Low BMD – paediatric interpretation — RACP Paediatrics MCQ

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ModerateEndocrineLow BMD – paediatric interpretationRACP Paediatrics

A 10-year-old on long-term systemic corticosteroids for nephrotic syndrome has a DXA scan showing lumbar spine BMD Z-score of -1.5. He has no fracture history. What is the correct interpretation?

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Correct answer: A — Low bone density – monitor

A BMD Z-score between -1.0 and -2.0 in children is 'low bone mineral density for chronological age' per ISCD paediatric guidelines. The term 'osteopenia' should NOT be used in children. Z-scores (not T-scores) are used. Osteoporosis in children requires BOTH low BMD (Z-score ≤-2.0) AND clinically significant fracture history. This child has low BMD requiring monitoring and optimisation of modifiable risk factors.

Reference: ISCD – 2019 – Paediatric Official Positions; RACP Paediatric Curriculum – Endocrine