Pubertal timing and adult fracture risk in men: A population-based cohort study

Vandenput L,Bygdell M,Nethander M,Kindblom Jm,Ohlsson C

doi:10.1530/ey.17.7.3

Abstract

Background Puberty is a critical period for bone mass accrual, and late puberty in boys is associated with reduced bone mass in adult men. The role of variations in pubertal timing within the normal range for adult fracture risk in men is, however, unknown. We, therefore, assessed the association between age at peak height velocity (PHV), an objective measure of pubertal timing, and fracture risk in adult men. Methods and findings In the BMI Epidemiology Study Gothenburg, 31,971 Swedish men born between January 1, 1945, and December 31, 1961, with detailed growth data (height and weight) available from centrally archived school healthcare records and the conscription register were followed until December 31, 2016. Age at PHV was calculated according to a modified infancy–childhood–puberty model, and fracture information was retrieved from the Swedish National Patient Register. The mean ± SD age at PHV was 14.1 ± 1.1 years. In total, 5,872 men (18.4%) sustained at least 1 fracture after 20 years of age and 5,731 men (17.9%) sustained a non-vertebral fracture after 20 years of age during a mean ± SD follow-up of 37.3 ± 11.7 years. Cox proportional hazards models adjusted for birth year and country of origin revealed that age at PHV was associated with the risk of any fracture and non-vertebral fracture. Participants with age at PHV in the highest tertile (after 14.5 years of age) were at greater risk of any fracture (hazard ratio [HR] 1.15, 95% confidence interval [CI] 1.08–1.22, P < 0.001) and non-vertebral fracture (HR 1.16, 95% CI 1.09–1.24, P < 0.001) compared with those with age at PHV in the lowest tertile (at 13.6 years of age or younger). Additional adjustments for birthweight, childhood BMI, adult educational level, and young adult height did not attenuate the associations between age at PHV and adult fracture risk. Limitations of this study include the inability to adjust for important risk factors for fracture, inadequate power to assess the relation between pubertal timing and specific fracture types, and the limited generalizability to other populations. Conclusions In this study, we observed that late pubertal timing was associated with increased adult fracture risk in men. These findings suggest that information on pubertal timing might aid in the identification of those men at greatest risk of fracture.

Highlights

Puberty, representing the transition from childhood to adulthood, plays an essential role in longitudinal and appositional bone growth as well as bone mineral acquisition [1]
We observed that late pubertal timing was associated with increased adult fracture risk in men
We previously showed that late age at peak height velocity (PHV) was associated with low trabecular and cortical volumetric bone mineral density (BMD) at the radius as well as previous fracture in 642 young adult Swedish men participating in the Gothenburg Osteoporosis and Obesity Determinants study [21]

Summary

Introduction

Puberty, representing the transition from childhood to adulthood, plays an essential role in longitudinal and appositional bone growth as well as bone mineral acquisition [1]. Retrospective epidemiological studies of pre- and postmenopausal women demonstrated that later age at menarche was associated with lower areal and volumetric bone mineral density (BMD) [10,11,12,13,14] and increased risk of osteoporotic fractures [15,16,17]. Later puberty, based on growth tempo from serial height measurements, was associated with sustained lower trabecular volumetric BMD and reduced bone size and calculated bone strength at the radius, as well as lower areal BMD at the lumber spine and total hip, in 792 men at 60–64 years of age from a British birth cohort study [22].

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