Introduction
Osteoporosis
Definition of osteoporosis in children
Factors affecting bone health
Assessment of bone mass and structure
Dual energy x-ray absorptiometry
Quantitative computed tomography
Peripheral quantitative computed tomography
High-resolution peripheral quantitative computed tomography
Quantitative ultrasound
Magnetic resonance imaging
Imaging of vertebral fractures
Modality | Spatial resolution (μm) | Effective radiation dose for whole-spine scanning (μSv) | Scan time (min) | Approximate cost (single scan - including cost of reporting in British £) [63] |
---|---|---|---|---|
Conventional radiography | 100×100 | 233 [64] | ˂1 | 37 |
Computed tomography | 600×600 | 10,000 [12] | ˂1 | 74-100 |
Magnetic resonance imaging | 234×234×500 | None | 10-30 | 120-163 |
Dual energy x-ray absorptiometry | 350×350 | 3 [65] | ˂1 | 58 |
Conventional radiography
Reference | Number of patients | Median age (years) | Scoring system | Imaging modality | Number of observers | Sensitivity and specificity | Agreement level (Kappa) |
---|---|---|---|---|---|---|---|
Mayranpaa et al. 2007 [12] | 65 | 12.1 | Genant semiquantitative technique | Radiographs and dual energy x-ray absorptiometry | 1 radiologist 1 orthopaedic spine surgeon | Not available | Radiographs Inter-observer 0.98 Dual energy x-ray absorptiometry Inter-observer 0.34 |
Halton et al. 2009 [4] | 186 | 5.3 | Genant semiquantitative technique | Radiographs | 2 radiologists | Not available | Inter-observer for fracture defined as Grade 1, 2 or 3 0.44 (95% confidence interval 0.28–0.59) Inter-observer for fracture defined as Grade 2 and 3 0.66 (95% confidence interval 0.46–0.87) |
Siminoski et al. 2014 [67] | 186 | 9.6 | Genant semiquantitative technique | Radiographs | 3 radiologists | Not available | Readability* Inter-observer 1) Vertebral level 0.33 to 0.50 2) Patient level 0.29 to 0.46 Intra-observer 1) Vertebral level 0.43 to 0.64 2) Patient level 0.41 to 0.61 Vertebral fracture: Inter-observer 1) Vertebral level 0.45 to 0.54 2) Patient level 0.43 to 0.48 Intra-observer 1) Vertebral level 0.52 to 0.72 2) Patient level 0.52 to 0.76 |
Diacinti et al. 2015 [13] | 58 | 7.0 | Genant semiquantitative technique | Dual energy x-ray absorptiome try | 2 radiologists | Sensitivity 96% Specificity 100% | Inter-observer 1) Vertebral level 0.81 (95% confidence interval 0.76–0.86) 2) Patient level 0.96 (95% confidence interval 0.89–1.03) |
Kyriakou et al. 2015 [14] | 165 | 13.4 | Genant semiquantitative technique | Dual energy x-ray absorptiometry | 2 non-radiologists | Sensitivity 75% Specificity 98% | Readability Inter-observer 1) Vertebral level 0.73 (95% confidence interval, 0.68–0.73) 2) Patient level 0.66 (95% confidence interval, 0.56, 0.77) Vertebral fracture: Inter-observer 1) Vertebral level 0.85 (95% confidence interval, 0.79–0.91) 2) Patient level 0.78 (95% confidence interval, 0.66–0.87) |
Adiotomre et al. 2017 [64] | 250 | 11.5 | Simplified algorithm-based qualitative technique | Radiographs and dual energy x-ray absorptiometry | 3 radiologists | Dual energy x-ray absorptiometry Sensitivity 70% (95% confidence interval 58–82%) Specificity 97% (95% confidence interval 94–100%) Radiographs Sensitivity 84% (95% confidence interval 0.70–0.99) Specificity 72% (95% confidence interval 0.47–0.97) | Dual energy x-ray absorptiometry Inter-observer 0.37 Intra-observer 0.63 Radiographs Inter-observer 0.42 Intra-observer 0.62 |
Crabtree et al. 2017 [15] | 80 | 12.0 | Genant semiquantitative technique | Dual energy x-ray absorptiometry | 1 paediatric radiologist 2 paediatricians | Sensitivity 1) Vertebral level 66% 2) Patient level 82% Specificity 1) Vertebral level 95% 2) Patient level 78% | Inter-observer 1) Vertebral level 0.63 (95% confidence interval 0.56–0.69) 2) Patient level 0.60 (95% confidence interval 0.42–0.77) |
Crabtree et al. 2017 [15] | 80 | 12.0 | Morphometric analysis | Dual energy x-ray absorptiometry | 1 paediatric radiologist 2 clinical scientists 1 radiographer | Sensitivity 1) Vertebral level 79% 2) Patient level 43% Specificity 1) Vertebral level 71% 2) Patient level 97% | Inter-observer 1) Vertebral level 0.32 (95% confidence interval 0.26–0.38) 2) Patient level 0.41 (95% confidence interval 0.24–0.59) |
Alqahtani et al. 2017 [68] | 137 | 12.0 | Morphometric analysis using SpineAnalyzer | Radiographs | 1 paediatric radiologist 2 radiographers 2 medical Students | Sensitivity 18% (95% confidence interval 0.14–0.22) Specificity 97% (95% confidence interval 0.97–0.98) | Inter-observer 0.05–0.47 Intra-observer using intraclass correlation coefficient 0.25–0.61 |