Bone Development In Children Research Articles

Analysis of predictive factors related to long-term hearing and temporal bone development in congenital microtia

ObjectiveTo investigate the predictive factors of long-term hearing threshold and temporal bone development in children with congenital microtia (CM). Methods74 patients (92 ears) with CM enrolled, which all had auditory brainstem response (ABR) results during infancy or toddlerhood, pure tone audiometry (PTA) and high-resolution computed tomography (HRCT) results during childhood or adolescence, and had not undergone any surgery. We compared the relationship between ABR, auditory steady-state response (ASSR), the affected side, auricular morphology, presence of external auditory canal stenosis or atresia, PTA average, mastoid pneumatization, Jarhsdoerfer scores, and wether cholesteatoma exists. ResultsThe average age of ABR in 92 ears was 2.72 ± 3.52 years old, PTA was 7.26 ± 2.51 and HRCT was 6.91 ± 2.76 years old. ABR-AC was related to PTA average, mastoid pneumatization, Jarhsdoerfer scores, and wether cholesteatoma exists in CM. While ABR-ABG was related to all of these factors except Jarhsdoerfer score, and ABR-BC had no relationship with any of them. ASSR only showed correlation with frequencies of 1, 2kHz and was related to Jarhsdoerfer score, with no other correlations observed. The impaired ear side showed no relevance. However, auricular morphology was related to all of these factors except wether cholesteatoma exist. External auditory canal stenosis or atresia was related to PTA average, but unrelated to mastoid pneumatization. ConclusionThe ABR examination in the infant stage plays a crucial role in predicting the long-term hearing and temporal bone development in patients with CM.

Variation of Bone Turnover Markers in Childhood and Adolescence.

To determine the bone metabolic marker changes from childhood to adolescence and to provide reference values for monitoring bone development in children in Southwest China. We surveyed 703 participants attending physical examinations from April 2019 and August 2021. Twenty-eight participants were excluded for lack of laboratory tests, and 14 people were excluded for diseases that might affect bone metabolism. A total of 661 children were selected for the study. According to the main developmental periods, the children were divided into preschool, preadolescence, and adolescence groups. Serum bone turnover markers including β-isomerized C-terminal telopeptide of type I collagen (β-CTx), N-terminal midfragment of osteocalcin (N-MID), and procollagen type 1 N-propeptide (P1NP) as well as growth and development indices such as serum calcium (Ca), phosphorus (Pi), alkaline phosphatase (ALP), and vitamin D were measured. The changes in bone metabolism-related markers and the correlations between the indices were analyzed. During the development in boys, the levels of β-CTx and N-MID increased with age from preschool to adolescence, while the levels of P1NP decreased and then increased. In girls, the levels of β-CTx and N-MID plateaued in early adolescence and showed little change in subsequent adolescence, while the levels of P1NP exhibited a downward trend. The correlations between bone metabolism markers and vitamin D were not significant. The levels of bone metabolism markers differed between boys and girls. Reference intervals can be used as essential tools to examine the levels of bone metabolism markers reasonably.

A Comprehensive Review of Minerals and Vitamins Synergy: Impacts on Childhood and Adolescent Bone Development

Bone development during childhood and adolescence is a critical period that lays the foundation for lifelong skeletal health. Adequate nutrition, particularly the intake of minerals and vitamins, is pivotal in ensuring optimal bone growth and development. This comprehensive review examines the synergy between minerals and vitamins and its impact on childhood and adolescent bone development. The review begins with exploring the significance of bone health during the formative years, emphasizing the long-term implications of suboptimal bone development. The topic then turns to the precise roles essential vitamins, particularly vitamin D, and crucial minerals, such as calcium and phosphorus, play in maintaining healthy bones. It highlights their interdependent roles and the interconnected biochemical pathways facilitating bone growth. Moreover, this review sheds light on the factors influencing these nutrients' absorption, utilization, and bioavailability in children and adolescents. Genetic factors, dietary habits, lifestyle choices, and other variables are examined for their potential effects on bone health outcomes. Through a meticulous analysis of existing clinical studies and observations, the review evaluates the impact of minerals and vitamin synergy on bone density, mineral content, and overall bone strength in the pediatric population. Furthermore, it elucidates the potential benefits of optimizing these nutrients during crucial growth stages. Evidence-based recommendations are provided to guide parents, caregivers, and healthcare professionals in promoting healthy bone development in children and adolescents. The importance of tailored dietary strategies, supplementation when necessary, and lifestyle modifications is emphasized for maximizing bone health outcomes. In conclusion, this comprehensive review underscores the vital role of minerals and vitamin synergy in childhood and adolescent bone development. It consolidates existing knowledge, identifies research gaps, and sets the stage for future investigations in pediatric skeletal health. Ultimately, this work aims to raise awareness about the significance of adequate nutrition in shaping resilient and robust bones, contributing to the overall well-being of the younger generation. Here we will discuss the necessary bone nutrients, such as Phosphorus, Calcium, Vit D, Vit A, Vit K2, Zinc, Magnesium, and Branched Chain Amino Acid.

The relationship between obesity and bone mineral density in children and adolescents: analysis of the National Health and Nutrition Examination Survey.

This study observed the relationship between fat mass and distribution, and areal bone mineral density (aBMD) in children and adolescents. A retrospective study was conducted on US children and adolescents aged 8-19years. Whole body (less head) aBMD was evaluated. Height (Ht) adjusted Z-scores for aBMD were calculated. After controlling for age, gender, race, and lean body mass index (LBMI) Z-score, there were significant negative associations between fat mass index (FMI) Z-score and aBMD Ht-Z-adjusted Z-score (β = - 0.272, P < 0.001, R2 = 0.033). In the linear regression models with aBMD Ht-Z-adjusted Z-score as the dependent variable, the regression coefficients of android fat mass were - 0.241 (P < 0.05, R2 = 0.002), - 0.473 (P < 0.001, R2 = 0.036), and - 0.474 (P < 0.001, R2 = 0.038) for healthy weight, overweight, and obesity group, respectively. The regression coefficients of visceral adipose tissue (VAT) mass were - 0.218 (P > 0.05, R2 = 0.001), - 2.025 (P < 0.001, R2 = 0.044), and - 1.826 (P < 0.001, R2 = 0.039), and the regression coefficients of subcutaneous adipose tissue (SAT) mass were - 0.467 (P < 0.001, R2 = 0.004), - 0.339 (P < 0.01, R2 = 0.024), and - 0.347 (P < 0.001, R2 = 0.018) for healthy weight, overweight, and obesity group, respectively. The present study suggests that fat mass has a slightly negative association with bone development in children and adolescents. Trunk fat accumulation, especially visceral adipose tissue, was correlated with the lower level of aBMD. This association was obvious in overweight and obese children.

Ambient ozone exposure and bone turnover markers in children: Results from the GINIplus and LISA birth cohorts

BackgroundMultiple environmental factors can regulate bone metabolism, and it is hypothesized that air pollution may be deleteriously involved in this regulation. However, only a few studies considered bone turnover markers (BTMs) - sensitive and specific markers of bone metabolism - as outcomes, and no study investigated the exposure to ambient ozone. Here, we intended to explore the associations between long-term exposure to ambient ozone and concentrations of two BTMs, osteocalcin and β-isomer of C-terminal telopeptide of type I collagen (CTx), amongst 10-year-old children. MethodsBased on the GINIplus and LISA birth cohorts, our cross-sectional analysis included 1848 children aged 10 years from Munich and Wesel. Serum osteocalcin and CTx concentrations were measured. We estimated ozone exposures by optimal interpolation, assessed nitrogen dioxide and particulate matter with an aerodynamic diameter <10 μm concentrations by land use regression models, and assigned the exposures to home addresses. Linear regression models were built and adjusted for covariates as well as co-pollutants. ResultsThe mean concentrations were 93.09 ng/mL and 663.66 ng/L for osteocalcin and CTx, respectively. In general, higher levels of ozone were associated with decreased concentrations of both BTMs. This held true for the two areas and different exposure metrics. The number of days per year with a maximum 8-h average concentration exceeding 120 μg/m³ showed consistent results across different models. Specifically, models adjusted for co-pollutants illustrated that the beta estimates and 95% confidence intervals on osteocalcin and CTx were −2.51 (−3.78, −1.14) and −44.53 (−57.12, −31.93), respectively, for an increase of 10 days. ConclusionsWe found that long-term exposure to ambient ozone was associated with decreased concentrations of BTMs in German children. This association might potentially affect bone metabolism. Nevertheless, unless other prospective studies confirm our results, the detrimental effects of ambient ozone on bone development in children should be interpreted cautiously.

Development of tibia & fibula bone deficits in children with neurofibromatosis type I - A longitudinal case-control comparison.

Neurofibromatosis type 1 (NF1) is associated with lower bone mass and increased risk of fracture. Children with NF1 display faltering growth from mid-childhood. However, to date tibia bone development in children with NF1 across childhood and the role of body size have not been explored. Therefore, we recruited 24 children with NF1 (12 girls, mean age 8.2±1.1y) and 104 children without NF1 (52 girls, mean age 11±1.7y). Tibia and fibula bone characteristics were assessed at 4% and 38% distal-proximal tibia length in all children at baseline using peripheral quantitative computed tomography (pQCT). Longitudinal scans were obtained in 21 children with NF1 (12 girls) over 3.4±0.3y and 71 children without NF1 (34 girls) over 1.1±0.1y, such that at follow-up mean age of both groups (NF1 10.9±1.3y, controls 11.4±1.4y) were similar. Effects of group (NF1/control) on bone outcomes as well as group-by-age interactions, indicating differences in rate of change in bone outcome bone outcomes were assessed via linear mixed effects models with adjustment for sex, age, pubertal status and in additional models with adjustment for height and weight Z-scores. Group (NF1/control)-by-age interactions indicated a slower rate of tibia and fibula bone mass accrual in children with NF1 at all measured sites. These associations were attenuated by 25-50% by adjustment for height and weight Z-scores. At the 4% site, deficits in bone mass at older ages were related to slower trabecular BMD accrual. At the 38% site, group-by-age interactions suggested that bone mass deficits resulted from poorer accrual of cortical CSA and to a lesser extent cortical BMD. Lower limb bone mass deficits evident in children with NF1 appear to be progressive and emerge in mid-childhood. In part, they are related to development of a similar pattern of deficits in longitudinal growth and body weight in NF1. Interventions promoting muscle development or physical activity may be partially effective in attenuating bone mass accrual deficits in this population.

Hepatic Steatosis is Negatively Associated with Bone Mineral Density in Children

To evaluate the relationship between hepatic steatosis and bone mineral density (BMD) in children. In addition, to assess 25-hydroxyvitamin D levels in the relationship between hepatic steatosis and BMD. A community-based sample of 235 children was assessed for hepatic steatosis, BMD, and serum 25-hydroxyvitamin D. Hepatic steatosis was measured by liver magnetic resonance imaging proton density fat fraction (MRI-PDFF). BMD was measured by whole-body dual-energy x-ray absorptiometry. The mean age of the study population was 12.5years (SD 2.5years). Liver MRI-PDFF ranged from 1.1% to 40.1% with a mean of 9.3% (SD 8.5%). Across this broad spectrum of hepatic fat content, there was a significant negative relationship between liver MRI-PDFF and BMD z score (R=-0.421, P<.001). Across the states of sufficiency, insufficiency, and deficiency, there was a significant negative association between 25-hydroxyvitamin D and liver MRI-PDFF (P<.05); however, there was no significant association between vitamin D status and BMD z score (P=.94). Finally, children with clinically low BMD z scores were found to have higher alanine aminotransferase (P<.05) and gamma-glutamyl transferase (P<.05) levels compared with children with normal BMD z scores. Across the full range of liver MRI-PDFF, there was a strong negative relationship between hepatic steatosis and BMD z score. Given the prevalence of nonalcoholic fatty liver disease and the critical importance of childhood bone mineralization in protecting against osteoporosis, clinicians should prioritize supporting bone development in children with nonalcoholic fatty liver disease.

Effect of milk vs. sugar-sweetened beverage supplementation on bone development in pre-pubertal pigs as model for children

Milk consumption has long been associated with better bone development in children, contrary to sugar-sweetened beverages (SSB); however, stronger evidence are needed. Therefore, this study aimed to use a pig model for growing children to evaluate the effect of milk vs. SBB consumption on the developing skeleton. For this, we used 24 pre-pubertal pigs (12 in Experiment 1, 8 males and 4 females, and 12 in Experiment 2, all males) randomly split into two groups to receive up to 750 mL of whole milk supplementation or an isocaloric maltodextrin solution (as SSB) for 13 or 11 weeks. Ultrasonography was used throughout the trial to record in vivo bone growth. The pigs were euthanised, and bones of the appendicular skeleton and the mandible were collected and measured with Dual X-Ray Absorptiometry (DEXA). A three-point bending test was used for biomechanical testing. After fracture, the cortical bone thickness was measured at three regions of the femur. Of the DEXA measurements taken, only the bone mineral density of the mandible was lower in pigs receiving milk vs. SSB. Compared to SSB, pigs consuming milk had also a larger occlusal surface thickness indicating lower teeth grinding, suggesting a calming effect of the milk. There was no difference in any biomechanical tests. In femur, the medial cortical was thicker in the SSB group, while the lateral cortical was thicker in the group receiving milk. Overall, there appears to be no effect of short-term milk supplementation on bone growth, mineral density and strength. Highlights Larger bone density and size was observed in male vs. female before puberty. Three cups of whole milk per day for 3 months did not improve bone density and strength compared to isoenergetic sugar-sweetened beverage in prepubertal pigs used as model for growing children despite higher amount of calcium in the diet. Lower bone density in the ramus of the mandible and less teeth grinding indicated a reduced stress in the animals feed with milk.

Spirulina Enhances Bone Modeling in Growing Male Rats by Regulating Growth-Related Hormones.

In recent years, growth hormone deficiency in children has been treated with hormone therapy despite the possible significant side effects. Therefore, it was deemed beneficial to develop functional foods or dietary supplements for safely improving children’s growth. Spirulina platensis is known for its high antioxidant, anti-aging, anti-cancer, and immunity-enhancing properties, as well as its high digestibility and high protein content, but little has been reported about its influence on bone development in children with a normal supply of protein. In this study, we evaluated the effects of spirulina on the bone metabolism and antioxidant profiles of three-week-old growing male rats. The animals were divided into four groups (n = 17 per group) and were fed AIN93G diets with 0% (control), 30% (SP30), 50% (SP50), and 70% (SP70) of casein protein replaced by spirulina, respectively, for seven weeks. We observed that spirulina enhanced bone growth and bone strength by stimulating parathyroid hormone and growth hormone activities, as well its increased antioxidant activity. These results indicate that spirulina provides a suitable dietary supplement and alternative protein source with antioxidant benefits for growth improvement in early developmental stages.

Long-term growth and bone development in children of HBV-infected mothers with and without fetal exposure to tenofovir disoproxil fumarate

Tenofovir disoproxil fumarate (TDF) is the preferred treatment to prevent maternal transmission of HBV, owing to its efficacy and safety. However, data are lacking on the long-term safety outcomes in children following fetal exposure to TDF. Children participating in a prospective, multisite trial of maternal TDF treatment during late pregnancy were recruited for follow-up visits once a year. Growth parameters, serum biochemistry, HBV serology, and bone mineral density (BMD) by dual-energy x-ray absorptiometery scan were measured. One hundred and twenty-eight children, 71 in the TDF and 57 in the control group, completed 255 follow-up visits at the age of 2 to 7 (median, 4.08) years. No differences in z-scores for weight-for-age (0.26 ± 0.90 vs. 0.22 ± 0.99, p= 0.481), z-scores for height-for-age (0.20 ± 1.02 vs. 0.25 ± 0.98, p= 0.812), and estimated glomerular filtration rate (169.12 ± 50.48 vs. 169.06 ± 34.46 ml/min/1.73m2, p= 0.479) were detected. After adjustment for age, sex and HBV status by multiple linear regression, children in the TDF and control group had comparable levels of serum calcium, phosphorus, bone-specific alkaline phosphatase, calcidiol and BMD of lumbar spines (0.55 ± 0.01 vs. 0.57 ± 0.01 g/cm2, p= 0.159) and left hip (0.56 ± 0.01 vs. 0.56 ± 0.01 g/cm2, p= 0.926). Children of HBV-infected mothers who did or did not receive tenofovir disoproxil fumarate treatment during late pregnancy had comparable long-term growth, renal function, and bone development up to 6-7 years after delivery. NCT01312012 (ClinicalTrials.gov) LAY SUMMARY: Currently there are insufficient long-term safety data in children born to mothers who took antiviral agents during pregnancy to prevent mother-to-infant transmission of hepatitis B virus (HBV). In this study, we found that children of HBV-infected mothers who did or did not receive tenofovir disoproxil fumarate treatment during late pregnancy had comparable long-term growth, renal function, and bone development up to 6-7 years after delivery.

Complicated Muscle-Bone Interactions in Children with Cerebral Palsy.

The goal of this review is to highlight the deficits in muscle and bone in children with cerebral palsy (CP), discuss the muscle-bone relationship in the CP population, and identify muscle-based intervention strategies that may stimulate an improvement in their bone development. The latest research suggests that muscle and bone are both severely underdeveloped and weak in children with CP, even in ambulatory children with mild forms of the disorder. The small and low-performing muscles and limited participation in physical activity are likely the major contributors to the poor bone development in children with CP. However, the muscle-bone relationship may be complicated by other factors, such as a high degree of fat and collagen infiltration of muscle,atypical muscle activation, andmuscle spasticity. Muscle-based interventions, such as resistance training, vibration, and nutritional supplementation, have the potential to improve bone development in children with CP, especially if they are initiated before puberty. Studies are needed to identify the muscle-related factors with the greatest influence on bone development in children with CP. Identifying treatment strategies that capitalize on the relationship between muscle and bone, while also improving balance, coordination, and physical activity participation, is an important step toward increasing bone strength and minimizing fractures in children with CP.

Osteological evidence of metabolic diseases from a post medieval North Italy archaeological site

Skeletal lesions related to metabolic diseases in children have been systematically investigated in paleopathological literature only in recent years. This work presents an infant pathological specimen from the post-medieval cemetery of the St. Mary’s Nativity church (15th–18th centuries, Segno, Trento, Trentino, Northeast Italy). The bones belonged to an individual of 9 ± 3 months of age, estimated upon an assessment of the stage of dental eruption. Metabolic diseases were diagnosed with paleopathological criteria according to previous literature. Differential diagnosis of the osteological evidence indicates a disease that might be caused by the lack of vitamin D or C. Comorbidity of vitamin C and D deficiency has been widely studied in clinical literature, particularly in children between 3 months and 5 years of age. The study of ancient osteoarchaeological materials allows us to improve our knowledge on diseases’ effects on bone development in children and, in this case, it represents additional evidence of the presence of metabolic diseases in a rural contest of the Italian post-medieval period.

Children sustain high levels of skin DNA photodamage, with a modest increase of serum 25-hydroxyvitamin D3 , after a summer holiday in Northern Europe.

Childhood solar ultraviolet radiation (UVR) exposure increases the risk of skin cancer in adulthood, which is associated with mutations caused by UVR-induced cyclobutane pyrimidine dimers (CPD). Solar UVR is also the main source of vitamin D, essential for healthy bone development in children. To assess the impact of a 12-day Baltic Sea (54° N) beach holiday on serum 25-hydroxyvitamin D3 [25(OH)D3 ] and CPD in 32 healthy Polish children (skin types I-IV). Blood and urine were collected before and after the holiday and assessed for 25(OH)D3 and excreted CPD, respectively, and personal UVR exposure was measured. Diaries were used to record sunbathing, sunburn and sunscreen use. Before- and after-holiday skin redness and pigmentation were measured by reflectance spectroscopy. The average ± SD daily exposure UVR dose was 2·4 ± 1·5 standard erythema doses (SEDs), which is borderline erythemal. The mean concentration of 25(OH)D3 increased (× 1·24 ± 0·19) from 64·7 ± 13·3 to 79·3 ± 18·7 nmol L-1 (P < 0·001). Mean CPD increased 12·6 ± 10·0-fold from 26·9 ± 17·9 to 248·9 ± 113·4 fmol μmol-1 creatinine (P < 0·001). Increased 25(OH)D3 was accompanied by a very much greater increase in DNA damage associated with carcinogenic potential. Overall, skin type had no significant effects on behavioural, clinical or analytical outcomes, but skin types I/II had more CPD (unadjusted P = 0·0496) than skin types III/IV at the end of the holiday. Careful consideration must be given to the health outcomes of childhood solar exposure, and a much better understanding of the risk-benefit relationships of such exposure is required. Rigorous photoprotection is necessary for children, even in Northern Europe.

Strategies for public health initiatives targeting dairy consumption in young children: a qualitative formative investigation of parent perceptions.

Dairy products contain essential nutrients to ensure healthy growth and bone development in children. However, a significant proportion of children in developed countries fail to consume the daily recommended intake of dairy products. Parents are the gatekeepers of familial nutritional intake and represent a potential vehicle through which to increase dairy consumption in children. As such, formative research was conducted to gain insight into parents' perceived barriers to and benefits of purchasing and consuming dairy products and to develop innovative message content that could be utilized in future public health campaigns. Seven in-depth group interviews were conducted in two phases between February and May 2015. Interviews were conducted in local recreational centres and libraries in British Columbia, Canada. Mothers (n 21, mean age 38 (sd 5) years) and fathers (n 9, mean age 38 (sd 3) years) of children aged 4-10 years. Parents perceived both positive and negative physical outcomes associated with consuming dairy. Lack of trustworthy information was a frequently discussed barrier theme to purchasing and consuming dairy products. Mothers were concerned about the cost of dairy products. Differences in purchasing and consumption strategies were reported between parents of children who consumed adequate dairy and those who did not. Parents believed the most appropriate communication channel was through print material. Messages targeting parents, as a means of increasing dairy consumption in children, should address barriers identified by parents. In addition, practical tips should be provided to promote purchasing and consumption of dairy products.

A Genomewide Association Study Identifies Two Sex-Specific Loci, at SPTB and IZUMO3, Influencing Pediatric Bone Mineral Density at Multiple Skeletal Sites.

Failure to achieve optimal bone mineral accretion during childhood and adolescence results in subsequent suboptimal peak bone mass, contributing to osteoporosis risk later in life. To identify novel genetic factors that influence pediatric bone mass at discrete skeletal sites, we performed a sex-stratified genomewide association study of areal bone mineral density (BMD) measured by dual-energy X-ray absorptiometry at the 1/3 distal radius, spine, total hip, and femoral neck in a cohort of 933 healthy European American children. We took forward signals with p < 5 × 10-5 and minor allele frequency (MAF) >5% into an independent cohort of 486 European American children in search of replication. In doing so, we identified five loci that achieved genome wide significance in the combined cohorts (nearest genes: CPED1, IZUMO3, RBFOX1, SPBT, and TBPL2), of which the last four were novel and two were sex-specific (SPTB in females and IZUMO3 in males), with all of them yielding associations that were particularly strong at a specific skeletal site. Annotation of potential regulatory function, expression quantitative trait loci (eQTL) effects and pathway analyses identified several potential target genes at these associated loci. This study highlights the importance of sex-stratified analyses at discrete skeletal sites during the critical period of bone accrual, and identifies novel loci for further functional follow-up to pinpoint key genes and better understand the regulation of bone development in children. © 2017 American Society for Bone and Mineral Research.

Prevalence of Vitamin D deficiency and associated risk factors among children residing at high altitude in Shimla district, Himachal Pradesh, India.

Introduction:Vitamin D is important for bone development in children. A high prevalence of Vitamin D deficiency (VDD) has been documented from different parts of India. However, limited data are available on VDD among children residing at high altitude region of country.Objectives:To assess the prevalence of VDD and associated risk factors among children in the age group of 6–18 years in Shimla, Himachal Pradesh.Methods:A community-based cross-sectional study was conducted in the year 2014–2015. A total of 626 children in the age group of 6–18 years were enrolled from 30 clusters which were identified using population proportionate to size sampling method. A minimum of 20 children in the age group of 6–18 years per cluster were selected using random number tables. The data on socioeconomic status, physical activity, sunlight exposure, and biochemical parameters of bone and mineral metabolism were assessed.Results:Ninety-three percent of school-age children were found Vitamin D deficient as per serum 25(OH) D levels of <20 ng/ml. The prevalence was significantly higher among females.Conclusion:A high prevalence of VDD was found in children residing in high altitude region.

Body composition during childhood and adolescence: relations to bone strength and microstructure.

Numerous studies have examined the association of body composition with bone development in children and adolescents, but none have used micro-finite element (μFE) analysis of high-resolution peripheral quantitative computed tomography images to assess bone strength. This study sought to examine the relations of appendicular lean mass (ALM) and total body fat mass (TBFM) to bone strength (failure load) at the distal radius and tibia. This was a cross-sectional study of 198 healthy 8- to <15-year-old boys (n = 109) and girls (n = 89) performed in a Clinical Research Unit. After adjusting for bone age, height, fracture history, ALM, and TBFM, multiple linear regression analyses in boys and girls, separately, showed robust positive associations between ALM and failure loads at both the distal radius (boys: β = 0.92, P < .001; girls: β = 0.66, P = .001) and tibia (boys: β = 0.96, P < .001; girls: β = 0.66, P < .001). By contrast, in both boys and girls the relationship between TBFM and failure load at the distal radius was virtually nonexistent (boys: β = -0.07; P = .284; girls: β = -0.03; P = .729). At the distal tibia, positive, albeit weak, associations were observed between TBFM and failure load in both boys (β = 0.09, P = .075) and girls (β = 0.17, P = .033). Our data highlight the importance of lean mass for optimizing bone strength during growth, and suggest that fat mass may have differential relations to bone strength at weight-bearing vs non-weight-bearing sites in children and adolescents. These observations suggest that the strength of the distal radius does not commensurately increase with excess gains in adiposity during growth, which may result in a mismatch between bone strength and the load experienced by the distal forearm during a fall. These findings may explain, in part, why obese children are over-represented among distal forearm fracture cases.

Dental Complications of Rickets in Early Childhood: Case Report on 2 Young Girls

Vitamin D is an essential hormone for calcium gut absorption. It is also involved in child growth, cancer prevention, immune system responses, and tooth formation. Due to inadequate vitamin D intake and/or decreased sunlight exposure, vitamin D deficiency has resurfaced in developed countries despite known inexpensive and effective preventive methods. Vitamin D deficiency is a common cause of rickets, a condition that affects bone development in children and that can have serious dental complications. Deficiency during pregnancy can cause enamel hypoplasia of primary teeth. Enamel regeneration is currently impossible; hypoplasia is therefore irreversible, and once affected, teeth are prone to fast caries development. Deficiency during early childhood can affect permanent teeth and ensuing caries can sometimes lead to tooth loss at a young age. Oral manifestations of rickets should be diagnosed early by both physicians and dentists to prevent severe dental complications. This case study presents 2 young girls with rickets in early childhood who suffered from subsequent serious tooth decay.

Bone development in children and adolescents with PKU

Individuals with phenylketonuria (PKU, OMIM 261600) have shown bone disease from childhood. Factors such as non-adherence to treatment, nutritional inadequacy, and high phenylalanine levels are associated with bone disease in several studies. This research aimed to describe the impact of dietary factors (consumption of energy, protein, calcium, phosphorus, and phenylalanine), and the control of plasma phenylalanine levels on bone age (BA) and bone mineral density (BMD). Thirteen patients of both genders, from 8 to 16 years old participated in this study. Control data were collected of phenylalanine levels, food frequency and record, hand and fist X-rays, and spinal bone densitometry. In children group (CG), individuals non-adherent to diet (NAD) consumed lower amounts of calcium (472 ± 100 mg/day) and energy (1743 ± 486 Kcal); they had higher rates of phenylalanine (564 ± 94 μmol/L) in blood, intake phenylalanine (701 ± 334 mg/g), and higher protein intake from free foods (14 ± 6.67 g/day); bone age (BA) values higher than the chronological age (CA) and less BMD values (-0.7 ± 1.6 SD) also were verified. In adolescent group (AG, N = 8) of NAD, values were lower for energy intake (1379 ± 258 Kcal), calcium (801 ± 152 mg/day), phosphorus (657 ± 102 mg/day), food protein (25 ± 7.6 g/day), and intake phenylalanine (1067 ± 382 mg/day) than recommended. Higher levels of plasma phenylalanine (851 ± 244 μmol/L), bone age greater than chronological age and lower BMD values (-2.4 ± -2.5 SD) were observed. The results suggest effects on BA and on BMD, in both children and adolescent groups. The bone development is expressed differently in children and adolescents. The non-adherence to the diet verified in both groups and the consequent imbalance in the nutrients intake involved in bone metabolism suggest that these factors influence the failure to thrive in children and reduced bone mineralization in adolescents.

Tracking of appendicular bone mineral density for 6 years including the pubertal growth spurt: Japanese Population-based Osteoporosis Kids Cohort Study

Bone development up to early adulthood plays an important role in determining the risk of osteoporosis later in life. However, bone development in children has not been fully documented by longitudinal studies in Japanese children. The purpose of this study is to determine the degree of tracking of areal bone mineral density (aBMD) from pre-puberty to 6-year follow-up, and to determine the target period to achieve maximal peak aBMD. This study was conducted as the pediatric part of a larger cohort study, the Japanese Population-based Osteoporosis (JPOS) study. Of 448 children aged 9-12 years who completed the baseline survey, 225 participated in the follow-up study 6 years later (follow-up rate: 50.2%). aBMD at the forearm was measured using dual-energy X-ray absorptiometry. aBMD values in pre-pubertal children at baseline showed a significant tracking correlation with aBMD obtained at 6-year follow-up in both genders (boys r = 0.655, girls r = 0.759). Although boys and girls in the lowest quartile of aBMD pre-pubertally had greater annual increases in aBMD from pre-puberty to 6-year follow-up than those in other aBMD quartiles, they still showed the lowest mean aBMD at 6-year follow-up. Children with lower pre-pubertal aBMD showed greater increases in BMD up until 6-year follow-up, but the increase was not great enough to catch up with other children. About 50% of the variance in aBMD at 6-year follow-up was determined by the aBMD achieved during the pre-pubertal period. Activities that increase aBMD are important not only for children during puberty, but also for younger pre-pubertal children.