Overdiagnosis of osteoporosis in children due to misinterpretation of dual-energy x-ray absorptiometry (DEXA)

J Pediatr. 2004 Feb;144(2):253-7. doi: 10.1016/j.jpeds.2003.08.054.


Objective: Dual-energy x-ray absorptiometry (DEXA) is increasingly used to evaluate children for osteoporosis. However, the interpretation of pediatric DEXA is complicated by growth and development. Because most DEXA scans are performed on adults, we hypothesized that physicians who interpret DEXA may not be aware of these pediatric issues, potentially leading to misdiagnosis.

Study design: Children (n=34, aged 4-17 years) diagnosed with low bone mineral density (BMD) based on a DEXA scan were referred for possible inclusion in a childhood osteoporosis protocol. The referral DEXA scans were analyzed for accuracy.

Results: Thirty (88%) of the scans had at least one error in interpretation. The most frequent error (62%) was use of T-score (SD score compared with young adults) to diagnose osteoporosis, which is inappropriate for children. Other errors included use of a reference database that does not consider gender or ethnic differences (21%), incorrect bone map (21%), inattention to short stature (15%), and other measurement or statistical error (12%). After correcting for these errors, 53% had normal BMD, whereas only 26% retained the diagnosis of low BMD. The remaining 21% could not be given a definitive diagnosis.

Conclusion: In children, the diagnosis of osteoporosis is often due to misinterpretation of a DEXA scan.

MeSH terms

  • Absorptiometry, Photon / methods*
  • Adolescent
  • Body Height / physiology
  • Bone Density / physiology
  • Child
  • Child, Preschool
  • Databases as Topic
  • Diagnostic Errors*
  • Female
  • Humans
  • Male
  • Osteoporosis / diagnosis*
  • Osteoporosis / physiopathology
  • Reference Values
  • United States