Peripheral Quantitative Computed Tomography (pQCT) to Assess Bone Health in Children, Adolescents, and Young Adults: a Review of Normative Data

The bone health of adults is dependent on the appropriate acquisition of peak bone mineral mass during late childhood and adolescence. Measurement of bone mineral density (BMD) in clinical practice is accomplished usually by dual energy x-ray absorptiometry that provides 2-dimensional (areal) values for BMD, does not distinguish cortical from trabecular bone, and should be adjusted for height and weight when used for children and adolescents. Peripheral quantitative computed tomography (pQCT) provides volumetric measures of BMD and geometry in both cortical and trabecular bone and, unlike dual energy x-ray absorptiometry, does not need adjustment for body size. Studies of bone health in young people require reference data for normative comparison. A literature review from 1946 to 2012 identified 1886 titles suggesting use of pQCT, with only 32 reporting some form of normative data. A detailed review of these 32 reports revealed a lack of consensus among users for standard scan locations in upper and lower limbs, acquisition protocols and analytical steps, and variables reported. Meaningful and effective use of pQCT for assessing bone strength and overall bone health in all age groups will require better defined normative data derived with common measuring techniques, equipment, and analytical approaches.