Pediatric pQCT-derived tibial bone mineral density estimates: A systematic review and meta-regression
Abstract
BACKGROUND
Assessing bone mineral density (BMD) in children and adolescents is essential for detecting skeletal deficits and fracture risk. Peripheral quantitative computed tomography (pQCT) has gained increasing attention as a valuable imaging tool due to its ability to assess bone quality. Unlike dual-energy x-ray absorptiometry, pQCT provides volumetric BMD measurements and distinguishes between cortical and trabecular compartments. Despite these advantages, its clinical adoption remains limited due to the lack of reference data and standardized protocols.
METHODS
A systematic search was conducted in CINAHL, Embase, PubMed, SPORTDiscus, and Web of Science from inception to November 2024. Studies reporting pQCT-derived tibial BMD in healthy children and adolescents (<19 years old) were included. Meta-regression models using natural cubic splines were applied to estimate age-specific BMD values for trabecular and cortical bone. Potential moderators, such as sex, race, reference line location, limb, and pQCT device, were evaluated to assess their influence on BMD outcomes.
RESULTS
Eighty-three studies (18,531 participants) were included in this review. The meta-regression models demonstrated a non-linear relationship between BMD and age, best described using natural cubic splines. Moderator analysis indicated that sex, race, and reference line location significantly influenced cortical BMD, while trabecular BMD was affected by reference line location and pQCT device. The…
How strong is the evidence?
Evidence Hub reads this as a systematic review, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 18,531 participants or records.
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