Moving towards an equitable future: Rethinking the use of race in pediatric densitometry

Current guidelines from the International Society for Clinical Densitometry (ISCD) recommend considering race, sex, and age in calculating pediatric bone density z-scores by Dual-Energy X-ray Absorptiometry (DXA). However, as patient populations become increasingly diverse, the application of these guidelines presents significant challenges, potentially leading to racial bias and systemic inequities in care. In response to growing calls for a reevaluation of race's role in clinical decision-making, we aimed to assess the readiness of front-line providers of DXA services to address these challenges. We conducted a professional, anonymized clinical practice survey targeting DXA technologists from various centers as part of a workshop for Reevaluation of the Role of Race, Ethnicity, and Ancestry in Clinical Decision-Making at the 2024 Annual Meeting of the Pediatric Academic Society. The survey focused on their experiences with the recording and use of race demographics. Our findings revealed inconsistencies in race data collection practices, varying levels of perceived patient comfort, and concerns about the potential perpetuation of racial bias. These results highlight the need for standardized guidelines to facilitate the sensitive and unbiased collection of race-related data during DXA exams, ultimately promoting equitable care for all patients.