Such a study would also allow a comparison of the bone indices studied in this paper; we conjecture that PBI will be optimal. Conclusion This paper has presented an automated method for performing classical radiogrammetry for assessment of bone mass in children. This is the first PXD101 molecular weight time that a dedicated paediatric algorithm, which can analyse all images over a wide age range and which adjusts the size of the ROI to the size of the hand, has been implemented. It is also the first time the precision of radiogrammetry in children has

been reported. We set up a framework of bone indices encompassing the three classical radiogrammetric bone indices (Fig. 2), and this led us to stipulate that the new Paediatric Bone Index is the preferred index for a paediatric population. However, it is stressed that this is still hypothetical, and the MCI, for instance, could still be a better predictor of fracture risk. The main limitations of the radiogrammetric methods are that they measure only cortical bone, they are insensitive to abnormal mineralisation, and they measure on a small part of the skeleton which might not be representative of the whole skeleton. A reference data base for modern Caucasian children was presented which allows for the SHP099 clinical trial determination of PBI SDS in clinical practice. PBI can be used to analyse retrospective studies, and this could lead to a rapid increase in our knowledge of the relationship

between bone mass in childhood and future fracture risk. Acknowledgement We would like to thank APO866 order Sven Helm for providing access to the Sjælland study and Novo Nordisk for making the VIDAR film scanner available.

Conflicts of interest H. H. Thodberg is the owner of Visiana, which Regorafenib order develops, owns and markets the BoneXpert technology for automated determination of bone age, which also includes the Paediatric Bone Index method described in this paper. For all other authors, none. References 1. Tanner JM, Healy MJR, Goldstein H, Cameron N (2001) Assessment of skeletal maturity and prediction of adult height (TW3 Method). WB Saunders, London 2. Binkovitz LA, Henwood MJ (2007) Pediatric DXA: technique and interpretation. Pediatric Radiology 37:21–31CrossRefPubMed 3. Moyer-Mileur LJ, Quick JL, Murray MA (2008) Peripheral quantitative computed tomography of the tibia: pediatric reference values. Journal of Clinical Densitometry 11:283–294CrossRefPubMed 4. Thodberg HH, Kreiborg S, Juul A, Pedersen KD (2009) The BoneXpert method for automated determination of skeletal maturity. IEEE Trans Med Imaging 28:52–66CrossRefPubMed 5. Martin DD, Deusch D, Schweizer R, Binder G, Thodberg HH, Ranke MB (2009) Clinical application of automated Greulich-Pyle bone age in children with short stature. Pediatr Radiol 39:598–607CrossRefPubMed 6. van Rijn RR, Lequin MH, Thodberg HH (2009) Automatic determination of Greulich and Pyle bone age in healthy Dutch children. Pediatric Radiology 39:591–97CrossRefPubMed 7.