHS Trust) and collaborators are conducting the prospective SNAP fracture study of children with chronic inflammatory and/or disabling conditions

Of the 330 sick children recruited, 71 had vertebral fractures.

The study examined three different methods to assess bone health

  1. DXA (Dual energy X-ray Absorptiometry)

  2. pQCT (peripheral Quantitative Computed Tomography)

  3. BHI (Bone Health Index) by BoneXpert

To figure out which bone health assessment is most predictive of fracture, the researchers studied the mean value of the Z-scores of the bone parameters in the fracture and non-fracture groups, and they found that the mean Z-scores were significantly different with p=0.01 for pQCT and BHI, while for DXA they were different with a poorer p-value, p=0.02.

In other words, quoting the abstract that reports the preliminary results:

“The variables most predictive of vertebral fracture were low trabecular density measured by pQCT and BHI by BoneXpert”.

It is remarkable that BHI and pQCT were equally efficient in predicting fractures, because BHI may be the more convenient method, as it requires only a bone age hand radiograph.

This is especially interesting since good paediatric reference curves are missing for DXA, and many conditions in children make pQCT difficult from a practical point of view, whereas BHI can be measured from a simple hand X-ray, and BoneXpert contains reference curves down to 1 month of bone age.

A previous study by Vogiatzi et al found a correlation between BHI SDS and fracture risk in Klinefelter children.