Mather, Sandra Joan; (2000) Ultrasound bone analysis in children and adolescents with anorexia nervosa and related eating disorders. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Since the development of the broadband ultrasound attenuation (BUA) technique [LANG 1984] there has been considerable interest in its use to assess osteoporosis in adults but its application in paediatrics has been limited. The first aim of this research was to test rigorously the utility of a commercial ultrasound machine, the CUBA Clinical, for longitudinal studies in paediatrics. The second aim was to use BUA to evaluate the bone status of children with anorexia nervosa and related eating disorders (ANRED). Cross-sectional data were obtained on 52 children with ANRED and 100 healthy control children, and longitudinal data were obtained on 23 children with ANRED and 62 controls. The precision of the CUBA Clinical, measured as the root mean square standard deviation of paired measurements on 50 children, was 6.02dB.MHz-1. Using 3 multiples of the precision as the benchmark for significant clinical change in vivo, the CUBA Clinical was not precise enough to measure significant BUA changes in a group of 85 children when scanned at one-year intervals. Cross-sectional data analysis demonstrated that the 52 children with ANRED had a significantly reduced mean BUA Z score compared to age and gender matched controls (mean -0.82, 95%CI -0.52, -1.12), but when compared to weight and gender matched controls the BUA Z scores were within normal limits (mean 0.02, 95%CI 0.33, -0.29). However a sub-group of 18 children with food avoidance emotional disorder (FAED) had mean BUA Z scores both for age and gender (mean -1.43, 95%CI -0.96, -1.90) and weight and gender (mean -0.56, 95%CI, -0.03, -1.09) which were significantly reduced below zero. Almost 89% (16/18) of these FAED children were pre-pubertal which is likely to have had an impact on the low BUA Z scores seen. In conclusion the CUBA Clinical is not precise enough to measure significant annual changes in BUA in paediatrics. Children with ANRED have significantly reduced BUA Z scores for age and gender. Pre and peri-pubertal children with FAED have both age and weight corrected BUA Z scores that are significantly reduced. They are therefore a sub-group less likely to attain an optimal peak bone mass and more likely to sustain a future osteoporotic fracture.

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