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PURPOSE: To explore sonographic cortical bone thickness (CoT) as a potential indicator of bone mineral density (BMD) measured by dual-energy X-ray absorptiometry for screening and diagnosing pediatric osteoporosis. METHODS: A prospective study included 41 osteopenic or osteoporotic patients and 52 healthy children. Radius cortical thickness (R-CoT), tibial cortical thickness (T-CoT), and second metatarsal cortical thickness (M-CoT) were measured by B-mode ultrasound; CoT values were compared between groups and the correlation between BMD and CoT was examined. RESULTS: There were no significant differences in R-CoT (P = 0.433), T-CoT (P = 0.057), and M-CoT (P = 0.978) values between the patient and control groups. No significant correlations were found between BMD T-scores and R-CoT (r = -0.073, P = 0.490), T-CoT (r = -0.154, P = 0.141), and M-CoT (r = 0.047, P = 0.657) values. CONCLUSION: Sonographic CoT values in children do not correlate with BMD values. Unlike in adults, sonographic CoT measurements do not appear to have a role in assessing BMD in the pediatric population. [ABSTRACT FROM AUTHOR]

Newborns admitted to the neonatal intensive care unit (NICU) regularly undergo painful procedures and may face various painful conditions such as postoperative pain. Optimal management of pain in these vulnerable preterm and term born neonates is crucial to ensure their comfort and prevent negative consequences of neonatal pain. This entails accurate and timely identification of pain, non-pharmacological pain treatment and if needed administration of analgesic therapy, evaluation of treatment effectiveness, and monitoring of adverse effects. Despite the widely recognized importance of pain management, pain assessment in neonates has thus far proven to be a challenge. As self-report, the gold standard for pain assessment, is not possible in neonates, other methods are needed. Several observational pain scales have been developed, but these often rely on snapshot and largely subjective observations and may fail to capture pain in certain conditions. Incorporation of biomarkers alongside observational pain scores holds promise in enhancing pain assessment and, by extension, optimizing pain treatment and neonatal outcomes. This review explores the possibilities of integrating biomarkers in pain assessment in the NICU. [ABSTRACT FROM AUTHOR]

In this pilot study, the aims were to determine the feasibility of whether pain behavior in extremely and very preterm infants and perceived parental stress change when parents are involved in pain reducing measures, either actively, performing facilitated tucking or passively, observing the intervention, in comparison to the involvement of nurses only. In addition, the infant's pain reactivity and parental stress over three time points of measurement was of interest. Extremely and very preterm infants in need of subcutaneous erythropoietin were randomly assigned to the two intervention groups. The intervention encompassed that one parent of each infant was involved during the painful procedure: Either parents executed facilitated tucking themselves or stood by, observing the procedure. Usual care involved that nurse executed facilitated tucking. All infants received 0.5 ml of 30% oral glucose solution via cotton swab before the painful procedure. Infant pain was observed with the Bernese Pain Scale for Neonates (BPSN) and measured with the MedStorm skin conductance algesimeter (SCA) before, during, and after the procedure. Parents' stress levels were measured before and after the painful procedure on the infant, using the Current Strain Short Questionnaire (CSSQ). Feasibility of a subsequent trial was determined by assessing recruitment, measurement and active parental involvement. Quantitative data collection methods (i.e. questionnaires, algesimeter) were employed to determine the number of participants for a larger trial and measurement adequacy. Qualitative data (interviews) was employed to determine parents' perspectives of their involvement. A total of 13 infants (98% participation rate) were included along with their mothers. Median gestational age was 27 weeks (IQR 26-28 weeks), 62% were female. Two infants (12.5%) dropped out of the study as they were transferred to another hospital. Facilitated tucking turned out to be a good method to actively involve parents in pain reducing measures. No significant differences between the two intervention and control groups were found concerning parental stress and infant pain (p =.927). Power analysis indicated that at least N = 741 infants (power of 81%, α =.05) would be needed to obtain statistically significant results in a larger trial, as effect sizes were smaller than expected. Two of the three measurement tools – i.e. the BPSN and CSSQ) – proved easy to implement and were well accepted. owever, the SCA was challenging in this context. Measurements were also found to be time-consuming and resource-intense (i.e. health professionals as assistants). Although the intervention was feasible and was readily accepted by parents, the study design was found to be challenging along with the SCA. In preparation of the larger trial, the study design needs to be revisited and adjusted. Thus, issues of time and resources may be resolved. In addition, national and international collaboration with similar neonatal intensive care units (NICU) needs to be considered. Thus, it will be possible to conduct an appropriately powered larger trial, which will yield important results to improve pain management in extremely and preterm infants in NICU. [ABSTRACT FROM AUTHOR]

Whilst quantitative ultrasound can be reliably used to assess bone health in adults, the fixed location of the transducers in current devices may result in inaccurate and unreliable measurements in bone assessment in children due to the variation in foot size during growth. To improve positioning for paediatric assessment, Jaworski et al. (1995) created an anatomical method to identify the region of interest (ROI), however, there have been no medical imaging studies to confirm that the Jaworski method results in consistent placement of the transducer on the centre of the calcaneal body to avoid edge artefacts. In this study, computed tomography scans of the tarsus were collected from 498 individuals (258 females; 240 males) aged 2 to 20 years and used to create three novel anatomical methods to identify ROI on the calcaneus using palpable landmarks. In addition, the established Jaworski method was applied to the same scans and compared to our novel methods. The maximum ROI significantly increased with age with males having significantly greater diameters, supporting the recommendation that ½ inch diameter transducers should be used on individuals younger than 7 years of age. We identified that 79% of the 'Jaworski points' lied anterosuperior to the ROI centre point identified in this study, with 10% of the points lying outside the ROI. Of the three novel methods, only the calcaneal insertion method demonstrated small measurement variance between individuals of the same age in each sex and is therefore the preferred method for ultrasound clinical application. [ABSTRACT FROM AUTHOR]

Purpose: To examine the influence of participation in competitive sports on bone parameters, as assessed by quantitative ultrasound (QUS) of the phalanges in female adolescents. Methods: Female adolescents (n = 329, 13.0-16.7 years old) were classified into handball (n = 55), swimming (n = 49) and control (n = 225) groups. QUS was used to evaluate the amplitude-dependent speed of sound (AD-SoS) and bone transmission time (BTT), and their z-scores (zAD-SoS and zBTT) were calculated. Anthropometric measurements and Tanner's stages were also obtained. Results: Swimmers had higher AD-SoS (2089 ± 43.8 m/s) and zAD-SoS (0.47 ± 0.8) than controls (2060 ± 54.0 m/s; 0.09 ± 1.0; both p ≤ .05) and both groups of athletes had higher BTT (handball: 1.44 ± 0.2 |as; swimming: 1.45 ± 0.2) and zBTT (handball: 0.71+0.8; swimming: 0.72 ±1.1) than the control group (1.37 ± 0.2 µs; 0.32 ± 0.9; all p ≤ .05). Swimmers had a higher total training time (TTT: 52.5 ± 27.6 months) and frequency of training per week (FT: 5.38 ±0.1) compared with the handball group (35.9 ±18.1; 3.32 ±0.8;p ≤ .05). zAD-SoS, BTT and zBTT were positively correlated with FT, while BTT and zBTT showed a positive correlation with TTT. Conclusions: Sports practice influences bone parameters and higher bone parameter values are related to the amount of time and frequency of weekly training. The differences in phalangeal QUS parameters are independent of the impact of weight-bearing exercise. [ABSTRACT FROM AUTHOR]

Long-term effects of type 2 diabetes mellitus (T2D) on bone health remain unclear. The objective of this study was to assess the possible association of bone mineral density (BMD) at multiple sites with T2D after correcting for several potential confounders such as age, sex, Tanner stage, and BMI known to affect BMD in adolescents with newly developed T2D. In this cross-sectional study, 17 children and adolescents with T2D and 59 age, sex, and BMI-matched controls were included. All subjects underwent dual-energy X-ray absorptiometry to measure regional and whole-body composition with Lunar Prodigy at the time of initial diagnosis. A BMD Z-score was calculated using data from healthy Korean children and adolescents after adjusting for height-for-age. The mean age of all subjects was 12.9 ± 2.4 years (range, 8.3-18.3 years). BMDht Z-scores for lumbar spine and total body after adjusted for age, sex, BMI SDS, and Tanner stage were not significantly different between patients and controls. However, BMDht Z-scores for femur neck and bone mineral apparent density (BMAD) Z-scores of lumbar spine were significantly lower in T2D patients than those in healthy controls. HOMA-IR or HbA1c was not associated with BMDht Z-scores at multiple sites. BMDht Z-scores at multiple sites except femur neck in adolescents with newly developed T2D were similar to those in obese controls after adjustment for potential confounders. [ABSTRACT FROM AUTHOR]

Summary: Two methods of skeletal status assessment—quantitative ultrasound (QUS) and densitometry (DXA)—were applied and compared in a group of children with different renal disorders. Skeletal assessments in children with different renal conditions should rather not be based on a single diagnostic tool. Lumbar spine DXA is very effective to reveal disturbances secondary to glucocorticoids, whereas total body DXA and QUS are both better in identification of disturbances related to decreased GFR.Introduction: The aim of the study was to evaluate the skeletal status in children in different stages of chronic kidney disease (CKD) or treated with glucocorticoids, using either densitometry (DXA) or quantitative ultrasound (QUS) methods.Methods: Seventy-six subjects (27 girls/49 boys) at the mean age of 11.8 ± 4.0 years were enrolled to the reported study. They were divided into three subgroups: with normal glomerular filtration rate (GFR) but treated with glucocorticoids (GCs, n = 38), with decreased GFR (CKD 2-5, n = 26) and with normal GFR and without any bone-toxic treatment (CKD 1, n = 12). DXA scans were carried out at lumbar spine (LS) and at total body (TB), and quantitative ultrasound (QUS) imaging was done at hand phalanges. QUS results were compared to those obtained from 310 healthy matched controls.Results: The average Z-score for LS-BMD and TB-BMD was below zero in all the study subgroups. Neither were there any significant differences in the mean Z-score for LS among the subgroups. The mean Z-score for TB was significantly the lowest in the CKD 2-5 subgroup. The percentage of subjects with TB Z-score ≤ − 2.0 was the highest in the CKD 2-5 subgroup (69.2%), whereas the percentage of subjects with LS Z-score ≤ − 2.0 was the highest in the GC subgroup (23.7%). QUS results in CKD 2-5 were significantly lower than those in the controls, whereas the results, obtained in GC and CKD 1 subgroups, were similar to those in healthy subjects.Conclusions: Skeletal status assessment in children and adolescents with different renal conditions should not be based on single diagnostic approach. DXA scanning, performed at lumbar spine, is potentially more appropriate to reveal disturbances secondary to long-term GC therapy, whereas TB-DXA is highly effective in the identification of skeletal disturbances related to decreased kidney function. QUS at hand phalanges seems to be a useful diagnostic means in CKD with diminished GFR but insufficient to detect GC-related disturbances. [ABSTRACT FROM AUTHOR]

Adults with Type 1 diabetes mellitus show a high risk of bone fracture, probably as a consequence of a decreased bone mass and microarchitectural bone alterations. The aim of the study was to investigate the potential negative effects of type 1 diabetes on bone geometry, quality, and bone markers in a group of children and adolescents. 96 children, mean age 10.5 ± 3.1 years, agreed to participate to the study. Bone geometry was evaluated on digitalized X-rays at the level of the 2nd metacarpal bone. The following parameters were investigated and expressed as SDS: outer diameter (D), inner diameter (d), cortical area (CA), and medullary area (MA). Bone strength was evaluated as Bending Breaking Resistance Index (BBRI) from the geometric data. Bone turnover markers (PINP, CTX-I, and BAP), sclerostin, Dkk-1, PTH, and 25OH-Vitamin D were also assessed. A group of healthy 40 subjects of normal body weight and height served as controls for the bone markers. D (- 0.99 ± 0.98), d (- 0.41 ± 0.88), CA (- 0.85 ± 0.78), and MA (- 0.46 ± 0.78) were all significantly smaller than in controls (p < 0.01). BBRI was significantly lower (- 2.61 ± 2.18; p < 0.0001). PTH, PINP, and BAP were higher in the diabetic children. Multiple regression analysis showed that CA and D were influenced by insulin/Kg/day and by BMI, while d was influenced by PINP only. Type 1 diabetic children show smaller and weaker bones. The increased bone turnover could play a key role since it might amplify the deficit in bone strength associated with the inadequate osteoblastic activity caused by the disease itself. [ABSTRACT FROM AUTHOR]

Background. Studies using dual energy X-ray absorptiometry (DXA) demonstrate a reduction in bone mineral density (BMD) in children and adolescents with Turner syndrome (TS). However, these studies do not take into account changes in bone size, which influence BMD in the case of short-statured patients. Phalangeal quantitative ultrasound (phQUS) measurements have shown an ability to reveal changes due to skeletal growth, aging, and bone and mineral disorders. There is limited data on bone mineral status in girls with TS assessed by 2 different techniques, i.e., DXA and phQUS. Objectives. The aim of this study was to investigate the potential negative impact of TS on bone status and to assess whether densitometric values were related to former fractures. Material and methods. In 43 TS girls aged 5-18 years, we evaluated bone status by 2 different densitometric techniques, DXA and phQUS. Results. The mean lumbar spine areal bone mineral density (LS aBMD) Z-score was significantly lower than 0 (the hypothetical mean) compared to the reference population (p < 0.001). The mean LS aBMD height-adjusted Z-score did not differ significantly from 0. The amplitude-dependent speed of sound (Ad-SoS) Z-score was significantly lower than 0 compared with a Polish reference population. There were no significant differences between fractured and fracture-free patients as regards Ad-SoS Z-score and LS aBMD height-adjusted Z-score. Conclusions. Girls with TS have normal bone density adjusted for height, but significantly decreased phQUS values. Neither DXA nor phalangeal Ad-SoS can identify young TS patients with former fractures. [ABSTRACT FROM AUTHOR]

Objectives: To assess the skeletal status in asthmatic children treated with inhaled corticosteroids in a longitudinal observation by quantitative ultrasound (US) measurement at the hand phalanges. Methods: Thirty ‐ four children were studied prospectively. Quantitative US measurements were performed at baseline and after a mean ± SD of 2.35 ± 0.20 years. The obtained results were compared to age ‐ , sex ‐ , and body size ‐ matched control participants selected from a database of previously examined healthy children. Individual changes in the amplitude ‐ dependent speed of sound (Ad ‐ SoS) during the follow ‐ up period were also analyzed. Results: The mean age of the asthmatic children was 10.6 ± 2.5 years. The mean Ad ‐ SoS in the asthmatic children at baseline was 1940.5 ± 49.6 m/s, and the mean Z score was −0.26 ± 0.80. Corresponding values at the follow ‐ up examination were 1976.2 ± 63.6 m/s and −0.18 ± 1.16. The results did not differ significantly in comparison to the healthy controls. The analysis of individual changes in Ad ‐ SoS revealed that 18 participants had a significant increase in this parameter (ie, exceeding the least significant change threshold), and 16 did not have a significant change in their values. No one had a significant decrease in Ad ‐ SoS. Conclusions: Quantitative US at the hand phalanges applied as a diagnostic tool revealed no essential differences in the pattern of skeletal development between asthmatic children treated with inhaled glucocorticosteroids and healthy controls. [ABSTRACT FROM AUTHOR]

Background:To determine the bone status in children with inflammatory bowel diseases (IBD) using quantitative ultrasound (QUS) measurement at hand phalanges and compare the obtained results with dual-energy X-ray absorptiometry (DXA). Methods:Fifty-one children with IBD underwent DXA and QUS measurements at hand phalanges in the year 2013. The control group for the QUS consisted of 460 children. Reference data for DXA comes from Hologic Explorer. Results:QUS measurements did not differ significantly between IBD patients and healthy controls. There was no difference between UC and CD subjects. DXA measurements in patients with IBD were lower than in the healthy population. Tanner stage and nutritional status correlated with bone status contrary to steroids therapy. Conclusion:Low bone mineral density often complicates IBD in children. QUS is not an appropriate method for the assessment of bone status in children. Nutritional status seems to have a greater impact on bone status than corticosteroids therapy. [ABSTRACT FROM PUBLISHER]

Copyright of Chinese Journal of Osteoporosis is the property of Chinese Journal of Osteoporosis and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Subjects with type 1 diabetes mellitus (T1DM) have decreased bone mineral density and an up to sixfold increase in fracture risk. Yet bone fragility is not commonly regarded as another unique complication of diabetes. Both animals with experimentally induced insulin deficiency syndromes and patients with T1DM have impaired osteoblastic bone formation, with or without increased bone resorption. Insulin/IGF1 deficiency appears to be a major pathogenetic mechanism involved, along with glucose toxicity, marrow adiposity, inflammation, adipokine and other metabolic alterations that may all play a role on altering bone turnover. In turn, increasing physical activity in children with diabetes as well as good glycaemic control appears to provide some improvement of bone parameters, although robust clinical studies are still lacking. In this context, the role of osteoporosis drugs remains unknown. [ABSTRACT FROM AUTHOR]

Aims: To establish normative data for phalangeal quantitative ultrasound (QUS) measures in Brazilian students. Methods: The sample was composed of 6870 students (3688 females and 3182 males), aged 6 to 17 years. The bone status parameter, Amplitude Dependent Speed of Sound (AD-SoS) was assessed by QUS of the phalanges using DBM Sonic BP (IGEA, Carpi, Italy) equipment. Skin color was obtained by self-evaluation. The LMS method was used to derive smoothed percentiles reference charts for AD-SoS according to sex, age, height and weight and to generate the L, M, and S parameters. Results: Girls showed higher AD-SoS values than boys in the age groups 7–16 (p<0.001). There were no differences on AD-SoS Z-scores according to skin color. In both sexes, the obese group showed lower values of AD-SoS Z-scores compared with subjects classified as thin or normal weight. Age (r2 = 0.48) and height (r2 = 0.35) were independent predictors of AD-SoS in females and males, respectively. Conclusion: AD-SoS values in Brazilian children and adolescents were influenced by sex, age and weight status, but not by skin color. Our normative data could be used for monitoring AD-SoS in children or adolescents aged 6–17 years. [ABSTRACT FROM AUTHOR]

Purpose: The aim of our study was to evaluate bone quality by quantitative ultrasound (QUS) at the phalanges in 129 monozygotic twin couples, outlining the differences between growing subjects and adults. Materials and methods: A total of 129 healthy monozygotic twin couples (42 of children under 18 years of age and 87 of adults) were studied by phalangeal QUS, measuring amplitude-dependent speed of sound (AD-SoS) and bone transmission time (BTT). Anthropometric data were also recorded. Results: In children AD-SoS and BTT were positively correlated with age ( r = 0.91, r = 0.91), height ( r = 0.88, r = 0.90) and weight ( r = 0.81, r = 0.87); in adults AD-SoS was negatively related to age ( r = −0.36), AD-SoS and BTT were positively related to height ( r = 0.37, r = 0.58). Absolute value differences between twins for AD-SoS and BTT were significantly higher in adult twins (25.9 ± 21.9 for AD-SoS and 0.08 ± 0.08 for BTT) than in children (14.5 ± 12.4 for AD-SoS and 0.05 ± 0.04 for BTT). Conclusion: Differentiation in bone tissue quality in twins increases with age, probably reflecting lifestyle, personal habits, likely acting through epigenetic mechanisms. [ABSTRACT FROM AUTHOR]

Background: Dual-energy absorptiometry (DXA) is the current reference standard for assessing pediatric osteoporosis; however due to its areal nature, it has limitations. Thus, quantitative ultrasound (QUS), a modality free of ionizing radiation, has been proposed as a potential surrogate for DXA. Objective: To semi-quantitatively assess the diagnostic accuracy of QUS for evaluating pediatric osteoporosis according to the U.S. Preventive Services Task Force guidelines. Materials and methods: We retrieved articles on the diagnostic accuracy of quantitative US for assessing abnormal bone quality or quantity in patients of mean age ≤19 years from MEDLINE, EMBASE and Cochrane Library CCTR databases. Evidences were analyzed for reliability, construct and criterion validity, and responsiveness of quantitative US, according to the following questions: (1) How reliable is the acquisition of QUS measurements? (2) Is QUS diagnostically accurate to characterize bone strength and quality in osteoporotic children? (3) Is QUS sensitive to detect changes in bone status over time? (4) Is QUS able to predict future skeletal fractures/degeneration? Three reviewers independently evaluated the quality of reporting and methodological quality using the Standards for Reporting of Diagnostic Accuracy (STARD) and the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tools. Results: Out of 262 retrieved references (215 unique), we included 28 studies (1,963 patients; 807 reported boys and 761 girls, others unspecified; reported mean age, 0-19 years). The mean quality of reporting score was 'excellent' in 24/28 (86%) studies; 11/28 (39%) studies had 'adequate' research design quality. Conclusion: There is no evidence of the diagnostic value of QUS at the present time despite the overall excellent and adequate research design quality of primary studies. Although QUS can produce reliable measurements, insufficient evidence has been reported to support other clinimetric properties of this technique. [ABSTRACT FROM AUTHOR]

Copyright of Revista Paulista de Pediatria is the property of Assocoacao de Pediatria de Sao Paulo and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: The aim of the study was to verify the association between body composition and physical fitness with bone status in children and adolescents. Methods: A cross-sectional study was conducted with 300 healthy students (148 boys, 152 girls). Weight, height, fat and fat-free mass, and percentage of body fat (%BF) were evaluated, as were physical fitness (abdominal exercise, flexibility, and horizontal jump tests) and maximum oxygen consumption. Bone parameters (amplitude-dependent speed of sound; AD-SoS) and the Ultrasound Bone Profile Index (UBPI) were evaluated using DBM Sonic BP ultrasonography. Results: In the study group, girls had higher bone parameter values than boys. A univariate analysis assessed in a stepwise multiple regression model was conducted. It showed that for boys, the %BF and height were significant independent variables for AD-SoS and UBPI, but the horizontal jump test only for AD-SoS (adjusted r² = 0.274; p < 0.001), and pubertal maturation only for UBPI (adjusted r² = 0.295; p < 0.001). For girls, age and %BF were identified as significant independent variables for AD-SoS and UBPI (adjusted r² = 0.093; p < 0.001) but height only for AD-SoS (adjusted r² = 0.408; p < 0.001). Conclusions: Variables related to growth (age, height, and pubertal maturation) are independent positive predictors for the bone parameters in both boys and girls. %BF is an independent negative predictor. For boys, the horizontal jump test was an independent positive predictor for AD-SoS, indicating that physical fitness related to the neuromotor system can influence the amount of bone present. [ABSTRACT FROM AUTHOR]

The purpose of this study was to: (a) determine the relationship between quantitative ultrasound (QUS) results and anthropometric, dietary and body composition factors and establish reference ranges for amplitude-dependent speed of sound (Ad-SoS) in the phalanges and broadband ultrasound attenuation (BUA) in the calcaneus of children from Extremadura, Spain, and (b) to present reference curves for this population. Healthy children ( n = 245), aged 4-16 years, were included (124 girls and 121 boys). Phalangeal and calcaneal QUS measurements were performed using DBM Sonic Bone Profiler and McCue CUBA Clinical ultrasound devices, respectively. Weight, height and body mass index (BMI) were evaluated by anthropometric methods. Fat percentage, fat mass, lean mass (FFM) and total body water (TBWater) were evaluated by bioelectrical impedance measurements using a Holtain body composition analyzer. Food intake was evaluated by a 7-day food record. A gender analysis revealed that Ad-SoS and BUA parameters increased significantly with age and that both positively correlated with age, weight, height, BMI, FFM and TBWater. For both genders, Ad-SoS showed significant and positive correlations with age, weight, height, BMI, FFM, BUA and TBWater. [ABSTRACT FROM AUTHOR]

Summary: This longitudinal study examined how calcaneal quantitative ultrasound (QUS) measures change during childhood while taking into account skeletal maturation, body mass index (BMI), and physical activity. The study reported sex differences in QUS growth curves and an inverse relationship between BMI and speed of sound (SOS) measures. Introduction: The aim of this study was to examine how calcaneal QUS parameters change over time during childhood and to determine what factors influence these changes. Methods: The study sample consisted of a total of 192 Caucasian children participating in the Fels Longitudinal Study. A total of 548 calcaneal broadband ultrasound attenuation (BUA) and SOS observations were obtained between the ages of 7.6 and 18 years. The best fitting growth curves were determined using statistical methods for linear mixed effect models. Results: There are significant sex differences in the pattern of change in QUS parameters ( p < 0.05). The relationship between QUS measures and skeletal age is best described by a cubic growth curve in boys and a linear pattern among girls. Boys experience their most rapid growth in BUA and SOS in early and late adolescence, while girls experience constant growth throughout childhood. Adiposity levels were significantly associated with the changes in SOS among boys ( p < 0.001) and girls ( p < 0.01), indicating that children with higher BMI are likely to have lower SOS over time compared to children with lower BMI. For girls, physical activity levels showed positive associations with changes in QUS measures ( p < 0.05). Conclusion: This study documents significant sex differences in the pattern of change in QUS measures over childhood and adolescence. Our study also shows significant influences of adiposity and physical activity on the pattern of change in QUS measures during childhood. [ABSTRACT FROM AUTHOR]

We present age- and gender-specific normative bone status data evaluated by quantitative ultrasound (QUS) in the calcaneus with the Lunar Achilles device and compare these estimates with bone mineral content (BMC) and bone mineral density (BMD) estimated by dual X-ray absorptiometry (DXA). Included were a sample of 518 population-based collected Swedish girls and 558 boys aged 6-19 years. QUS measurements included speed of sound (SOS), broadband ultrasound attenuation (BUA), and stiffness index (SI) in the calcaneus. DXA measurements included BMC and BMD in the femoral neck (FN), lumbar spine (L2-L4), and total body (TB). Height and weight were measured with standard equipment. Age, height, and weight were significantly associated with SOS, BUA, and SI. Compared to SOS, in both girls and boys there was a higher correlation between BUA and FN BMC (r = 0.71 and r = 0.73, respectively), FN BMD (r = 0.68 and r = 0.67, respectively), L2-L4 BMC (r = 0.70 and r = 0.64, respectively), L2-L4 BMD (r = 0.69 and r = 0.64, respectively), TB BMC (r = 0.76 and r = 0.75, respectively), and TB BMD (r = 0.74 and r = 0.74, respectively). The correlations between SOS and FN BMC (r = 0.38 and r = 0.52, respectively), FN BMD (r = 0.41 and r = 0.52, respectively), L2-L4 BMC (r = 0.31 and r = 0.40, respectively), L2-L4 BMD (r = 0.32 and r = 0.41, respectively), TB BMC (r = 0.42 and r = 0.49, respectively), and TB BMD (r = 0.48 and r = 0.54, respectively) were lower, although still significant (all P < 0.001). BUA seems to be the QUS parameter that best resembles the changes in BMC during growth. [ABSTRACT FROM AUTHOR]

In order to keep subscribers up-to-date with the latest developments in their field, John Wiley & Sons are providing a current awareness service in each issue of the journal. The bibliography contains newly published material in the field of diabetes/metabolism. Each bibliography is divided into 26 sections: 1 Reviews; 2 General; 3 Genetics; 4 Epidemiology; 5 Immunology; 6 Obesity; 7 Prediction and Prevention; 8 Intervention: a) General; b) Care; c) Drug Therapy; d)Economics; e) Gene therapy; f) Nursing; g) Nutrition; h) Surgery; i) Transplantation; 9 Pathology and Complications: a) General; b) Cardiovascular; c) Eye disease; d) Gestational and fetal; e) Neurological; f) Podiatrical; g) Renal; 10 Endocrinology & Metabolism; 11 Experimental Studies; 12 Diagnosis and Techniques. Within each section, articles are listed in alphabetical order with respect to author [ABSTRACT FROM AUTHOR]

The aim of the study was to investigate the potential negative impact of type 1 diabetes on bone status of adolescents. Bone status in adolescents with type 1 diabetes was assessed by means of quantitative ultrasound (QUS) and the influence of metabolic control and other disease-related and growth variables was analysed. Group I consisted of 99 pubertal (Tanner ≥2) adolescents (49 female), aged 14.3 ± 2.5 years, diabetes duration 4.6 ± 2.3 years. Controls (group II) were 297 children, matched by sex and age, from a healthy population. The influence of glycated haemoglobin (current: HbA1cD; last year’s mean: HbA1cY; whole duration mean: HbA1cT), diabetes duration, percentage of life with disease and daily insulin requirement (DIR) on amplitude dependent speed of sound (Ad-SoS) at distal phalanges was studied. In comparison to the control group, adolescents with type 1 diabetes presented significantly higher BMI SDS (0.82 [95% CI 0.54, 1.10] vs −0.06 [95% CI −0.16, 0.04] p < 0.001) and lower Ad-SoS SDS (−0.34 [95% CI −0.57, −0.11] vs −0.03 [95% CI −0.15, 0.08], p < 0.05). No correlation between Ad-SoS SDS and sex, DIR or diabetes duration was observed. The lower Ad-SoS SDS reflects reduced bone status, and the reduction was significantly more marked in those patients whose HbA1cT was higher than 7.0% when compared with those whose HbA1cT was lower. Bone status of adolescents with type 1 diabetes mellitus assessed with QUS differs from that of healthy peers and is dependent on long-term metabolic control. [ABSTRACT FROM AUTHOR]

Quantitative ultrasound (QUS) is a non-invasive technique for the investigation of bone tissue in several pathologies and clinical conditions, especially in the field of osteoporosis. The versatility of the technique, its low cost and lack of ionising radiation have led to the diffusion of this method worldwide. Several studies have been conducted in the last years to investigate the potential of QUS in multiple areas with promising results; the technique has been applied in the prediction of osteoporotic fractures, in monitoring therapies, in the investigation of secondary osteoporosis, in paediatrics, neonatology and genetics. Our review article gives an overview of the most relevant developments in the field of quantitative ultrasound, both in clinical and in experimental settings. [ABSTRACT FROM AUTHOR]

Children with cerebral palsy have various risk factors for compromised bone health. Evidence concerning their bone fragility is gathering; however, there is no consensus regarding risk factors, indications for evaluation, follow-up, or treatment. We performed an evidence-based review targeted to address the following questions concerning children with cerebral palsy: Is bone strength impaired and what are the risk factors? Are these children at increased risk for bone fractures? What are the relations between bone mineral density and fracture risk? What methods can be used for bone health assessment? How can bone strength be improved? Currently, the most acceptable method for evaluating bone status in children is dual-energy x-ray absorptiometry. Evidence demonstrates reduced bone mass in children with cerebral palsy; yet, no clear association with fractures. Preventive methods are suggested. [ABSTRACT FROM AUTHOR]

We evaluate reference data to examine whether there are sex-, age-, height-, weight- and BMI-related differences of quantitative ultrasound parameters (QUS) for healthy Chinese children and adolescents. A total of 726 healthy children and adolescents (360 male and 366 female) aged from 10–21 years were examined with a Lunar Achilles Express densitometer. The measurements on the right heel included speed of sound (SOS), broadband ultrasound attenuation (BUA), and a calculated stiffness index (SI). Our results found that there were no significant differences for BUA, SOS and SI between males and females, except in the age range of 12 to 13 years. The values of all parameters were significantly higher in the 12-year-old females compared to males, and BUA values were significantly higher in 13-year-old females compared to males. A spurt in QUS parameters were observed at 12 years in females and at 14 years in males. A steady increase of BUA, SOS, and SI was seen with increasing body height and weight in both sexes. In conclusion, the present results can be used as reference data for children and adolescents in China. [ABSTRACT FROM AUTHOR]

Growing awareness that osteoporosis may have its antecedents in childhood has led to increasing interest in assessing bone mass in children and adolescents. Several noninvasive imaging techniques are currently available to measure properties of the growing skeleton, including bone mass, density, cross-sectional area, and microarchitecture. Dual-energy x-ray absorptiometry (DXA) is the most widely used technique, but it has several major limitations associated with its dependence on two-dimensional projections. Quantitative CT and peripheral quantitative CT allow three-dimensional imaging but are more costly and have higher radiation exposure. Quantitative ultrasound is simple and inexpensive but can measure bone "quality" only at a single peripheral site. MRI techniques for measuring bone are still under development and not yet ready for clinical use. For all of these techniques, clinical interpretation of the bone measures obtained remains a significant challenge. Further research is needed to relate these measures to osteoporosis in the elderly and to shortterm and long-term fracture risk. [ABSTRACT FROM AUTHOR]