Introduction
Dear Editor,
In the most recent issue of Trends in Pediatrics, Akin and Goksoy1 used dual-energy X-ray absorptiometry (DEXA) to assess bone mineral density (BMD) in Turkish pediatric patients with rare metabolic disorders of organic acidemias (OA) and glycogen storage diseases (GSD). They found low BMD in the studied OA and GSD populations and observed that these populations were affected by certain modifiable determinants, such as vitamin D status and dietary calcium intake. Akin and Goksoy1 thankfully highlighted numerous valuable limitations of the study. We herein introduce another valued one. Notwithstanding, monitoring bone health status using BMD by DEXA requires reference to BMD reference values (BMDRVs). Age, sex, weight, and ethnicity are among the many determinants that control BMDRVs2, and BMDRVs have been introduced for certain pediatric populations based on these determinants.3-5 Türkiye is among forerunner countries that formulated local pediatric BMDRVs in 2006 to help practicing pediatricians and endocrinologists monitor bone health integrity in pediatric Turkish population, especially among those with chronic illnesses.6 Akin and Goksoy1 in the study methodology unexpectedly referred to a foreign standard (2019 ISCD Official Position)7 rather than a local one6 in evaluating BMD in the study population. As a result, the study’s findings might be halted, and consequently, their clinical applicability could be additionally jeopardized by the aforementioned limitation.
Source of funding
The authors declare the study received no funding.
Conflict of interest
The authors declare that there is no conflict of interest.
References
- Kumru Akin B, Goksoy E. Low bone mineral density in rare metabolic disorders: data from a Turkish cohort of patients with glycogen storage disorders and organic acidemias. Trends in Pediatr. 2025;6:194-201. https://doi.org/10.59213/TP.2025.320
- Guss CE, McAllister A, Gordon CM. DXA in children and adolescents. J Clin Densitom. 2021;24:28-35. https://doi.org/10.1016/j.jocd.2020.01.006
- Lopez-Gonzalez D, Wells JC, Cortina-Borja M, Fewtrell M, Partida-Gaytán A, Clark P. Reference values for bone mineral density in healthy Mexican children and adolescents. Bone. 2021;142:115734. https://doi.org/10.1016/j.bone.2020.115734
- Prajantawanich K, Manpayak T, Pooliam J, Nakavachara P. Updated reference values for BMD and lean mass measured by DXA in Thai children. J Bone Miner Metab. 2024;42:728-40. https://doi.org/10.1007/s00774-024-01550-2
- Khadilkar A, Oza C, Sanwalka N, et al. Reference data for Lunar iDXA for the assessment of bone health in Indian children and youth: a cross-sectional study. Indian Pediatr. 2025;62:578-85. https://doi.org/10.1007/s13312-025-00091-9
- Goksen D, Darcan S, Coker M, Kose T. Bone mineral density of healthy Turkish children and adolescents. J Clin Densitom. 2006;9:84-90. https://doi.org/10.1016/j.jocd.2005.08.001
- ISCD. 2019 ISCD official positions pediatric. Available at: https://iscd.org/learn/official-positions/pediatric-positions/. (Accessed on Nov 8, 2025).
Copyright and license
Copyright © 2025 The author(s). This is an open-access article published by Aydın Pediatric Society under the terms of the Creative Commons Attribution License (CC BY) which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is properly cited.
