Physiologic predictors of lumbar spine bone mass in neonates

Dual energy x-ray absorptiometry (DXA) of the lumbar spine (LS) was measure d in 201 singleton infants with birth weights from 1152 to 3970 g and gesta tional ages from 27 to 42 wk. All infants were well and studied at a mean ( +/-SD) of 2.1 (+/-1.6) days after birth. There were 75 Caucasian (46 males, 29 females) and 126 African American infants (58 males, 68 females). Scan acquisition of the first to fourth lumbar vertebrae was performed with a si ngle beam whole body scanner (Hologic QDR 1000/W densitometer, Hologic Inc, Waltham, MA, U.S.A.) using the infant spine mode. Scan analysis was perfor med with software version 4.57Q acid consistent region of interest. The SD of difference for duplicate LS scans is <1.4% at a mean bone mineral conten t (BMC) of 2.14 g. Results show that LS BMC, area, bone mineral density (BM D) increased by approximately 550%, 280% and 180%, respectively, between 27 and 42 wk gestational age. Body mass accounted for about 70% and 55% of th e variance in BMC and BMD respectively. In contrast, the infant's length ap pears to be the best determinant of LS area and accounts for about 75% of t he variance in LS area. Race, gender or season has little or no effect on L S bone mass. There was progressive increase in BMC and area from first to f ourth lumbar vertebra but BMD was significantly higher only at the fourth l umbar vertebra. We conclude that DXA LS can be performed even in small pret erm infants. Its excellent precision, low radiation exposure and rapid scan acquisition offers promise as a useful tool for widespread use in pediatri cs. Our data may be used as a basis for further studies in physiologic and pathologic situations that may affect bone mineralization in infants.