Abstract
BackgroundAdolescence is a critical stage for bone accrual. It is also decisive for the establishment of behaviors such as smoking and alcohol drinking.ObjectiveTo quantify the short- and long-term associations between smoking and drinking initiation and bone mineral density in adolescent girls.MethodsWe used prospective data from 731 girls identified in public and private schools in Porto, Portugal. Evaluations were conducted when participants were 13 and 17 years old. Bone mineral density (BMD) was measured at the forearm by dual-energy X-ray absorptiometry and weight, height and fat-free mass were measured. Pubertal development status was estimated using menarche age. Self-administered questionnaires were used to collect data on smoking and alcohol drinking, physical exercise and calcium and vitamin D intakes. BMD in early and late adolescence was analyzed as a continuous or dichotomous (Z-score cutoff: −1.0) variable. Associations were calculated using linear or logistic regression.ResultsOver one quarter of these girls had tried smoking by 13, while 59% had drunk alcoholic beverages and 20% had experienced both behaviors by that age. Lower mean BMD at 17 years of age was observed in girls who had ever smoked by 13, as well as in those who reported drinking at that age. There were no significant cross-sectional associations between experience and frequency of smoking or drinking and BMD at 13 years of age. However, we observed significant associations between BMD z-score<−1 in late adolescence and having ever smoked by 13, after adjustment for menarche age and sports practice, (OR = 1.92; 95% CI: 1.21, 3.05) and with ever smoking and drinking in the same period (OR = 2.33; 95% CI: 1.36, 4.00).ConclusionOur study adds prospective evidence to the role of early initiation of smoking and alcohol drinking as relevant markers of lower bone mineral density in late adolescence.
Highlights
It is currently believed that bone quality is characterized by important tracking throughout the life course, in such a way that the probability of fragility fracture in old age may be partly traced back to the bone properties attained during the first decades of life [1]
Our study adds prospective evidence to the role of early initiation of smoking and alcohol drinking as relevant markers of lower bone mineral density in late adolescence
By prospectively evaluating a population-based cohort of girls, we aimed at quantifying the associations between early initiation of smoking and alcohol drinking and forearm bone mineral density in early and late adolescence
Summary
We used prospective data collected from 731 adolescent girls recruited and followed up as part of the Epidemiological Health Investigation of Teenagers in Porto (EPITeen), a cohort of urban adolescents born in 1990. In order to assess smoking and drinking as markers of a set of adverse health behaviors, we used previously-defined behavioral clusters as exposures These groups were identified in this population using the natural structure of the following set of data: sports activities, fruit intake, sleeping hours and time spent in sedentary activities, as well as tobacco and alcohol use [23]. To assess possible confounders or mediators, menarche age, anthropometric parameters, nutrient and supplement intake, physical activity, oral contraceptives, parental education, and behavioral clusters were described according to classes of smoking and drinking behaviors, as well as according to bone mineral density z-score classes ($21SD or ,21 SD) at 13 and 17 years of age.
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