Race-neutral Pediatric Reference Ranges for Bone Mineral Density Predict Prospective Fractures in Childhood.

Summary

Using longitudinal DXA data, the authors created race-neutral pediatric BMD/BMAD reference ranges and showed these Z-scores predict prospective fractures (12–18% risk reduction per SD). Race-neutral Z-scores were 0.5–0.7 SD higher than race-specific Z-scores for Black children, supporting equity-focused interpretation.

Key Findings

• Race-neutral pediatric BMD/BMAD Z-scores were 0.5–0.7 SD higher than race-specific Z-scores in Black children.
• Each 1 SD increase in race-neutral Z-score was associated with a 12–18% reduction in prospective fracture risk.
• Growth and lifestyle factors modified group differences but did not negate fracture prediction by race-neutral Z.

Clinical Implications

Consider adopting race-neutral BMD/BMAD Z-scores for pediatric DXA interpretation, especially in Black children previously monitored with race-specific ranges. Implement careful transition strategies to maintain longitudinal comparability.

Limitations

• Sample size by subgroup and exact follow-up duration were not detailed in the abstract
• Implementation may challenge longitudinal comparability for children previously monitored with race-specific references

Future Directions

Prospective multi-center validation of race-neutral Z-scores across diverse populations and integration into pediatric bone health guidelines, with transition tools for legacy race-specific monitoring.