{"doi":"10.1210/clinem/dgaf183","title":"Race-neutral Pediatric Reference Ranges for Bone Mineral Density Predict Prospective Fractures in Childhood","abstract":"INTRODUCTION: Race-specific reference ranges for pediatric areal bone mineral density (BMD) are widely used, but the value of race-based clinical algorithms has been questioned. We developed race-neutral pediatric reference ranges for areal BMD and bone mineral apparent density (BMAD) and compared race-specific vs race-neutral Z-scores in their ability to predict prospective fractures. MATERIAL AND METHODS: This secondary analysis of the Bone Mineral Density in Childhood Study used longitudinal BMD data of the spine, hip, forearm, and total body less head and BMAD from dual-energy x-ray absorptiometry (DXA) scans. Race/ethnicity, dietary calcium, physical activity, and prospective fractures were assessed by questionnaire. Race-neutral reference ranges and height-for-age Z-score adjustment equations were created using the lambda-sigma-mu method. Race-neutral and race-specific Z-scores were compared using linear mixed-effect modeling. Cox proportional hazard modeling was used to test whether race-neutral Z-scores associated with fracture. RESULTS: Race-neutral BMD and BMAD Z-scores were 0.5 to 0.7 SD greater than race-specific Z-scores for Black children but only ∼0.1 SD lower for children from other race/ethnicity groups. Growth and lifestyle factors modified group differences. One SD increase in race-neutral Z-scores was associated with a 12% to 18% reduced risk of fracture. CONCLUSION: We present the first race-neutral pediatric reference ranges for BMD and BMAD that are weighted to be representative of the US population and demonstrate that these Z-scores associate with fracture risk. Adoption of these new reference ranges should be considered, with thoughtful implementation for patients previously monitored with race-specific reference ranges, especially among children who identify as Black.","journal":"The Journal of Clinical Endocrinology & Metabolism","year":2025,"id":514213,"datarank":0.3397747442638423,"base_score":2.1972245773362196,"endowment":2.1972245773362196,"self_citation_contribution":0.32958368660043297,"citation_network_contribution":0.01019105766340935,"self_endowment_contribution":0.32958368660043297,"citer_contribution":0.01019105766340935,"corpus_percentile":null,"corpus_rank":null,"citation_count":8,"citer_count":6,"citers_with_citation_signal":2,"citers_with_endowment":2,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.825,"is_data_producer":false,"deposit_databanks":null,"is_oa":false,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":298528,"name":"Karen K. Winer","orcid":"0000-0001-8261-5188","position":1,"is_corresponding":false},{"id":32955,"name":"Andrea Kelly","orcid":"0000-0003-1724-9868","position":2,"is_corresponding":false},{"id":303652,"name":"David S. Freedman","orcid":"0000-0001-8014-0289","position":3,"is_corresponding":false},{"id":45175,"name":"Jonathan A. Mitchell","orcid":"0000-0003-3765-2419","position":4,"is_corresponding":false},{"id":414254,"name":"David R. Weber","orcid":"0000-0001-6895-2372","position":5,"is_corresponding":false},{"id":45173,"name":"Shana E. McCormack","orcid":"0000-0002-1143-4459","position":6,"is_corresponding":false},{"id":941977,"name":"Tara McWilliams","orcid":"0000-0002-2332-0256","position":7,"is_corresponding":false},{"id":45181,"name":"Joan M. Lappe","orcid":"0000-0001-8274-2515","position":8,"is_corresponding":false},{"id":45186,"name":"Sharon E. Oberfield","orcid":"0000-0001-9652-1107","position":9,"is_corresponding":false},{"id":34070,"name":"John Shepherd","orcid":"0000-0003-2280-2541","position":10,"is_corresponding":false},{"id":40827,"name":"Struan F.A. Grant","orcid":"0000-0003-2025-5302","position":11,"is_corresponding":false},{"id":45180,"name":"Heidi J. Kalkwarf","orcid":"0000-0001-9030-8401","position":12,"is_corresponding":false},{"id":45189,"name":"Babette S. Zemel","orcid":"0000-0002-6164-7348","position":0,"is_corresponding":true}],"reference_count":44,"raw_metadata":{"citation_network_status":"fetched"},"created_at":"2026-07-19T02:48:29.165853Z","pmid":"40129031","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}