References
  1. Ward LM, Konji VN,Ma J. The management of osteoporosis in children. Osteoporosis Int 2016;7:2147-2149
  2. Sala A, Barr RD. Osteopenia and cancer in children and adolescents. The fragility of success. Cancer 2007;109:1420-1431
  3. Mostoufi-Moab S, Halton J. Bone morbidity in childhood leukemia. Epidemiology, mechanisms, diagnosis and treatment. Curr Osteoporosis Rep 2014;12:300-312
  4. Barr R, Nayiager T, Gordon C, Marriot C, Athale U. Body composition and bone health in long-term survivors of acute lymphoblastic leukemia in childhood and adolescence: the protocol for a cross-sectional cohort study. BMJ Open 2015;5: e006191
  5. Fonseca A, Gordon CL, Barr RD. Peripheral quantitative computed-tomography (pQCT) to assess bone health in children, adolescents, and young adults: A review of normative data. J Pediatr Hematol Oncol 2013;35:581-589
  6. Ness KK, Krull KR, Jones KE et al. Physiologic frailty as a sign of accelerated aging among adult survivors of childhood cancer. J Clin Oncol 2013;31:4496-4503
  7. Silverman LB, Stevenson KE, O’Brien JE et al. Long term results of Dana Farber Cancer Institute Childhood ALL Consortium protocols for children with newly diagnosed acute lymphoblastic leukemia (1985-2000). Leukemia 2010;24:320-324
  8. Calder KM, Inglis D, MacIntyre NJ. Comparison of pQCT-based measures of radial bone geometry and apparent trabecular bone structure using manufacturer and in-house-developed algorithms. J Clin Densitom 2010;13:433-440
  9. Gordon CL, Webber CE, Adachi JD, Christoforou N. In vivoassessment of trabecular bone structure at the distal radius from high-resolution computed tomography images. Phys Med Biol 1996; 41:495-508.
  10. Gordon CL, Webber CE, Nicholson PS. Relation between image-based assessment of distal radius trabecular structure and compressive strength. Can Assoc Radiol J 1998;49:390-397.
  11. MacIntyre NJ, Adachi JD, Webber CE. Gender differences in normal age-dependent patterns of radial bone structure and density. J Clin Densitom 1999;2:163-173.
  12. MacIntyre NJ, Adachi JD, Webber CE. In vivo detection of structural differences between dominant and nondominant radii using peripheral quantitative computed tomography. J Clin Densitom 1999;2:413-422.
  13. Atkinson SA, Halton JM, Bradley C, Wu B, Barr RD. Bone and mineral abnormalities in childhood acute lymphoblastic leukemia: influence of disease drugs and nutrition. Int J Cancer 1998; 11 Suppl: 35-39.
  14. Gordon CL, Webber CE, Cottreau M. Radiation dose associated with peripheral quantitated computer tomography scanning in children. J Bone Miner Res 2003;18: S 302
  15. Neu CM, Rauch F, Manz F et al. Modeling of cross-sectional bone size, mass and geometry at the proximal radius: a study of normal bone development using peripheral quantitative computed tomography. Osteoporos Int 2001;12:538-547.
  16. Moyer-Mileur LJ, Quick JL, Murray MA. Peripheral quantitative computed tomography of the tibia: pediatric reference values. Clin Densitom 2008;11:283-294.
  17. Leonard MB, Elmi A, Mostoufi-Moab S et al. Effect of sex, race and puberty on cortical bone and the functional muscle-bone unit in children, adolescents and young adults. J Clin Endocrinol Metab 2010;95:1681-1689.
  18. Dowthwaite JN, Scerpella TA. Distal radius geometry and skeletal strength indices after peripubertal artistic gymnastics. Osteoporos Int 2011;22:207-216.
  19. Pollock NK, Laing EM, Taylor RG et al. Comparisons of trabecular and cortical bone in late adolescent black and white females. J Bone Miner Metab 2011;29:44-53.
  20. Wetzsteon RJ, Zemel BS, Shultz I et al. Mechanical loads and cortical bone geometry in healthy children and young adults. Bone 2011;48:1103-110.
  21. Roggen I, Roelants M, Sioen I et al. Pediatric reference values for tibial trabecular bone mineral density and bone geometry parameters using peripheral quantitative computed tomography. Calcif Tissue Int 2015;96:527-533.
  22. Jaworski M, Graff K. Peripheral quantitative computed tomography of the distal and proximal forearm in children and adolescents: bone densities, cross-sectional sizes and soft tissues reference data. J Musculoskelet Neuronal Interact 2018;18:237-247.
  23. Jiang H, Yates CJ, Gorelik A, Kale A, Song Q, Wark JW. Peripheral quantitative computed tomography (pQCT) measures contribute to the understanding of bone fragility in older patients with low trauma fracture. J Clin Densitom 2018;21:140-147.
  24. Adams JE, Engelke K, Zemel BS, Ward KA. Quantitative computer tomography in children and adolescents: The 2013 ISCD Pediatric Official Positions. J Clin Densitom 2014; 17: 258-274.
  25. Jaworski M, Kobylińska M, Graff K. Peripheral quantitative computed tomography of the lower leg in children and adolescents: bone densities, cross-sectional sizes and muscular distribution reference data. J Musculoskelet Newuronal Interact 2020, in press.
  26. Neu CM, Manz F, Rauch F, Merkel A, Schoenau E. Bone densities and bone size at the distal radius in healthy children and adolescents: a study using peripheral quantitative computed tomography. Bone 1; 28: 227-232.
  27. Marriott CJC, Beaumont LF, Farncombe TH et al. Body composition in long-term survivors of acute lymphoblastic leukemia diagnosed in childhood and adolescence: A focus on sarcopenic obesity. Cancer 2018;124:1225-1231.
  28. Saggese G, Baroncelli GI, Bertelloni S. Osteoporosis in children and adolescents: diagnosis, risk factors, and prevention. J Pediatr Endocrinol Metab 2001;14:833-859.
  29. Di Iorgi N, Maruca K, Patti G, Mora S. Update on bone density measurements and their interpretation in children and adolescents. Best Pract Res Clin Endocrinol Metab 2018;32:477-498.
  30. Micklesfield LK, Norris SA, Pettifor JM. Determinants of bone size and strength in 13-year-old South African children: the influence of ethnicity, sex and pubertal maturation. Bone 2011; 48: 777-785.
  31. Micklesfield LK, Norris SA, Pettifor JM. Ethnicity and bone: A South African perspective. J Bone Miner Metab 2011; 29- 257-267.
  32. Lüscher SH, Nocciolino LM, Pilot N et al. Differences in the cortical structure of the whole fibula and tibia between long-distance runners and untrained controls. Toward a wider conception of he biomechanical regulation of cortical bone structure. Front Endocrinol 2019; 10:833.
  33. Brennan BMD, Mughal Z, Roberts SA et al. Bone mineral density in childhood survivors of acute lymphoblastic leukemia treated without cranial irradiation. J Clin Endocrinol Metab 2005; 90: 689-694.
  34. Ashby RL, Ward KA, Roberts SA, Edwards L, Mughal MZ, Adams JE. A reference database for the Stratec XCT-2000 peripheral quantitative computed tomography (pQCT) scanner in healthy children and young adults aged 6-19 years. Osteoporos Int 2009; 20: 1337-1346.
  35. Moustofi-Moab S, Brodsky J, Isaacoff EJ et al. Longitudinal assessment of bone density and structure in childhood survivors of acute lymphoblastic leukemia without cranial radiation. J Clin Endocrinol Metab 2012; 97: 3584-3592.
Figure legends
Figure 1. Consort diagram
Figure 2. The distal pQCT scans are segmented with gradient and density threshold steps to reveal the trabecular pattern. For this distal tibia scan A, the trabecular pattern can be skeletonized to reveal its connectivity. The trabecular pattern can also be examined to reveal loss of individual trabecular elements which result in apparent holes in the bone network. As illustrated in B, a hole size analysis can be applied to the trabecular pattern