Dexa scan useful for early detection of pediatric cystic fibrosis-related bone disease

"A DXA scan is a useful screening tool which can be used for identifying pediatric patients who could benefit from further therapy and intervention for the preservation of adequate bone health avoiding further loss," Christina Chadwick from the University of Florida in Gainesville, Florida, USA, and colleagues wrote in their study. They stressed that quality improvement (QI) initiatives could improve screening, diagnosis, and early intervention, including physical therapy.

Cystic fibrosis (CF)-related bone disease (CFBD) is observed in adults and can be linked with malnutrition and respiratory illness. The data regarding CFBD in pediatric cystic fibrosis is limited and conflicting. Further investigation needs to be done on pediatric CFBD, given the longer life expectancy and promotion of disease prevention.

For this purpose, a quality improvement project was initiated from April 2016 to December 2018 to improve CFBD screening in patients aged eight and above per the CFF (current CF Foundation) guidelines. A dual-energy X-ray absorptiometry scan was formulated based on the degree of BMD (bone mineral density), shared CFBD guideline recommendations, and ordered scans for eligible patients at weekly review meetings.

DXA results were reviewed from 141 patients following approval from the institutional review board, and data was collected on genetics, comorbidities, relevant serum studies, medication exposure, and anthropometric measures.

The study led to the following findings:

• Fifty-three percent of the patients had normal BMD (n = 75). 12% had a Z score ≤ −2.
• Patients with lower BMD also had lower mean forced expiratory volume (FEV1) percent predicted (FEV1%) and lower body mass index %.
• Patients with lower BMD were overall older at the time of DXA.
• During the study duration, 13 patients who had abnormal DXA results underwent repeat DXAs after physical therapy; 11 of the 13 showed improvement in DXA results.

"A DXA scan is a useful screening tool and is used to identify children who could benefit from further therapy and intervention to protect bone health and avoid further loss," the researchers conclude. "QI initiatives can result in improved screening and diagnosis and earlier interventions such as physical therapy."

"Further studies are required to understand better the utility of physical therapy in children with cystic fibrosis."

Reference:

Chadwick C, Arcinas R, Ham M, Huang R, Hunter S, Mehta M, Sharma P, Varghese PA, Williams K, Troendle DM, Sathe M. The use of DXA for early detection of pediatric cystic fibrosis-related bone disease. Pediatr Pulmonol. 2023 Jan 2. doi: 10.1002/ppul.26304. Epub ahead of print. PMID: 36593123.