Bone Mineral Density Accrual Research Articles

Longitudinal impact of substance use and depressive symptoms on bone accrual among girls aged 11-19 years.

Osteoporosis is primarily evident in postmenopausal women, but its roots are traceable to periods of growth, including during adolescence. Depression, anxiety, and smoking are associated with lower bone mineral density (BMD) in adults. These associations have not been studied longitudinally across adolescence, when more than 50% of bone accrual occurs. To determine the impact of depressive and anxiety symptoms, smoking, and alcohol use on bone accrual in girls 11-19 years, 262 healthy girls were enrolled in age cohorts of 11, 13, 15, and 17 years. Using a cross-sequential design, girls were seen for three annual visits. Outcome measures included total body bone mineral content and BMD of the total hip and lumbar spine using dual energy x-ray absorptiometry. Depressive and anxiety symptoms and smoking and alcohol use were by self-report. Higher-frequency smoking was associated with a lower rate of lumbar spine and total hip BMD accrual from ages 13-19. Higher depressive symptoms were associated with lower lumbar spine BMD across 11-19 years of age. There was no effect of depressive symptoms on total body bone mineral content, and there was no effect of alcohol intake on any bone outcome. Adolescent smokers are at higher risk for less than optimal bone accrual. Even in the absence of diagnosable depression, depressive symptoms may influence adolescent bone accrual. These findings have import for prevention of later osteoporosis and fractures.

Bone Mineral Density and Nutritional Status of Healthy Sri Lankan PreSchool Children

: Background: We wished to assess bone mineral density (BMD) values and factors that contribute to bone mineral accrual among preschool children in Sri Lanka. Currently, this information is not available.Objectives: To measure BMDs of spine and hip, using a central-type DXA, in a representative sample of preschool children in Southern Sri Lanka and to study their anthropometry and micronutrient status in order to study the associations of such measurements with bone mineral status.Patients and Methods: We measured BMD of the spine and hip using dual-energy absorptiometry in 105 preschool children (52 boys) aged 3–5 years in Southern Sri Lanka. We also studied their anthropometric characteristics and micronutrient status (iron, zinc, calcium, ceruloplasmin, free thyroxine, and vitamins A and D).Results: Although spine BMD showed no sex difference (mean BMD 0.451 g/cm2 and 0.447 g/cm2 in boys and girls, respectively; p = 0.70), proximal femur BMD values were significantly higher (p = 0.02) among boys (0.594 g/cm2) than among girls (0.557 g/cm2). Boys had significantly higher bone area in the spine, compared to girls (mean 25.58 vs. 24.05 cm2; p = 0.02). After controlling for other independent variables studied (anthropometry and biochemistry), weight and serum calcium accounted for 26% of the BMD variation (R2 = 0.26). One unit change in body weight (1 kg) or serum calcium level (1 mmol/L) was associated with a change in spine BMD of 0.051 g/cm2 or 0.016 g/cm2, respectively.Conclusions: In addition to higher BMD in the proximal femur boys have broader bones, particularly in the spine. Among different indices of body measurements and multiple nutritional factors, body weight and serum calcium appear to be the main determinants of BMD accrual. Implication for health policy/practice/research/medical education:Study on determinants of childhood bone mineral accrual would identify the major determinant of peak bone mass in later life. Please cite this paper as: Hettiarachchi M, Lekamwasam S, Liyanage C. Bone Mineral Density and Nutritional Status of Healthy Sri Lankan Preschool Children. Int J Endocriol Metab.2011;9(2):335-40. DOI: 10.5812/kowsar.1726913X.2385 Copyright © 2012, Kowsar M.P.Co. All rights reserved.

Bone mineral density accrual in students with autism spectrum disorders: Effects of calcium intake and physical training

The purpose of this study was to investigate the effects of weight bearing exercise and calcium intake on bone mineral density (BMD) of students with autism spectrum disorders. For this reason 60 boy students with autism disorder (age 8–10 years old) were assigned to four groups with no differences in age, BMD, calcium intake, and physical activity: exercise groups with or without calcium supplementation (Ex+Ca+ and Ex+Ca−) and non-exercise groups with or without calcium supplementation (Ex−Ca+ and Ex−Ca−). The intervention involved 50min of weight bearing exercise performed 3 sessions a week and/or the addition of dietary calcium rich food using enriched cow milk with vitamin D containing 250mg calcium per serving, over 6 months. Paired-samples t test, one way ANOVA analysis, and Tukey tests were used to determine the main and combined effects of training and calcium on BMD. All groups showed greater femoral neck BMD after 6 months. The increase in femoral neck BMD in the Ex+Ca+ group was 14.04% greater than increase in the Ex+Ca− group (P<0.05). Apparently, the effect of training was greater than calcium intake because the Ex+Ca− group achieved 4.71% greater BMD than Ex−Ca+ group (P<0.05). In this study, all experimental groups had greater BMD than the control group (Ex−Ca−) (P<0.05).In these participants, additional weight bearing exercise and calcium supplementation resulted in a greater increase in BMD than controls at the loaded site (femoral neck). These results help to provide more evidence for public health organizations to deal with both exercise and nutrition issues in children with autism disorder for the achievement and of peak BMD.

Bone mineral density in partially recovered early onset anorexic patients - a follow-up investigation

Background and aimsThere still is a lack of prospective studies on bone mineral development in patients with a history of early onset Anorexia nervosa (AN). Therefore we assessed associations between bone mass accrual and clinical outcomes in a former clinical sample. In addition to an expected influence of regular physical activity and hormone replacement therapy, we explored correlations with nutritionally dependent hormones.Methods3-9 years (mean 5.2 ± 1.7) after hospital discharge, we re-investigated 52 female subjects with a history of early onset AN. By means of a standardized approach, we evaluated the general outcome of AN. Moreover, bone mineral content (BMC) and bone mineral density (BMD) as well as lean and fat mass were measured by dual-energy x-ray absorptiometry (DXA). In a substudy, we measured the serum concentrations of leptin and insulin-like growth factor-I (IGF-I).ResultsThe general outcome of anorexia nervosa was good in 50% of the subjects (BMI ≥ 17.5 kg/m2, resumption of menses). Clinical improvement was correlated with BMC and BMD accrual (χ2 = 5.62/χ2 = 6.65, p = 0.06 / p = 0.036). The duration of amenorrhea had a negative correlation with BMD (r = -.362; p < 0.01), but not with BMC. Regular physical activity tended to show a positive effect on bone recovery, but the effect of hormone replacement therapy was not significant. Using age-related standards, the post-discharge sample for the substudy presented IGF-I levels below the 5th percentile. IGF-I serum concentrations corresponded to the general outcome of AN. By contrast, leptin serum concentrations showed great variability. They correlated with BMC and current body composition parameters.ConclusionsOur results from the main study indicate a certain adaptability of bone mineral accrual which is dependent on a speedy and ongoing recovery. While leptin levels in the substudy tended to respond immediately to current nutritional status, IGF-I serum concentrations corresponded to the individual's age and general outcome of AN.

Safety and Efficacy of Intravenous Zoledronic Acid in Paediatric Osteoporosis

To study the safety and efficacy of zoledronic acid treatment in children with osteoporotic bone disorders. Observational study in 22 patients with osteogenesis imperfecta and related conditions who were treated at our institution with zoledronic acid. These patients had initial treatment with pamidronate. Lumbar spine z-scores, annual change in areal bone mineral density, bone mineral adjusted density, fracture number and linear growth before and after zoledronic acid treatment was commenced were compared. Patients were treated for a mean of 3.4 years with zoledronic acid after a mean of 3.75 years of pamidronate therapy. There was no difference in areal bone mineral density accrual in the first year of zoledronic acid treatment compared to the preceding year of pamidronate treatment. Lumbar spine z-scores and bone mineral adjusted density continued to increase with zoledronic acid. Number of fractures during treatment was significantly reduced compared to baseline with either bisphosphonate, with no difference between treatments. Linear growth was not affected. Zoledronic acid is at least as effective as pamidronate as treatment for paediatric osteoporosis, and has a similar safety profile.

Interaction of interleukin-6 and estrogen receptor gene polymorphisms on bone mass accrual in Chinese adolescent girls

We assessed the main and interaction effects of interleukin-6 and estrogen receptor gene polymorphisms on bone mass accrual in Chinese adolescent girls. A total of 228 premenarche Chinese girls (9-11.5 years old) were recruited for a 2-year follow-up study. Bone mineral density (BMD) at the total body, lumbar spine (L1-L4), and total left hip were measured by dual-energy X-ray absorptiometry at baseline and follow-up. The -174G/C and -634C/G polymorphism of IL-6 gene, and PvuII and XbaI polymorphisms of the estrogen receptor (ER)-alpha gene, were determined. The -634C/G polymorphism of the IL-6 gene and PvuII polymorphism of ER-alpha gene were significantly associated with bone mass accrual after adjusting the potential confounding factors. Girls with pp genotype of ER-alpha gene had greater percentage accrual in BMD of total body (P = 0.010) and femoral intertrochanter (P = 0.038) than their PP and Pp counterparts. Girls with CC genotype of IL-6 -634G/C gene had higher percentage accrual in BMD of total body (P = 0.032) and femoral trochanter (P = 0.048) than their CG + GG counterparts. Significant interaction effects of IL-6 -634C/G polymorphism and ER-alpha PvuII polymorphism were observed on percentage change in BMD of total left hip (P = 0.009) and femoral intertrochanter (P = 0.007). The genotype CC (IL-6 -634C/G) x pp (ER-alpha PvuII) was associated with greater BMD accrual than other genotype combination in Chinese adolescent girls. We found that the IL-6 -634C/G and ER-alpha PvuII polymorphism were significantly associated with BMD accrual and that they have an interactional effect on BMD accrual in Chinese adolescent girls.

Bone Mineral Accrual in Osteopenic and Nonosteopenic Girls With Idiopathic Scoliosis During Bracing Treatment

A prospective longitudinal follow-up study. To assess the effect of standardized bracing treatment on bone mineral density (BMD) accumulation in girls with adolescent idiopathic scoliosis (AIS) and to analyze the possible influencing factors of BMD accumulation during bracing treatment. The association between osteopenia and AIS has been reported in numerous studies. Although a very recent study argued that bracing did not appear to affect BMD accumulation, the impact of initial bone mineral status on the BMD accrual during the bracing treatment has not been analyzed before. Using a dual energy radiograph absorptiometer, BMD and BMC measurements were taken initially and with a follow-up after 1 year in the lumbar spine (L2-L4, LS) and femoral neck (FN) of the nondominant side on AIS girls who were treated with braces. Differences in bone mineral accrual in initially osteopenic and non-osteopenic AIS girls were analyzed. The BMD accumulation rates were correlated with maturity status at entry, the anthropometric data, and the duration of bracing. Forty-nine patients with AIS were included. At entry, osteopenia was found in 16 and 14 girls at the site of LS and FN, respectively. After an average duration of 1.1 years brace treatment, more than 94% of AIS girls had a positive bone mineral accrual. The annual accumulation rates of LS-BMD and FN-BMD were 0.054 g/(cm2 x yr) and 0.076 g/(cm x yr) respectively, and both were similar initially in osteopenic and non-osteopenic patients. Neither the total nor the daily bracing time correlated significantly with the accumulation rates at either site. The annual accumulation rate of LS-BMD was found to be inversely correlated with maturity at entry whereas positively correlated with changes in height and weight. It is concluded that nearly all of AIS girls had positive bone mineral accrual at LS and FN during over-1-year brace treatment. Brace treatment and the initial bone mineral status may not play important roles in the BMD accumulation. Growth potential of AIS patients is one of the key factors influencing bone mineral accrual during brace treatment.

The Impact of Depot Medroxyprogesterone Acetate on Adolescent Bone Mineral Density

Background: Depot medroxyprogesterone acetate intramuscular injection 150 mg/mL (DMPA-IM 150) is a progestin-only hormonal contraceptive widely used among adolescents. Since use of DMPA-IM 150 may lead to relative estrogen deficiency, there is a concern regarding its effect on bone mineral density (BMD), particularly when used during adolescence, a critical period of BMD accrual.

An Open Label 12-Month Pilot Trial on the Effects of the Aromatase Inhibitor Anastrozole in Growth Hormone (GH)-Treated GH Deficient Adolescent Boys

To investigate whether 12 mo treatment with the aromatase inhibitor anastrozole can achieve sustained suppression of estrogen production and delay epiphyseal fusion in growth hormone deficient (GHD) adolescent males. 20 adolescents with GHD were recruited (mean age +/- SE: 14.7 +/- 0.5 yr). Ten continued on GH (control group), and 10 on GH and anastrozole (Rx group) for 12 mo. After 12 mo E2 concentrations declined 60% in the Rx group (from 1.8 +/- 0.5 to 0.7 +/- 0.3 pg/ml, p <0.05) whereas they increased in controls (from 1.2 +/- 0.7 to 1.8 +/- 0.7, p <0.05). Testosterone increased 117% in the Rx group (from 304 +/- 31 to 626 +/- 64 ng/dl), 47% in controls (from 274 +/- 89 to 398 +/- 51) (p = 0.03, ANOVA between groups). IGF-I increased 42% in controls (454 +/- 22 to 711 +/- 109 ng/ml, p <0.05), but remained invariant in the Rx group (446 +/- 29 to 540 +/- 80, p = NS). Bone markers, plasma lipids, insulin, glucose, and liver function tests were all unchanged between groups with no differences either in body composition or bone mineral density accrual. There were no differences in growth velocity, height SDS, bone age advancement, predicted adult height or testicular volumes between groups after 12 mo. Anastrozole treatment potently decreases estrogen concentrations in adolescent males with GHD while allowing normal virilization, without deleterious effects on body composition, plasma lipids, bone metabolism or the tempo of puberty. Twelve months of treatment, however, did not increase predicted adult height. Further studies are needed to ascertain whether more prolonged estrogen blockade is helpful in the treatment of growth retardation in puberty.

Vitamin D and attainment of peak bone mass among peripubertal Finnish girls: a 3-y prospective study

Little is known about the effect of vitamin D status on bone gain in adolescents. The objective was to examine whether vitamin D status is associated with accrual of bone mineral density (BMD) and bone mineral apparent density (BMAD). This 3-y prospective study examined the association between changes in BMD or BMAD and serum 25-hydroxyvitamin D [25(OH)D] in 171 healthy Finnish girls aged 9-15 y. Lumbar spine and femoral neck BMDs were measured by dual-energy X-ray absorptiometry. Baseline 25(OH)D correlated significantly with the unadjusted 3-y change in BMD at the lumbar spine (r = 0.35, P < 0.001) and femoral neck (r = 0.32, P < 0.001) in all participants. The difference from baseline in adjusted 3-y BMD accumulation between those with severe hypovitaminosis D [25(OH)D < 20 nmol/L] and those with a normal vitamin D status [25(OH)D > or = 37.5 nmol/L] was 4% (12.7%, 13.1%, and 16.7% for the lowest, middle, and highest tertiles of 25(OH)D, respectively; P for trend = 0.01) at the lumbar spine in the girls with advanced sexual maturation at baseline (n = 129). Moreover, the adjusted change in lumbar spine BMD was 27% greater in the highest vitamin D intake tertile than in the lowest tertile in the same girls (P for trend = 0.016). Pubertal girls with hypovitaminosis D seem to be at risk of not reaching maximum peak bone mass, particularly at the lumbar spine. Dietary enrichment or supplementation with vitamin D should be considered to ensure an adequate vitamin D status.

Lumbar bone mineral density in normal subjects aged 3-6 years: a prospective study

Longitudinal studies on bone mineral density (BMD) accrual in young children are scarce. The purpose of the present study was to evaluate prospectively the development of spinal BMD in healthy Finnish children aged 3-6 y by dual-energy x-ray absorptiometry (DXA). Lumbar spine (L2-L4) areal BMD (g/cm2) was measured by DXA (Lunar DPX) in 20 children (10M, 10F) aged 3.3-6.9 y (median 4.8 y) at baseline and after a median follow-up of 1.0y (range 0.8-1.1 y). Apparent volumetric BMD (BMDvol, g/cm3) was calculated to minimize the effect of bone size on BMD in growing spine. At baseline, lumbar areal and volumetric BMDs (mean +/- SD) for males were 0.623+/-0.087 g/cm2 and 0.270+/-0.034 g/cm3, respectively, and for females 0.620+/-0.082 g/cm2 and 0.254+/-0.035 g/cm3, respectively. During the median follow-up of 1 y, lumbar areal and volumetric BMDs (mean +/- SD) increased in males by 4.7+/-2.7% (p < 0.01) and 3.5+/-3.5% (p <0.05), respectively, and in females by 7.2+/-5.3% (p <0.01) and 3.1+/-3.1% (p <0.05), respectively. No statistically significant difference in the BMD values was observed between the sexes. A significant increase in both areal and apparent volumetric BMD was observed in children aged 3-6 y during a follow-up of I y. The increase in volumetric BMD indicated that there was a real accrual of BMD in growing spine measured by DXA. The present study provides prospective data on BMD accrual in young children for the evaluation of bone mass development in early childhood.

Lumbar bone mineral density in normal subjects aged 3–6 years: a prospective study

Longitudinal studies on bone mineral density (BMD) accrual in young children are scarce. The purpose of the present study was to evaluate prospectively the development of spinal BMD in healthy Finnish children aged 3–6 y by dual‐energy x‐ray absorptiometry (DXA). Lumbar spine (L2‐L4) areal BMD (g/cm2) was measured by DXA (Lunar DPX) in 20 children (10M, 10F) aged 3.3‐6.9 y (median 4.8 y) at baseline and after a median follow‐up of 1.0 y (range 0.8‐1.1 y). Apparent volumetric BMD (BMDvol, g/cm3) was calculated to minimize the effect of bone size on BMD in growing spine. At baseline, lumbar areal and volumetric BMDs (mean ± SD) for males were 0.623 ± 0.087 g/cm2 and 0.270 ± 0.034 g/cm3, respectively, and for females 0.620 ± 0.082 g/cm2 and 0.254 ± 0.035 g/cm3, respectively. During the median follow‐up of 1 y, lumbar areal and volumetric BMDs (mean ± SD) increased in males by 4.7 ± 2.7% (p &lt; 0.01) and 3.5 ± 3.5% (p &lt; 0.05), respectively, and in females by 7.2 ± 5.3% (p &lt; 0.01) and 3.1 ± 3.1% (p &lt; 0.05), respectively. No statistically significant difference in the BMD values was observed between the sexes. Conclusion: A significant increase in both areal and apparent volumetric BMD was observed in children aged 3–6 y during a follow‐up of 1 y. The increase in volumetric BMD indicated that there was a real accrual of BMD in growing spine measured by DXA. The present study provides prospective data on BMD accrual in young children for the evaluation of bone mass development in early childhood.

Surgically induced endometriosis attenuates accrual of bone mineral density in growing rats

Objective: A possible association of endometriosis with decreased bone mineral density in women has been proposed. It has been reported that cortical and trabecular bone mass of the distal portion of the radius is decreased in patients with endometriosis. The objective of this study was to investigate the relationship between endometriosis and bone mineral density with the use of a rat model. Study Design: Cycling female Sprague-Dawley rats (180 days old) were randomly assigned to 1 of 2 groups. The treatment group (n = 16) underwent surgical induction of endometriosis. Female rats (n = 17) with surgically transplanted abdominal muscle served as control animals. Dual-energy x-ray absorptiometry measurements were obtained before surgery and after 90 days with a Lunar DPX-MD+ (GE Lunar, GE Medical Systems, Milwaukee, Wis) bone densitometer, with software standardized for small animal research. Results: Experimental animals had grossly visible endometriotic disease at necropsy (90 days). The mean net change in total bone mineral density from baseline to 90 days in the control group was +0.019 ± 0.002 g/cm2, whereas the mean net change in total bone mineral density for the experimental group was +0.013 ± 0.002 g/cm2. The experimental group gained less bone than the control group (P =.02). Conclusion: The age-appropriate increase in bone mineral density known to occur in this animal model is attenuated by surgically induced endometriosis. This finding supports the idea that endometriosis might be associated with decreased bone mineral density. (Am J Obstet Gynecol 2001;184:331-5.)

Bone Mineral Density in Weight-Bearing and Nonweight-Bearing Female Athletes

Bone mineral density (BMD) development and maintenance is enhanced with weight-bearing exercise, while bed rest and zero gravity results in BMD loss. The purpose of this study is to determine if BMD is significantly different in female athletes engaged in weight-bearing versus nonweight-bearing sports. Six BMD sites and anthropometric measurements were assessed at 3 equal intervals utilizing 2-way ANOVA’s. Controlling for body-weight, differences in BMD were investigated utilizing ANCOVA. Pearson and Spearman Rank Correlations were utilized to investigate interrelationships between anthropometric, VO2max, and BMD measurements. Swimmers were taller and heavier with greater percent, body fat. BMD was significantly different between runners and swimmers only at the distal, which was higher for swimmers at 6 months. There was no difference in radial BMD when utilizing ANCOVA, with weight serving as the covariate. Swimming does not appear to be a contraindicated activity for BMD accrual and maintenance.

Altered loading patterns and femoral bone mineral density in children with unilateral Legg-Calvé-Perthes disease.

Maximization of bone accrual during the growing years is thought to be an important factor in minimizing fracture risk in old age. Mechanical loading through physical activity has been recommended as a modality for the conservation of bone mineral in adults; however, few studies have evaluated the impact of different loading regimes in growing children. The purpose of this study was to compare bone mineral density (BMD) in weight-bearing and non-weight-bearing limbs in 17 children with unilateral Legg Calvé Perthes Disease (LCPD). Children with this condition have an altered weight-bearing pattern whereby there is increased mechanical loading on the noninvolved normal hip and reduced loading on the involved painful hip. Thus, these children provide a unique opportunity to study the impact of differential mechanical loading on BMD during the growing years while controlling for genetic disposition. BMD at four regions of the proximal femur (trochanter, intertrochanter, femoral neck, total of the regions) was measured using dual energy x-ray absorptiometry (DXA), and the values were compared between the involved and noninvolved sides of the children with LCPD. The BMD of the both sides also were compared with normative values based on both chronological and skeletal age data. A significantly higher BMD was found on the noninvolved side over the involved side for all regions (P < 0.01 and percentage differences of 12-15%) except at the femoral neck (percentage difference of 3.9%). The BMD (at all regions) of the noninvolved side also was significantly greater (P < 0.01) than either the chronological or skeletal age based norms for all sites except the trochanter. The results support the concept that mechanical loading of the skeleton during the growing years is an important factor in BMD accrual.