Femur neck bone mineral density and fracture risk by age,sex, and race or Hispanic origin in older US adults from NHANES III

Summary

We provide the first reference values for bone mineral content and bone mineral density according to age and sex in Iranian children and adolescents. The prevalence of hypovitaminosis D was high, and levels of physical activity were low in our sample. Multiple regression analyses showed age, BMI, and Tanner stage to be the main indicators of bone mineral apparent density.

Purpose

Normal bone structure is formed in childhood and adolescence. The potential determinants which interact with genetic factors to influence bone density include gender, nutritional, lifestyle, and hormonal factors. This study aimed to evaluate bone mineral content (BMC) and the bone mineral density (BMD) and factors that may interfere with it in Iranian children.

Methods

In this cross-sectional study, 476 healthy Iranian children and adolescents (235 girls and 241 boys) aged 9–18 years old participated. BMC and BMD of the lumbar spine, femoral neck, and total body were measured by dual-energy X-ray absorptiometry using a Hologic Discovery device, and bone mineral apparent density (BMAD) of the lumbar spine and the femoral neck were calculated.

Results

We present percentile curves by age derived separately for BMC, BMD, and BMAD of the lumbar spine, left femoral neck, and total body excluding the head for boys and girls. Maximum accretion of BMC and BMD was observed at ages of 11–13 years (girls) and 12–15 years (boys).The prevalence of hypovitaminosis D was high and physical activity was low in our participants. However, in multiple regression analyses, age, BMI, and Tanner stage were the main indicators of BMD and BMAD

Conclusion

These normative data aid in the evaluation of bone density in Iranian children and adolescents. Further research to evaluate the evolution of BMD in Iranian children and adolescents is needed to identify the reasons for significant differences in bone density values between Iranian populations and their Western counterparts.     

Diagnostic evaluation of bone densitometric size adjustment techniques in children with and without low trauma fractures

Summary

Several established methods are used to size adjust dual-energy X-ray absorptiometry (DXA) measurements in children. However, there is no consensus as to which method is most diagnostically accurate. All size-adjusted bone mineral density (BMD) values were more diagnostically accurate than non-size-adjusted values. The greatest odds ratio was estimated volumetric BMD for vertebral fracture.

Introduction

The size dependence of areal bone density (BMD_a) complicates the use of DXA in children with abnormal stature. Despite several size adjustment techniques being proposed, there is no consensus as to the most appropriate size adjustment technique for estimating fracture risk in children. The aim of this study was to establish whether size adjustment techniques improve the diagnostic ability of DXA in a cohort of children with chronic diseases.

Methods

DXA measurements were performed on 450 children, 181 of whom had sustained at least one low trauma fracture. Lumbar spine (L₂–L₄) and total body less head (TBLH) Z-scores were calculated using different size adjustment techniques, namely BMD_a and volumetric BMD for age (bone mineral apparent density (BMAD)); bone mineral content (BMC) and bone area for height; BMC for bone area; BMC for lean mass (adjusted for height); and BMC for bone and body size.

Results

Unadjusted L₂–L₄ and TBLH BMD_a were most sensitive but least specific at distinguishing children with fracture. All size adjustments reduced sensitivity but increased post-test probabilities, from a pre-test probability of 40 % to between 58 and 77 %. The greatest odds ratio for fracture was L₂–L₄ BMAD for a vertebral fracture and TBLH for lean body mass (LBM) (adjusted for height) for a long bone fracture with diagnostic odds ratios of 9.3 (5.8–14.9) and 6.5 (4.1–10.2), respectively.

Conclusion

All size adjustment techniques improved the predictive ability of DXA. The most accurate method for assessing vertebral fracture was BMAD for age. The most accurate method for assessing long bone fracture was TBLH for LBM adjusted for height.     

High bone mineral apparent density in children with X-linked hypophosphatemia

Summary

Bone mineral apparent density (BMAD) in children with X-linked hypophosphatemia (XLH) was evaluated, as they are unlikely to have extra-skeletal ossifications contributing to the elevated bone mineral density of the spine in adult patients. Children with XLH also had significantly higher BMAD of the spine compared to femoral neck.

Introduction

BMAD obtained by dual-energy X-ray absorptiometry scans in children with XLH was evaluated, as they are unlikely to have the extra-skeletal ossifications contributing to the elevated bone mineral density of the spine in adult patients.

Methods

A total of 15 children with biochemically and genetically verified XLH were recruited. Anthropometric measurements were performed, and to correct for the short stature (small bones), the BMAD of the spine and the femoral neck was evaluated.

Results

Z-scores of BMAD of the spine (mean (95 % CI); 2.0 (1.3–2.7); p?<?0.001) were significantly elevated compared to reference children. Z-scores of the femoral neck (1.0 (?0.0 to 2.1); p?=?0.059) tended to be elevated. Spine Z-scores were significantly higher than the Z-scores of the femoral neck, (paired t test, p?=?0.02). BMAD of the spine was evaluated according to the Molgaard’s approach; XLH children had normal bone size of the spine for age due to a normal sitting height Z-score of ?0.4 (?1.0 to 0.1); p?=?0.1. Z-scores of bone mineral content (BMC) of the spine for bone area were elevated (1.4 (0.8–2.1); p?<?0.001). No reference data were available to allow evaluation of the BMAD of the femoral neck by the Molgaard's approach.

Conclusions

Children with XLH have an increased BMAD and a high BMC for bone area at the lumbar spine, and this was due to causes other than extra-skeletal ossifications and corrected for bone size. The BMAD of the spine was significantly higher compared to the femoral neck.     

Calcium and vitamin D for osteoprotection in children with new-onset nephrotic syndrome treated with steroids: a prospective,randomized, controlled,interventional study

Background

There are no robust guidelines on strategies to prevent the adverse skeletal effects of glucocorticoids in children.

Objectives

To evaluate the role of prophylactic calcium and vitamin D on bone health in children with new-onset nephrotic syndrome (NS) treated with short-term (12 weeks), high-dose glucocorticoids.

Methods

Prospective, randomized, controlled, single blind, interventional study conducted on 41 steroid-naïve pre-pubertal children (29 boys, 12 girls). All children received prednisolone for 12 weeks (60 mg/m²/day daily for 6 weeks, followed by 40 mg/m²/day alternate days for 6 weeks). Recruited children were randomized into the intervention group (IG; vitamin D 1,000 IU/day and elemental calcium 500 mg/day) and the control group (CG). Bone mineral content (BMC) and bone mineral density (BMD) at the lumbar spine (L1–L4) were estimated at baseline and at 12 weeks. Mean percentage changes in BMC and BMD in IG and CG were compared.

Results

Children in the IG showed an increase of 11.2 % in BMC versus the CG, who showed an 8.9 % fall (p?<?0.0001). Net intervention-attributable difference in BMC was 20.1 %. BMD increased in both groups (IG 2.8 % vs CG 0.74 %), but the difference was not statistically significant (p?=?0.27).

Conclusions

Short-term, high-dose glucocorticoid therapy decreases the BMC of the lumbar spine in steroid-naïve children with NS. Vitamin D and calcium co-administration not only prevents this decline, but also enhances BMC of the lumbar spine.     

Apparent bone mineral density estimated from DXA in healthy men and women

The aim of this study was to measure bone mineral density (BMD) in healthy people and examine the influence of age, anthropometry, and postmenopause on calculated bone mineral apparent density (BMAD). The study included 541 healthy subjects (249 men and 292 women), aged 20 to 79 years. Anthropometric measurements included height, weight, and body mass index (BMI). Bone mineral content (BMC) and areal BMD were measured at the lumbar spine and proximal femur, using dual-energy X-ray absorptiometry (DXA). The calculation of volumetric density relied on the formula BMAD=BMD/BA (where BA = bone area). Association between densitometric parameters and age, height, weight, and postmenopause was analyzed with multiple regression. BMC and BMD decreased with age, especially in postmenopausal women. The average annual bone loss in spine was 0.2% in both sexes, whereas femur loss was 0.5% in men and 0.3% in women. Bone area slightly increased with age in both sexes, and BMD loss after the age of 50 could be attributed to bone area increase. To minimize the effect of bone size on bone density, volumetric density and areal density were regressed to age, anthropometry, and postmenopause. Age and postmenopause were significantly associated with BMD and BMAD in the spine and femur. Furthermore, BMD showed a stronger association with height and weight than BMAD, in both regions. Weaker association of body height and weight with BMAD than with BMD suggests that BMD depends on the bone size and body size and that the different BMDs could be the consequence of the difference in those parameters.     

Bone mineral density by age, gender, pubertal stages, and socioeconomic status in healthy Lebanese children and adolescents

Gender, ethnicity, and lifestyle factors affect bone mass acquisition during childhood, thus the need for age- and sex-adjusted Z scores using ethnic-specific data for bone mineral density (BMD) measurement. This study aimed at establishing normative data for BMD in healthy Lebanese children and adolescents. Three hundred sixty-three healthy children aged 10 to 17 years (mean+/-SD: 13.1+/-2.0) were studied. BMD, bone mineral content (BMC), and lean mass were measured by dual-energy X-ray absorptiometry (DXA) using a Hologic 4500A device, and apparent volumetric BMD (BMAD) of the lumbar spine and the femoral neck were calculated. BMD, BMC, and BMAD were expressed by age groups and Tanner stages for boys and girls separately. There was a significant effect of age and puberty on all bone parameters, except at the femoral neck BMAD in boys. BMC and BMD were higher at cortical sites in boys, including subtotal body and hip; whereas, in girls, it was higher at a site more enriched in trabecular bone, namely the lumbar spine. At several skeletal sites, girls had significantly higher BMD adjusted for lean mass than boys. By the end of puberty, adolescents had a mean BMD that was 43-66% higher at the lumbar spine and 25-41% higher at cortical sites than pre-pubertal children, depending on the gender. Mean BMD values in the study group were significantly lower (P<0.01) than Western normative values, with Z scores ranging between -0.2 and -1.1. In both genders, children of lower socioeconomic status tended to have lower BMD than those from a higher socioeconomic background. This study allows additional insight into gender dimorphism in mineral accretion during puberty. It also provides a valuable reference database for the assessment of BMD in children with pubertal or growth disorders who are of Middle Eastern origin.     

Effect of whole body vibration (WBV) therapy on bone density and bone quality in osteopenic girls with adolescent idiopathic scoliosis: a randomized, controlled trial

Summary

The aim of this randomized controlled trial was to determine whether whole body vibration (WBV) therapy was effective for treating osteopenia in adolescent idiopathic scoliosis (AIS) patients. Results showed that WBV was effective for improving areal bone mineral density (aBMD) at the femoral neck of the dominant side and lumbar spine BMC in AIS subjects.

Introduction

AIS is associated with osteopenia. Although WBV was shown to have skeletal anabolic effects in animal studies, its effect on AIS subjects remained unknown. The objective of this study was to determine whether WBV could improve bone mineral density (BMD) and bone quality for osteopenia in AIS subjects.

Methods

This was a randomized, controlled trial recruiting 149 AIS girls between 15 and 25 years old and with bone mineral density (BMD) Z-scores <?1. They were randomly assigned to the Treatment or Control groups. The Treatment group (n?=?61) stood on a low-magnitude high-frequency WBV platform 20 min/day, 5 days/week for 12 months. The Control group (n?=?63) received observation alone. Bone measurement was done at baseline and at 12 months: (1) aBMD and BMC at femoral necks and lumbar spine using dual-energy X-ray absorptiometry (DXA) and (2) bone quality including bone morphometry, volumetric BMD (vBMD), and trabecular bone microarchitecture using high-resolution peripheral quantitative computed tomography (HR-pQCT) for nondominant distal radius and bilateral distal tibiae.

Results

The Treatment group had numerically greater increases in all DXA parameters with a statistically significant difference being detected for the absolute and percentage increases in femoral neck aBMD at the dominant leg (0.015 (SD?=?0.031)g/cm², 2.15 (SD?=?4.32)%) and the absolute increase in lumbar spine BMC (1.17 (SD?=?2.05)g) in the Treatment group as compared with the Control group (0.00084 (SD?=?0.026)g/cm², 0.13 (SD?=?3.62)% and 0.47 (SD?=?1.88)g, respectively). WBV had no significant effect for other bone quality parameters.

Conclusions

WBV was effective for improving aBMD at the femoral neck of the dominant side and lumbar spine BMC in AIS subjects.     

Cortical and trabecular bone at the radius and tibia in male and female adolescents with Down syndrome: a peripheral quantitative computed tomography (pQCT) study

Summary

We aimed to describe the structure and strength of the tibia and radius of adolescents with Down syndrome. We observed that despite higher levels of volumetric bone mineral density in determined skeletal sites, they are at higher risk of developing osteoporotic fractures in the future due to their lower bone strength indexes.

Introduction

The aims of the study were to describe the cortical and trabecular volumetric bone mineral density (vBMD), bone mineral content (BMC), area, and bone strength in adolescents with Down syndrome (DS) and to compare them with adolescents without disabilities.

Methods

Thirty adolescents (11 girls) with DS and 28 without disabilities (10 girls) participated in the study. Peripheral quantitative computed tomography measurements were taken at proximal and distal sites of the tibia and radius. Values of total, trabecular, and cortical BMC; vBMD; and area were obtained of each scan. Cortical thickness and endosteal and periosteal circumferences were also measured, and different bone strength indexes were calculated. Student’s t tests were applied between groups.

Results

The DS group showed greater vBMD at distal radius, BMC at proximal radius, and total and cortical vBMD at proximal tibia. The non-DS group showed higher total and trabecular area at the distal radius and total, cortical, and trabecular BMC and area at distal tibia. Higher values of periosteal and endosteal circumference and bone strength were also found in non-DS group.

Conclusions

From these results, it can be believed that even with higher vBMD in determined skeletal sites, adolescents with DS are at higher risk of suffering bone fractures due to an increased fragility by lower resistance to load bending or torsion.     

Low bone turnover and low bone density in a cohort of adults with Down syndrome

Summary

Increased incidence of osteoporosis in Down syndrome has been reported, but etiology is not established. We report low bone turnover markers and bone mineral density (BMD) in a cohort of people with Down syndrome without consistent clinical risk factors. Our results should guide future studies and treatments for this common problem.

Introduction

To better understand the etiology for osteoporosis in Down syndrome (DS), we measured bone density by dual-energy X-ray absorptiometry (DXA) and circulating biochemical markers of bone formation and resorption in a cohort of 30 community-dwelling DS adults.

Methods

Seventeen males and 13 females followed in the University of Arkansas Down Syndrome Clinic were evaluated by DXA to estimate BMD and underwent phlebotomy to measure serum procollagen type-1 intact N-terminal propeptide (P1NP) to evaluate bone formation, and serum C-terminal peptide of type-I collagen (CTx) to evaluate bone resorption.

Results

Seven of 13 DS females and 12 of 17 DS males had low bone mass at one of measured sites (z?≤??2.0). When data were grouped by age, males had apparent osteopenia earlier than females. The mean P1NP in the normal group was 19.2?±?5.2 ng/ml vs. 2.2?±?0.9 ng/ml in the DS group (P?=?0.002). Serum CTx levels in the normal group were 0.4?±?0.1 ng/ml vs. 0.3?±?0.1 ng/ml (P?=?0.369).

Conclusions

Low BMD in adults with DS is correlated with a significant decrease in bone formation markers, compared to controls without DS, and is independent of gender. These data suggest that diminished osteoblastic bone formation and inadequate accrual of bone mass, with no significant differences in bone resorption, are responsible for the low bone mass in DS. These observations question the use of antiresorptive therapy in this population and focus attention on increasing bone mass by other interventions.     

Physical activity throughout adolescence and bone mineral density in early adulthood: the 1993 Pelotas (Brazil) Birth Cohort Study

Summary

Association between three physical activity (PA) measurements throughout adolescence and bone density at 18 years of age was investigated. PA was associated with both lumbar spine and femoral neck bone mineral density (BMD) in early adulthood independent of type of PA used in the analysis. The results were more consistent in boys.

Introduction

This study amis to evaluate if PA during adolescence could influence BMD later in life.

Methods

A population-based birth cohort study was carried out. PA was assessed at 11 and 15 years of age by questionnaire and included sports performed while BMD (lumbar spine and femoral neck) was measured by dual-energy X-ray absorptiometry at 18 years. A peak strain score was generated based on ground reaction forces of different PA. PA was measured as peak strain score, peak strain score multiplied by minutes/week and minutes/week. Unadjusted and adjusted analyses were performed using linear regression.

Results

Overall, 3,811 adolescents were studied (1,866 boys and 1,945 girls). The peak strain score at 11 and 15 years was associated with lumbar and femoral neck BMD at 18 years in boys. Among girls, high-impact PA at 11 years was positively associated with lumbar and femoral BMD (p?=?0.01; p?<?0.001). After adjusted analysis, weekly minutes of PA at 11 years were not associated with lumbar spine but were associated with femoral neck BMD (p?<?0.001); at 15 years, weekly minutes of PA were positively associated with BMD at both sites. Regardless of PA status at 11 years of age, attaining the recommendations of PA (300 min/week) at 15 years appears to be important for BMD at 18 years in both sites in boys and girls. The results Appeared to be more consistent in boys.

Conclusions

PA during adolescence was positively associated with both lumbar spine and femoral neck BMD in early adulthood independent of type of PA used in the analysis.     

Low bone density and bone metabolism alterations in Duchenne muscular dystrophy: response to calcium and vitamin D treatment

Summary

Boys with Duchenne muscular dystrophy often have reduced bone mass and increased fracture risk. In this prospective study on 33 patients, calcifediol (25-OH vitamin D₃) plus adjustment of dietary calcium to the recommended dose reduced bone resorption, corrected vitamin D deficiency, and increased bone mass in about two-thirds of cases.

Introduction

Low BMC and BMD and bone metabolism alterations are frequent in boys with Duchenne muscular dystrophy (DMD), especially now that long-term glucocorticosteroid (GC) treatment is the standard of care. This prospective study was designed to evaluate the effects of a first-line treatment (25-OH vitamin D₃ [calcifediol] plus adjustment of dietary calcium to the recommended daily dose) on bone.

Methods

Thirty-three children with DMD on GC treatment were followed for 3?years: one of observation and two of treatment. Main outcome: spine and total body BMC and BMD increase; secondary outcome: changes in bone turnover markers (C-terminal [CTx] and N-terminal [NTx] telopeptides of procollagen type I; osteocalcin [OC]).

Results

During the observation year, BMC and BMD decreased in all patients. At baseline and after 12?months, serum CTx and urinary NTx were higher than normal; OC and parathyroid hormone at the upper limit of normal; 25-OH vitamin D₃ significantly lower than normal. After 2?years of calcifediol and calcium-rich diet, BMC and BMD significantly increased in over 65% of patients, and bone metabolism parameters and turnover markers normalized in most patients (78.8%). During the observation year, there were four fractures in four patients, while during the 2?years of treatment there were two fractures in two patients.

Conclusions

Calcifediol plus adequate dietary calcium intake seems to be an effective first-line approach that controls bone turnover, corrects vitamin D deficiency, and increases BMC and BMD in most patients with DMD. Lack of response seems related to persistently high bone turnover.     

Association between serum uric acid and lumbar spine bone mineral density in peri- and postmenopausal Japanese women

Summary

Previous studies on the association between uric acid and bone mineral density yielded conflicting results. In this study, we demonstrated positive association between uric acid and lumbar spine bone mineral density in peri- and postmenopausal Japanese women. Further research is needed to elucidate the underlying mechanism.

Introduction

Oxidative stress has been implicated in the pathogenesis of osteoporosis. Uric acid, a potent antioxidant substance, has been associated with bone mineral density but previous studies have yielded conflicting results. The objective of the study was to examine the association between serum uric acid and lumbar spine bone mineral density (BMD).

Methods

This was a retrospective analysis of medical records of 615 women, aged 45–75 years, who had lumbar spine BMD measurement by dual-energy X-ray absorptiometry as a part of health checkup from August 2011 to July 2012.

Results

Mean serum uric acid level was 4.7 mg/dL. Serum uric acid level was positively and significantly associated with lumbar spine BMD independent of age, body mass index, smoking, drinking, physical activity, years after menopause, diabetes mellitus, hypertension, serum calcium, estimated glomerular filtration rate, plasma C-reactive protein, and serum alkaline phosphatase (standardized beta?=?0.078, p?=?0.049). Uric acid rapidly increased until the age of 60 years, and then decelerated but continued to increase thereafter. The association between lumbar spine BMD and uric acid remained significantly positive after excluding women older than 60 years.

Conclusion

The present study showed that higher uric acid levels were linearly associated with higher lumbar spine BMD in peri- and postmenopausal Japanese women. Further research is needed to elucidate the underlying mechanism of the association between uric acid and BMD.     

Optimal monitoring time interval between DXA measures in children

The monitoring time interval (MTI) is the expected time in years necessary to identify a change between two measures that exceeds the measurement error. Our purpose was to determine MTI values for dual‐energy X‐ray absorptiometry (DXA) scans in normal healthy children, according to age, sex, and skeletal site. 2014 children were enrolled in the Bone Mineral Density in Childhood Study and had DXA scans of the lumbar spine, total hip, nondominant forearm, and whole body. Measurements were obtained annually for seven visits from 2002 to 2010. Annualized rates of change were calculated by age and sex for all bone regions. A subgroup of 155 children ages 6 to 16 years (85 boys) had duplicate scans for calculation of scan precision. The bone mineral density (BMD) regions of interest included the spine, total body less head (TBLH), total hip, femoral neck, and one‐third radius. Bone mineral content (BMC) was also evaluated for the spine and TBLH. The percent coefficient of variation (%CV) and MTI were calculated for each measure as a function of age and sex. The MTI values were substantially less than 1 year for the TBLH and spine BMD and BMC for boys ≤ 17 years and girls ≤ 15 years. The hip and one‐third radius MTIs were generally 1 year in the same group. MTI values as low as 3 months were found during the peak growth years. However, the MTI values in late adolescence for all regions were substantially longer and became nonsensical as each region neared the age for peak bone density. All four DXA measurement sites had reasonable (< 1 year) MTI values for boys ≤ 17 years and girls ≤ 15 years. MTI was neither useful nor stable in late adolescence and young adulthood. Alternative criteria to determine scan intervals must be used in this age range. © 2011 American Society for Bone and Mineral Research     

The Impact of Intense Training on Endogenous Estrogen and Progesterone Concentrations and Bone Mineral Acquisition in Adolescent Rowers

The effect of 18 months of training on the ovarian hormone concentrations and bone mineral density (BMD) accrual was assessed longitudinally in 14 adolescent rowers and 10 matched controls, aged 14–15 years. Ovarian hormone levels were assessed by urinary estrone glucuronide (E₁G) and pregnanediol glucuronide (PdG) excretion rates, classifying the menstrual cycles as ovulatory or anovulatory. Total body (TB), total proximal femur (PF), femoral neck (FN) and lumbar spine (LS) (L2–4) bone mass were measured at baseline and 18 months using dual-energy X-ray densitometry. Results were expressed as bone mineral content (BMC), BMD and bone mineral apparent density (BMAD). Five rowers had anovulatory menstrual cycles compared with zero prevalence for the control subjects. Baseline TB BMD was significantly higher in the ovulatory rowers, with PF BMD, FN BMD and LS BMD similar for all groups. At completion, the LS bone accrual of the ovulatory rowers was significantly greater (BMC 8.1%, BMD 6.2%, BMAD 6.2%) than that of the anovulatory rowers (BMC 1.1%, BMD 3.9%, BMAD 1.6%) and ovulatory controls (BMC 0.5%, BMD 1.1%, BMAD 1.1%). No difference in TB, PF or FN bone accrual was observed among groups. This study demonstrated an osteogenic response to mechanical loading, with the rowers accruing greater bone mass than the controls at the lumbar spine. However, the exercise-induced osteogenic benefits were less when rowing training was associated with low estrogen and progesterone metabolite excretion. Received: 8 December 1998 / Accepted: 15 March 1999     

Bone mineral density in men and children with haemophilia A and B: a systematic review and meta-analysis

Summary

Although haemophilia is not considered among the classic causes of secondary osteoporosis, the present meta-analysis provides strong evidence that men with haemophilia have a significant reduction in both lumbar spine and femoral bone mineral density, which appears to begin in childhood.

Introduction

Haemophilia is not considered among the classic causes of secondary osteoporosis. The aim of this study was to systematically review the literature for case–control trials that have studied bone mass in males with haemophilia and to meta-analyze the best evidence available.

Methods

Electronic databases MEDLINE, EMBASE and CENTRAL were systematically searched for case–control trials that have studied bone mass in men or boys with haemophilia. Standardized mean difference (SMD) for bone mineral density (BMD) in the lumbar spine was the main study outcome and SMD in femoral neck and total hip BMD the secondary ones. Patient and control characteristics, such as age, body mass index (BMI), level of physical activity and blood-borne infections were recorded as possible predictors of the main outcome.

Results

Thirteen studies were included in the systematic review and ten in the main outcome meta-analysis. Men with haemophilia demonstrated reduced lumbar spine [random effects SMD [95 % confidence interval (CI)] = ?0.56 (?0.84, ?0.28), between-study heterogeneity (I ²)?=?51 %] and femoral neck BMD [random effects SMD (95 % CI) = ?0.82 (?1.21, ?0.44), I ²?=?63 %] compared with controls, which indicated a large and clinically significant association. Similar results were obtained for children [random effects SMD (95 % CI) = ?0.92 (?1.77, ?0.07), I ²?=?92 %]. No evidence of publication bias was detected. There was no evidence that age, BMI, level of physical activity or presence of blood-borne infections predicted lumbar spine BMD.

Conclusions

This meta-analysis shows that men with haemophilia present a significant reduction in both lumbar spine and hip BMD, which appears to begin in childhood.     

Marital histories,marital support,and bone density: findings from the Midlife in the United States Study

Summary

We examined the association between marital life history and bone mineral density (BMD) in a national sample from the US. In men, being stably married was independently associated with better lumbar spine BMD, and in women, more spousal support was associated with better lumbar spine BMD.

Introduction

Adult bone mass may be influenced by stressors over the life course. We examined the association between marital life history and bone mineral density (BMD) net socioeconomic and behavioral factors known to influence bone mass. We sought evidence for a gender difference in the association between marital history and adult BMD.

Methods

We used data from 632 adult participants in the Midlife in the United States Study to examine associations between marital history and BMD, stratified by gender, and adjusted for age, weight, menopausal stage, medication use, childhood socioeconomic advantage, adult financial status, education, physical activity, smoking, and alcohol consumption.

Results

Compared to stably married men, men who were currently divorced, widowed, or separated, men who were currently married but previously divorced, widowed, or separated, and never married men had 0.33 (95 % CI: 0.01, 0.65), 0.36 (95 % CI: 0.10, 0.83), and 0.53 (95 % CI: 0.23, 0.83) standard deviations lower lumbar spine BMD, respectively. Among men married at least once, every year decrement in age at first marriage (under age 25) was associated with 0.07 SD decrement in lumbar spine BMD (95 % CI: 0.002, 0.13). In women, greater support from the spouse was associated with higher lumbar spine BMD.

Conclusions

Our findings suggest that marriage before age 25 and marital disruptions are deleterious to bone health in men, and that marital quality is associated with better bone health in women.     

The influence of serum ghrelin,IGF axis and testosterone on bone mineral density in boys at different stages of sexual maturity

The aim of our study was to examine the relationship between bone mineral density (BMD) and serum ghrelin, insulin-like growth factor-1 (IGF-1), IGF-binding protein 3 (IGFBP-3), and testosterone levels in boys at different stages of puberty. The study included 60 healthy nonobese Estonian schoolboys at the age of 10–18 years. Subjects were divided in three groups (20 boys in each) based on the results of self-assessment using illustrated questionnaire of pubertal stage (G1, I; G2–G3, II; G3–G4, III). Morning fasting blood samples were collected for analysis of ghrelin, testosterone, IGF-1, and IGFBP-3. Total body BMD, lumbar BMD, lumbar apparent volumetric BMD (BMAD), and bone mineral content (BMC) were measured by DXA. Serum testosterone concentration was the most important biochemical predictor of BMD in the total group, explaining 48.8% of variability in total body BMD, 51.4% in lumbar BMD, and 36.8% in lumbar BMAD. Body mass and height were both related to BMD and BMC throughout puberty. The serum IGF-1/IGFBP-3 ratio was correlated with serum testosterone (r = 0.69) and ghrelin (r = −0.58) levels, but also with total BMD (r = 0.39), lumbar BMD (r = 0.42; P < 0.001 in all cases), BMAD (r = 0.29; P < 0.01), and total BMC (r = 0.48; P < 0.001). We conclude that serum testosterone concentration and serum IGF-1/IGFBP-3 molar ratio are the major determinants of bone mineral density in boys at different pubertal stages. Serum ghrelin concentration did not appear to have a direct independent effect on BMD. If present, the association may be mediated through sex hormones and the GH-IGF-I axis.     

Two-year changes in bone and body composition in young children with a history of prolonged milk avoidance

No previous longitudinal studies of calcium intake, anthropometry and bone health in young children with a history of avoiding cows milk have been undertaken. We report the 2-year changes of a group of 46 Caucasian children (28 girls, l8 boys) aged 8.1±2.0 years (mean ± SD) who had low calcium intakes at baseline and were short in stature, with elevated body mass index, poor skeletons and lower Z scores for both areal bone mineral density (BMD, in grams per square centimeter) and volumetric density (bone mineral apparent density, BMAD, in grams per cubic centimeter), compared with a reference population of milk drinkers. At follow-up, adverse symptoms to milk had diminished and modest increases in milk consumption and calcium intake had occurred. Total body bone mineral content (BMC) and bone area assessed by dual energy X-ray absorptiometry had increased (P<0.05), and calcium intake from all sources was associated with both these measures (P<0.05). However, although some catch-up in height had taken place, the group remained significantly shorter than the reference population (Z scores –0.39±1.14), with elevated body mass index (Z scores 0.46±1.0). The ultradistal radius BMC Z scores remained low (–0.31±0.98). The Z scores for BMD had improved to lie within the normal range at predominantly cortical sites (33% radius, neck of femur and hip trochanter) but had worsened at predominantly trabecular sites (ultradistal radius and lumbar spine), where values lay below those of the reference group (P<0.05). Similarly, although volumetric BMAD Z scores at the 33% radius had normalized, BMAD Z scores at the lumbar spine remained below the reference population at follow-up (–0.67±1.12, P<0.001). Our results demonstrate persisting height reduction, overweight and osteopenia at the ultradistal radius and lumbar spine in young milk avoiders over 2 years of follow-up.     

Bone density interpretation and relevance in Caucasian children aged 9-17 years of age: insights from a population-based fracture study.

The interpretation of bone density measurement in children is difficult due to a number of factors including rapid change in body size and uncertain clinical significance of bone density in children. This study asked two questions. (1) Is there a preferred bone density measurement site or type for fracture risk in children? (2) What is the best way to interpret bone density in children? This population-based case control study included 321 upper limb fracture cases and 321 class- and sex- matched randomly selected controls. Bone density at the hip, spine, and total body (including the arm) was measured by a Hologic QDR2000 densitometer (Waltham, MA) and examined as bone area (BA), bone mineral content (BMC), bone mineral density (BMD), bone mineral apparent density (BMAD), and BMC/lean mass (BMCLM). The only dual-energy X-ray absorptiometry (DXA) variables that were consistently associated with fracture risk in both boys and girls were spine BMD and BMAD for total upper limb fractures, and spine and hip BMAD for wrist and forearm fractures. No significant associations were observed for BA and BMCLM and inconsistent associations for BMC and other BMD sites. Five-yr fracture risk varied from 15–24% depending on site and gender in a child with a Z-score of -3. In the controls, all DXA variables were associated with age, height, and weight, but the weakest associations were with BMAD. In conclusion, in this study the spine BMAD had the strongest and most consistent association with upper limb fracture risk in children. The associations with age and body size imply that age specific Z-scores will be the most convenient for interpretation of DXA measures in children. Five-yr wrist and forearm fracture risk has potential as a clinical endpoint of immediate relevance.     

Bone mineral density in prepubertal obese and control children: relation to body weight,lean mass,and fat mass

The aim of the study was to determine the influence of obesity on bone status in prepubertal children. This study included 20 obese prepubertal children (10.7 +/- 1.2 years old) and 23 maturation-matched controls (10.9 +/- 1.1 years old). Bone mineral area, bone mineral content (BMC), bone mineral density (BMD), and calculation of bone mineral apparent density (BMAD) at the whole body and lumbar spine (L1-L4) and body composition (lean mass and fat mass) were assessed by DXA. Broadband ultrasound attenuation (BUA) and speed of sound (SOS) at the calcaneus were measured with a BUA imaging device. Expressed as crude values, DXA measurements of BMD at all bone sites and BUA (69.30 versus 59.63 dB/MHz, P < 0.01) were higher in obese children. After adjustment for body weight and lean mass, obese children displayed lower values of whole-body BMD (0.88 versus 0.96 g/cm2, P < 0.05) and BMC (1190.98 versus 1510.24 g, P < 0.01) in comparison to controls. When results were adjusted for fat mass, there was no statistical difference between obese and control children for DXA and ultrasound results. Moreover, whole-body BMAD was lower (0.086 versus 0.099 g/cm3, P < 0.0001), whereas lumbar spine BMAD was greater (0.117 versus 0.100 g/cm3, P < 0.001) in obese children. Thus, it was observed that, in obese children, cortical and trabecular bone displayed different adaptation patterns to their higher body weight. Cortical bone seems to enhance both size and BMC and trabecular bone to enhance BMC. Finally, considering total body weight and lean mass of obese children, these skeletal responses were not sufficient to compensate for the excess load on the whole body.