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Background <p>Bone mineral density (BMD) accrual during childhood is critical for lifelong skeletal health. Data regarding pediatric low bone mass and body composition in Indonesia remains limited. This study aimed to determine the prevalence of low bone mass for age in a multicenter Indonesian pediatric cohort and to examine the relationship between whole-body composition parameters and total body BMD to identify key determinants of skeletal health during growth.</p> Methods <p>This retrospective cross-sectional study included children aged 0–18&#xa0;years who underwent dual-energy X-ray absorptiometry (DXA) across four integrated centers between 2019 and 2025. Bone status was interpreted using age- and sex-adjusted Z-scores according to ISCD criteria. Whole-body composition parameters were analyzed. Correlation and hierarchical multivariable linear regression analyses were performed to identify independent predictors of total body BMD.</p> Results <p>A total of 66 participants (mean age 13.8 ± 2.7&#xa0;years; 74.2% male) were included. Low bone mass for age was identified in 22.7% of children within this referral-based pediatric DXA cohort. Total body BMD showed strong positive correlations with age, BMI, lean mass, and appendicular lean mass index (ALMI) (all p &lt; 0.001). In multivariable regression, ALMI emerged as the strongest independent predictor of BMD (β = 0.065, 95%CI 0.046–0.085), increasing model R2 from 0.60 to 0.897. Fat mass was not independently associated with BMD after adjustment.</p> Conclusion <p>Low bone mass for age was identified in approximately one in five children within this referral-based pediatric DXA cohort. Lean mass, particularly ALMI, is the principal independent determinant of pediatric BMD, emphasizing the importance of muscle mass in skeletal development.</p>

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Prevalence and Determinants of Bone Mineral Density in a Referral-Based Indonesian Pediatric DXA Cohort: A Multicenter Study

  • 期刊论文

  • 发表日期：

    2026年6月22日

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  • Jeanne Leman,
  • Mathelda Diah Wulandari,
  • Patricia Jorisal,
  • Olivia Violetta,
  • Gilbert Sterling Octavius

摘要

Background

Bone mineral density (BMD) accrual during childhood is critical for lifelong skeletal health. Data regarding pediatric low bone mass and body composition in Indonesia remains limited. This study aimed to determine the prevalence of low bone mass for age in a multicenter Indonesian pediatric cohort and to examine the relationship between whole-body composition parameters and total body BMD to identify key determinants of skeletal health during growth.

Methods

This retrospective cross-sectional study included children aged 0–18 years who underwent dual-energy X-ray absorptiometry (DXA) across four integrated centers between 2019 and 2025. Bone status was interpreted using age- and sex-adjusted Z-scores according to ISCD criteria. Whole-body composition parameters were analyzed. Correlation and hierarchical multivariable linear regression analyses were performed to identify independent predictors of total body BMD.

Results

A total of 66 participants (mean age 13.8 ± 2.7 years; 74.2% male) were included. Low bone mass for age was identified in 22.7% of children within this referral-based pediatric DXA cohort. Total body BMD showed strong positive correlations with age, BMI, lean mass, and appendicular lean mass index (ALMI) (all p < 0.001). In multivariable regression, ALMI emerged as the strongest independent predictor of BMD (β = 0.065, 95%CI 0.046–0.085), increasing model R2 from 0.60 to 0.897. Fat mass was not independently associated with BMD after adjustment.

Conclusion

Low bone mass for age was identified in approximately one in five children within this referral-based pediatric DXA cohort. Lean mass, particularly ALMI, is the principal independent determinant of pediatric BMD, emphasizing the importance of muscle mass in skeletal development.