Peak Bone Mineral Density Research Articles

A Comprehensive Analysis of Bone Mineral Density Changes across the Lifespan: Insights from National Surveys.

There is limited research providing an overall understanding of bone mineral density (BMD) changes throughout different stages of life. This study aimed to investigate the pattern of BMD changes across childhood, adolescence, adulthood, and old age, as well as exploring the critical time of peak BMD (PBMD). Participants of three major ethnicities from National Health and Nutrition Examination Survey 1999 to 2018 were involved: 46,381 and 20,944 participants aged 8-85 years old were included in the Lumbar spine BMD (LSBMD) and femoral neck BMD (FNBMD) studies, respectively. BMD was measured using dual-energy X-ray absorptiometry. The generalized additive model was used to construct smoothed percentile curves. Both males and females experienced a sharp increase in LSBMD during puberty, with females reaching their PBMD earlier than males. Females' LSBMD remained higher than males' before the age of approximately 50, except for Non-Hispanic Blacks. For males, LSBMD reached a plateau at around 30 years old after reaching the peak value. Females exhibited two peak points on the fitted curves, with the second PBMD occurring around 36-37 years old. Ethnic variations were observed, with Non-Hispanic Blacks displaying the highest BMD levels at all ages. Non-Hispanic Whites and Mexican Americans had lower BMD levels, with Mexican Americans generally exhibiting the lowest BMD. FNBMD reached its peak earlier than LSBMD, and males consistently had higher FNBMD than females. This nationally representative study contributes to the understanding of BMD changes across the lifespan, and might provide guidance for bone health interventions in different population groups.

Automated Opportunistic Osteoporosis Screening Using Low-Dose Chest CT among Individuals Undergoing Lung Cancer Screening in a Korean Population.

Opportunistic osteoporosis screening using deep learning (DL) analysis of low-dose chest CT (LDCT) scans is a potentially promising approach for the early diagnosis of this condition. We explored bone mineral density (BMD) profiles across all adult ages and prevalence of osteoporosis using LDCT with DL in a Korean population. This retrospective study included 1915 participants from two hospitals who underwent LDCT during general health checkups between 2018 and 2021. Trabecular volumetric BMD of L1-2 was automatically calculated using DL and categorized according to the American College of Radiology quantitative computed tomography diagnostic criteria. BMD decreased with age in both men and women. Women had a higher peak BMD in their twenties, but lower BMD than men after 50. Among adults aged 50 and older, the prevalence of osteoporosis and osteopenia was 26.3% and 42.0%, respectively. Osteoporosis prevalence was 18.0% in men and 34.9% in women, increasing with age. Compared to previous data obtained using dual-energy X-ray absorptiometry, the prevalence of osteoporosis, particularly in men, was more than double. The automated opportunistic BMD measurements using LDCT can effectively predict osteoporosis for opportunistic screening and identify high-risk patients. Patients undergoing lung cancer screening may especially profit from this procedure requiring no additional imaging or radiation exposure.

Atividade física, maturação biológica e saúde óssea como função do status socioeconômico em escolas colombianas.

Introduction: Several studies describe the different benefits of physical activity in children and adolescents. Indeed, when a deficit of physical activity is evident in these age groups, there is a concomitant increase in metabolic and metabolic disorders. Objective: to analyze the patterns of physical activity, biological maturation and bone mineral content in Colombian schoolchildren between 8 and 16 years of age according to the socioeconomic status to which they belong. Materials and methods: A quantitative, descriptive, cross-sectional study with a correlational scope, which included a representative sample of Colombian schoolchildren between 8 and 16 years of age, who were assessed for their level of physical activity through the PAQ-C, also, different anthropometric measurements are evaluated and indirectly the peak growth velocity (PSV) and bone mineral density (BMD) are prolonged. Results: a total of 2147 schoolchildren were evaluated, of which 56.7% belonged to educational institutions of the public system, statistically significant associations were found between sex and socioeconomic status with the level of physical activity and the other study variables. Conclusion: It can be concluded that physical activity, biological maturation and bone health are closely related to socioeconomic status in Colombian schoolchildren, which allows early diagnoses and decision-making regarding educational and public health programs and strategies.

DXA-based appendicular composition measures in healthy aging Caucasian Greek women: a cross-sectional study.

As the global population of older persons increases, age-related medical conditions will have a greater impact on public health. DXA-derived bone and soft tissue metrics are associated with adverse clinical events in aging persons. This study aims to investigate the regional body composition of the appendices by whole-body DXA scans, and the age-related relationships between measures of bone and soft tissue in healthy Caucasian females of a Greek origin residing in the Mediterranean area. Body composition of the legs and the arms was analyzed, and lean mass (LM) and fat mass (FM) metrics were calculated in 330 women aged 20-85years, using DXA. Peak bone mineral density (BMD) of the legs and arms was achieved between ages 20-30 and 41-50years, respectively. The overall BMD reduction with age was for the legs 43% and the arms 32.2% (p < 0.001). Peak %LM of the legs and the arms was achieved between ages 20-30. The overall reduction of %LM with age was for the legs 22.5% (p < 0.001) and arms 6.6% (p < 0.05). Peak %FM of the legs and arms was attained between ages 31-40 and 61-70, respectively. The overall %FM reduction with age was for the legs and arms 7.5% and 1.9% (p > 0.05). In appendicular sites, Greek women reach peak values of bone mass in the legs first, in early adulthood. Bone loss predominates in the legs as women age. Also, with advancing age Greek women show preferential significant decreases of %LM and %FM in the legs as opposed to the arms. Although variation in appendicular bone and soft tissue metrics is present, the implications of variable biological crosstalks among the tissue components as women age may ultimately lay the foundation for future clinical trials aimed at healthy aging.

Secular Trends in Peak Bone Mineral Density: The National Health and Nutrition Examination Survey 1999-2018.

Peak bone mineral density (BMD) is one of the most important factors influencing the development of osteoporosis. It was predicted that a 10% increase in peak BMD will delay the onset of osteoporosis by 13years. However, changes in peak BMD over time are unknown. This study aimed to investigate secular trends in peak BMD among young adults in the United States. Based on the National Health and Nutrition Examination Survey from 1999-2018, 3,975 males aged 19-28years and 2370 females aged 31-40years were our target population for estimating peak lumbar spine BMD. BMD was measured by dual-energy X-ray absorptiometry. Generalized linear models adjusted for multiple covariates were used to examine the secular trends in peak BMD in males and females, respectively. Secular trends for peak lumbar spine BMD from 1999-2000 to 2017-2018 were not statistically significant in males or females (all Plinear and Pquadratic > 0.05). Similar results were observed in race/ethnicity subgroups (all Plinear and Pquadratic > 0.05). However, in stratified analyses by obesity category, peak lumbar spine BMD in obese males and females increased from 1999-2000 to 2009-2010 and then decreased until 2017-2018, while peak lumbar spine BMD in non-obese females decreased from 1999-2000 to 2005-2006 and then increased until 2017-2018 (all Pquadratic < 0.05). Peak lumbar spine BMD was greater in obese males and females than in non-obese males and females up to 2009-2010, but not from 2011-2012 onwards. Overall, there were no significant secular trends in peak lumbar spine BMD. However, secular trends differed between obese and non-obese groups.

Opposing Effects of Nutritional Supply on Bone Health at Different Ages: Based on the National Health and Nutrition Examination Survey Database.

(1) Background: Nutrients play an essential role in bone health, whether in achieving peak bone mineral density (BMD) or maintaining bone health. This study explores the relationship between nutrient supply and femoral bone health at different ages. (2) Methods: A total of 5603 participants meeting the inclusion and exclusion criteria were included in this study using the National Health and Nutrition Examination Survey (NHANES) database from 2005 to 2010, 2013 to 2014, and 2017 to 2018. Femoral bone mineral density and bone status were dependent variables, and dietary nutrient intake and nutrient intake status were independent variables. The relationship between dietary nutrient intake and bone mineral density was explored, and the importance of nutrients affecting bone status was analyzed through a neural network model. At the same time, we investigated the relationship between nutrient intake and bone status. (3) Results: The peak of age and femoral bone mineral density appeared at 20 years old in our study. After grouping by age, logistic regression analysis showed that before 20 years old, without adjusting other variables, high-fat diet was more likely to have normal bone mass than appropriate fat diet (OR: 4.173, 95%CI: 1.007-17.289). After adjusting for all demographic factors, niacin intake (OR: 1.062, 95%CI: 1.019-1.108) was beneficial for normal bone mass, while vitamin B6 intake (OR: 0.627, 95%CI: 0.408-0.965) was not. After 20 years old, after adjusting for carbohydrate, protein, vitamin B6, niacin, dietary fat, vitamin B2, and vitamin B12, vitamin B2 intake (OR: 1.153, 95%CI: 1.04-1.278) was beneficial for normal bone mass, while vitamin B6 intake (OR: 0.842, 95%CI: 0.726-0.976) was not. After adjusting for all confounding factors, vitamin B2 intake (OR: 1.288, 95%CI: 1.102-1.506) was beneficial for normal bone mass. In addition, we found that even if there was no statistical significance, the effects of high-fat diet on bone mass were different at different ages. (4) Conclusions: By conducting an in-depth analysis of the NHANES database, this study reveals that dietary factors exert divergent effects on bone health across different age groups, implying the necessity of implementing tailored dietary strategies to maintain optimal bone health at distinct life stages.

Effect of Plyometrics on Bone Mineral Density in Young Adults: A Systematic Review and Meta-Analysis

ABSTRACT Context Osteoporosis is a chronic bone metabolic disease characterized by decreased bone mass, leading to increased frailty and a subsequent fracture risk. Peak bone mineral density (BMD) is achieved in early adulthood and may be the most important factor leading to the development of osteoporosis in older adults. Objective This study aimed to analyze the effects of plyometrics on BMD in young men and premenopausal women. Design This study used randomized controlled trials found in MEDLINE, Embase, and CINAHL published between January 1, 1990, and November 1, 2022. Keywords included plyometrics, jumping, jump training, bone health, and bone mineral density. Articles were assessed for methodological quality using the Consolidated Standards of Reporting Trials 2010 checklist. Eligibility Criteria Randomized controlled trials investigating BMD in healthy premenopausal women and men between the ages of 18 and 60 yr that compared plyometrics with control were included. Study Selection Two reviewers independently screened 553 abstracts. Main Outcome Measures Mean baseline and follow-up dual-energy x-ray absorptiometry scores and standard deviations were extracted to calculate the standard mean difference. After extraction, the magnitude of difference between control and treatment groups were analyzed using the Hedges and Olkin method for effect size. Results The 12 included studies had high methodological quality. Of the 12 studies, 10 reported statistically significant increase in BMD at ≥1 site when compared with control. Two studies showed equal improvement when compared with resistance-only training. After analysis, a large positive effect size with strongly positive correlation was seen between plyometrics and lumbar spine BMD. Conclusion Plyometric training is a safe and time-efficient method to improve BMD in premenopausal people 18–65 yr old. Large effect sizes were associated with increased training intensity and lasted months after the intervention was complete. Plyometrics seems to be a comparable alternative to resistance training with respect to bone health.

Age-related variations in trunk composition and patterns of regional bone and soft tissue changes in adult Caucasian women by DXA.

We explored the regional variations in body composition with advancing age in healthy Caucasian females living in the Mediterranean area. The objectives of this study were to establish body composition values for the trunk in healthy women of a Greek origin and to evaluate the effects of aging on the distribution of truncal bone mass, fat mass (FM) and lean mass (LM). Body composition of the trunk and detailed analysis of its anatomical components-the ribs, the thoracic spine, the lumbar spine and the pelvis, and FM and LM ratios--were calculated in 330 women aged 20-85years, using DXA. Peak bone mineral density (BMD) of the trunk was attained between ages 30 and 33. The overall truncal BMD reduction with age was 20.7% (p < 0.001). Peak %LM of the trunk was achieved at age 20. The overall reduction of %LM with age for the trunk was 9.8% (p < 0.001). Peak %FM of the trunk was attained between ages 68 and 73, and the overall %FM reduction with age was 2.8% (p > 0.05). Multiple comparative analyses showed that the 51-60years age group was the landmark age for significant changes of truncal bone mass measures across all age groups (p = 0). For truncal LM and FM metrics, multigroup comparative analysis showed the turning point of significant changes in soft tissue was the 41-50 age bracket (p = 0 and p = 0, respectively). In Greek women, truncal %LM exceeded by far %FM across all ages (p = 0). Our results suggest that aging affects body composition of the trunk in ambulatory healthy women of a Greek origin differently, leading to menopausal loss of bone mass, senior adulthood loss of lean mass, and middle-age storage of fat mass. In adult women, these age-related associations between bone and soft tissue metrics on DXA exams carry implications for the attainment of optimal peak values and shifts in body composition overtime, impacting lifelong skeletal health.

031 Medical and surgical management of endometriosis in teenagers

Menstrual symptoms such as dysmenorrhea are frequently reported, both in adults as in the adolescent population. A significant number of high school students report missed school days due to menstrual symptoms. Endometriosis is associated with painful menstruation and chronic pelvic pain. It’s true prevalence in the adolescent population is unknown, although 2/3rds of laparoscopies performed for pelvic pain in adolescents show endometriosis. Before discussing treatment, it is vital that severe menstrual pain is not regarded as normal, and should warrant further medical advice (which may include ultrasound) in case it has an impact on school and social activities, to reduce diagnostic and treatment delay. Treatment of endometriosis-associated pain may be medical and/or surgical, although data in the adolescent population are scarce. First line medical treatment can be offered with NSAIDs, and where appropriate hormonal treatment such as combined oral contraceptives or progestogens. Although GnRH-analogues have shown to be effective for pain treatment, they should be used very restrictively and with great caution due to their side effects and reduction of (peak) bone mineral density. Surgical treatment can be offered in case of pain not responding to hormonal treatment, or in case large cysts or bowel/ureter obstruction is found. Laparoscopy should be performed by an experienced team, to avoid repeat surgery and its associated risks. Postoperative hormonal treatment is advised to reduce recurrence rates.

Reproductive health and stress fracture risk: a wearables solution

Introduction: Insulin-like growth factor 1 (IGF-I) is a mitogenic and metabolic growth factor that can act both systemically and locally, being produced predominantly in the liver but also by other tissues including the brain, kidneys, muscle, and bone1,2. IGF-I is well-established as an important mediator of bone formation, remodelling, and repair and can be easily measured in serum. IGF-I stimulates osteoblast proliferation, bone matrix protein synthesis, alkaline phosphatase activity and differentiation. Loss of IGF-I results in decreased long bone size, reduced growth plates, and delayed formation of secondary ossification centers in mice. Conversely, transgenic mice with osteoblast-targeted overexpression of IGF-I demonstrate an accelerated bone formation rate with increased bone mineral density (BMD) and trabecular and cortical bone volume. The essential nature of IGF-I in bone development is recapitulated in humans. Individuals with disruptions in the IGF-I gene causing reduced serum IGF-I concentrations have a severe reduction in peak BMD compared to normal age-matched individuals. Methods: This presentation will provide an overview of the relationship between the IGF-I system and bone health and remodelling, with a particular emphasis toward military relevance and utility of measuring IGF-I during military training2,3. Because the IGF-I system is involved in bone formation, remodelling, and repair, female recruits sustaining stress fractures during military training would be of special interest with regard to differential circulating concentrations of IGF-I system components compared to their uninjured female counterparts. Moreover, serum measurements of the IGF-I system could possibly provide further insight into stress fracture injury risk. Conclusions: Preliminary data3 suggest that circulating IGF-I system components are differentially expressed in females sustaining stress fractures during military BT. Additionally, data suggest that the bioavailable IGF-I response to strenuous exercise may differ in female recruits susceptible to stress fracture injury when compared to non-injured recruits. This suggests the possibility that increased susceptibility to stress fracture injury may be attributed to differences in the IGF-I system response to physical training (i.e., increased susceptibility to stress fracture may be due to a blunted bioavailable IGF-I response to training or increased basal levels of certain IGFBPs). However, the underlying mechanism for the differences in IGF-I system component concentrations between recruits sustaining stress fractures and uninjured counterparts is still unclear and warrants further investigation. References 1Nindl BC, Pierce JR. Insulin-like growth factors I as a biomarker of health, fitness, and training status. Med Sci Sports Exerc 2010; 42(1):39-49. https://doi.org/10.1249/mss.0b013e3181b07c4d 2Nindl BC, McClung JP, Miller JK, et al. Bioavailable IGF-I is associated with fat-free mass gains after physical training in women. Med Sci Sports Exerc 2011; 43(5):793-799. https://doi.org/10.1249/MSS.0b013e31820065.ea 3Strohbach CA, Scofield DE, Nindl BC, et al. Female recruits sustaining stress fractures during military basic training demonstrate differential concentrations of circulating IGF-I system components: a preliminary study. Growth Horm IGF Res 2012; 22(5):151-157. https://doi.org/10.1016/j.ghir.2012.04.007

Age-Related Changes in Trabecular Bone Score and Bone Mineral Density in Chinese Men: A Cross-Sectional and Longitudinal Study.

PurposeThis study was designed to explore age-related changes in trabecular bone score (TBS) and bone mineral density (BMD) in Chinese men through cross-sectional and longitudinal studies.Patients and MethodsWe included adult men who had at least twice TBS and BMD examinations in our hospital between January 2013 and December 2020. All men were divided into an age subgroup per 10 years, comparing differences in baseline lumbar spine (LS) TBS and BMD at various parts between each age group and analyzing age-related changes in TBS and BMD during follow-up.ResultsBaseline data showed that in men aged 36 to 85 years, BMD in the hip region showed a decreasing trend with age (P for trend < 0.01). However, TBS reached a high value around the age of 50, after which it decreased with age (P for trend = 0.03). During a mean follow-up of 3 years, the average annual change rate at TBS was −0.17% in men aged 36 to 85 years, with the fastest decrease rate −1.08% at 66 to 75 years (P < 0.05). The mean annual rate of change in LS BMD in different age subgroups increased with age (P for trend = 0.001). There was no significant decrease in mean annual change in BMD in hip regions.ConclusionIn men aged 36~85 years, the trend of TBS was inconsistent with BMD. Men experience a high value of LS TBS around age 50, later than the commonly believed age of peak BMD, which may reflect developmental differences between bone microstructure and bone minerals. The TBS may be used as a better indicator of changes in bone strength than BMD in adult men at short-term follow-up. The rapid loss of TBS at age 66 to 75 may have implications for the prevention and medication of osteoporosis in men.

Bone mineral density in patients with single ventricle

The accrual of bone mineral density (BMD) during childhood and adolescence is important because once peak BMD is achieved in early adulthood it declines from there. If peak BMD is low, then osteoporosis, fractures, and possibly other adverse outcomes can occur. The accrual of peak BMD is multifactorial, but there have been concerns that children with chronic disease, especially those with slow accrual of physical activity, are at risk for low BMD and, ultimately, low peak BMD. In this volume of The Journal, Vaikunth et al report on the results of a study of patients with single ventricle and Fontan physiology who underwent dual energy x-ray absorptiometry (DXA). They also evaluated leg lean mass as a measure of skeletal muscle. They excluded patients with Fontan baffle obstruction, moderate to severe kidney or liver disease, and patients with protein losing enteropathy. They found low BMD in both cortical and trabecular bone. Lower leg lean mass was associated with lower BMD. These results highlight that DXA, which is widely available in the clinical setting, is useful in the evaluation of BMD in these patients. The results in this study may be seen as a best-case scenario as patients with complications following their Fontan procedure were excluded. Finally, the lower leg lean mass indicates that diminished physical activity may be an important factor, suggesting possible interventions that could improve BMD during childhood and peak BMD in young adulthood. Article page 202 ▸ Deficits in the Functional Muscle–Bone Unit in Youths with Fontan PhysiologyThe Journal of PediatricsVol. 238PreviewTo determine whether dual energy X-ray absorptiometry (DXA), a clinically available tool, mirrors the magnitude of deficits in trabecular and cortical bone mineral density (BMD) demonstrated on peripheral quantitative computed tomography in youth with Fontan physiology. Full-Text PDF

LGR4 Gene Polymorphisms Are Associated With Bone and Obesity Phenotypes in Chinese Female Nuclear Families.

ObjectiveThe current study was conducted to determine whether peak bone mineral density (BMD) and obesity phenotypes are associated with certain LGR4 gene polymorphisms found in Chinese nuclear families with female children.MethodsA total of 22 single nucleotide polymorphisms (SNPs) located in and around the LGR4 gene were identified in 1,300 subjects who were members of 390 Chinese nuclear families with female children. Then, BMD readings of the femoral neck, total hip, and lumbar spine as well as measurements of the total lean mass (TLM), total fat mass (TFM), and trunk fat mass were obtained via dual-energy X-ray absorptiometry. The quantitative transmission disequilibrium test was used to analyze the associations between specific SNPs and LGR4 haplotypes and peak BMD as well as between LGR4 haplotypes and TLM, percent lean mass, TFM, percent fat mass, trunk fat mass, and body mass index (BMI).ResultsHere, rs7936621 was significantly associated with the BMD values for the total hip and lumbar spine, while rs10835171 and rs6484295 were associated with the trunk fat mass and BMI, respectively. Regarding the haplotypes, we found significant associations between GAA in block 2 and trunk fat mass and BMI, between AGCGT in block 3 and total hip BMD, between TGCTCC in block 5 and femoral neck BMD, and between TACTTC in block 5 and both lumbar spine and femoral neck BMD (all P-values < 0.05).ConclusionGenetic variations of the LGR4 gene are related to peak BMD, BMI, and trunk fat mass.

An Updated Reference for Calculating Bone Mineral Density T-Scores

Bone mineral density (BMD) T-score references may be updated when the peak BMD of the population is unclear and warrants reevaluation. To update BMD T-score references using the peak BMD from the most recent National Health and Nutrition Examination Survey (NHANES) data. This cross-sectional study used NHANES data from 2005 to 2014. Non-Hispanic White females between the ages of 10 and 40 years (N = 1549) were our target population to estimate peak BMD (SD). Individuals aged ≥ 50 years (N = 5523) were used to compare the percentages of osteoporosis and low bone mass based on existing and updated BMD T-score references. BMD data within the age at attainment of peak BMD ± 5 years were used to calculate updated BMD T-score references. The updated average of BMD (SD) for diagnosing osteoporosis at the femoral neck and lumbar spine were 0.888 g/cm2 (0.121 g/cm2) and 1.065 g/cm2 (0.122 g/cm2), respectively. The percentages of individuals with osteoporosis at the femoral neck and low bone mass at the femoral neck and lumbar spine based on the updated BMD T-score references were higher than the percentages of people designated with these outcomes under the existing guidelines (P < 0.001). However, we observed the opposite pattern for lumbar spine osteoporosis (P < 0.001). We calculated new BMD T-score references at the femoral neck and lumbar spine. We found significant differences in the percentages of individuals classified as having osteoporosis and low bone mass between the updated and existing BMD T-score references.

Anti-Mullerian Hormone as Predictor of Future and Ongoing Bone Loss During the Menopause Transition.

The menopause transition in women is a period of significant bone loss, with rapid declines in bone mineral density (BMD) commencing a year before the final menstrual period (FMP). Changes in menstrual bleeding patterns cannot reliably tell us if this rapid bone loss has begun or is imminent. We hypothesized that low circulating levels of anti-Mullerian hormone (AMH), which decline as women approach the FMP, would be associated with future and ongoing rapid bone loss. We used data from The Study of Women's Health Across the Nation, a multisite, multi-ethnic, prospective cohort study of the menopause transition to test this hypothesis. Adjusted for age, body mass index, race/ethnicity, and study site, every 50% decrement in AMH level in premenopause and early perimenopause was associated with 0.14% per year faster decline over the following 3 to 4 years in lumbar spine BMD and 0.11% per year faster decline in femoral neck BMD (p < 0.001 for both). AMH in late perimenopause was not associated with the rate of future BMD decline. AMH was also associated with the magnitude of ongoing bone loss, measured as percent of peak BMD lost by the end of the next 2 to 3 years. Every 50% decrement in AMH level was associated with 0.22% additional loss in spine BMD in premenopause, 0.43% additional loss in early perimenopause, and 0.50% additional loss in late perimenopause (p < 0.001 for all three). If a woman will lose more of her peak BMD than the site-specific least significant change (LSC) at either the lumbar spine or femoral neck by the next 2 to 3 years, then AMH below 100 pg/mL will detect it with sensitivity of 50% in premenopause, 80% in early perimenopause, and 98% in late perimenopause. These findings suggest that AMH measurement can help flag women at the brink of significant bone loss for early intervention. © 2022 American Society for Bone and Mineral Research (ASBMR).

Lean mass and peak bone mineral density

ObjectivesThe association between body composition parameters and peak bone mineral density is not well documented. The aim of this study is to assess the relative contributions of lean mass and fat mass on peak bone mineral density (BMD). MethodsThe study involved 416 women and 334 men aged between 20 and 30 years who were participants in the population-based Vietnam Osteoporosis Study. Whole body composition parameters (eg, fat mass and lean mass) and BMD at the lumbar spine and femoral neck were measured by dual-energy X-ray absorptiometry. The association between lean mass and fat mass and BMD was analyzed by the linear regression model using the Least Absolute Shrinkage and Selection Operator (LASSO). ResultsPeak BMD in men was higher than women, and the difference was more pronounced at the femoral neck (average difference: 0.123 g/cm2; 95% confidence interval [CI] 0.105–0.141 g/cm2) than at the lumbar spine (average difference 0.019 g/cm2; 95% CI, 0.005–0.036 g/cm2). Results of LASSO regression indicated that lean mass was the only predictor of BMD for either men or women. Each kilogram increase in lean mass was associated with ∼0.01 g/cm2 increase in BMD. Lean mass alone explained 16% and 36% of variation in lumbar spine and femoral neck BMD, respectively. ConclusionsLean mass, not fat mass, is the main determinant of peak bone mineral density. This finding implies that good physical activity during adulthood can contribute to the maximization of peak bone mass during adulthood.

The influence of biological maturation and neuromuscular performance on peak bone mineral density in children

The growth and development cycle of the adult is characterized by substantial changes in physical size and maturity, and is controlled by the simultaneous influence of genetic components and the environment. Changes in the development of bones, muscles and adipose tissue are among the most important aspects of adolescent physical development. The aim of this research was to examine the correlation between bone mineral density (BMD) and neuromuscular performance in children at different stages of maturation. The study included 31 participants of both sexes (11.7±1.89 years). Body composition was assessed through bone densitometry using an energy duo X-ray source. The neuromuscular performance of the upper limbs was analyzed by the medicine ball hand grip and throwing tests. The lower limbs by the vertical counter-motion jump test, and skeletal maturation was analyzed by bone age. Maturation was used as an effect control between the association of BMD and neuromuscular performance. The results demonstrated significant associations between the performance of upper (P<0.0001) and lower (P=0.01) limbs and BMD. On inter-group comparison for only the accelerated maturational stage, male participants had greater BMD than female participants (P=0.001; effect size 3.13). Regarding the maturational stages, male participants in the accelerated maturational stage demonstrated higher BMD than those in the normal and delayed maturational stages (P=0.04; effect size 3.10), whereas female participants did not demonstrate significant differences in BMD accumulation. BMD has a strong correlation with the neuromuscular performance of upper and lower limbs of children of both sexes.

Relationship Between Estrogen Treatment and Skeletal Health in Women With Cystic Fibrosis

Patients with cystic fibrosis (CF) are at risk for CF-related bone disease. Women with CF may use estrogen supplementation for reasons other than skeletal health. It is unknown whether estrogen therapy has a beneficial impact on skeletal health in women with CF. In this retrospective cohort study of women with CF followed at a single CF center, the lumbar spine bone mineral density (BMD) of women with CF exposed to supplemental and not exposed to supplemental estrogen were compared. Spline function models included the main effect of estrogen exposure and the interaction between age and estrogen supplementation. Of the 145 subjects analyzed, 44 subjects were exposed to supplemental estrogen. The baseline characteristics of estrogen exposed and unexposed subjects were similar except for use of CF transmembrane conductance regulator modulators and anti-osteoporosis medications. Women exposed to estrogen reached peak BMD around 21 years of age, but women not exposed to estrogen reached peak BMD around 25 years of age. A significant interaction of age and estrogen supplementation indicated that the lumbar spine BMD trajectories differed by exposure group. Our study demonstrates that few women with CF of reproductive age are prescribed estrogen therapy. Furthermore, estrogen exposure up to age 21 is associated with improved BMD, but estrogen exposure after age 21 does not appear to be associated with improved BMD. Further studies are needed to understand the reasons for the low rates of estrogen use in young women with CF and the optimal timing, dose and formulation of estrogen prescription.

Association between LGR4 polymorphisms and peak bone mineral density and body composition.

Leucine-rich repeat-containing G protein-coupled receptor 4 (LGR4) could affect differentiation of osteoblasts and bone mass through potentiating Wnt/β-catenin signaling. LGR4 is also relevant to glycolipid metabolism. The present study aims to explore the relationship between genetic variations in LGR4 gene and peak bone mineral density (peak BMD) and body composition phenotypes in Chinese nuclear families. 22 single-nucleotide polymorphisms (SNPs) were selected and five blocks were constructed in LGR4. Body composition (lean mass and fat mass) and peak BMD were measured by dual-energy X-ray absorptiometry (DXA). Quantitative transmission disequilibrium test (QTDT) analysis was used to explore the relationship between LGR4 genotypes and the mentioned phenotypes. For QTDT analysis after 1000 permutations, significant within-family associations were observed between rs11029986 and total fat mass (TFM) and percentage of TFM (PFM) (P = 0.014 and 0.011, respectively), rs12787344, rs4128868, rs4923445, and rs7936621 and body mass index (BMI) (P = 0.008, 0.003, 0.046, and 0.003, respectively), rs11029986 and total hip BMD (P = 0.026), and rs12796247, rs2219783, and lumbar spine BMD (P = 0.013 and 0.027, respectively). Haplotypes GCGT and AAGC (both in block 3) were observed in significant within-family association with BMI (P = 0.003 and 0.002, respectively). It is the first family-based association analysis to explore and demonstrate significant associations between LGR4 genotypes and variations of peak BMD and body composition in young Chinese men. The results are consistent with the findings that recent studies revealed, and confirm the critical relationship between LGR4 gene and both BMD and body composition.

Gender-Specific Body Composition Relationships between Adipose Tissue Distribution and Peak Bone Mineral Density in Young Chinese Adults.

Background The relationships between adipose tissue distribution and peak bone mineral density (BMD) in young adults are still unclear. The aim of this study was to investigate the body composition associations between fat mass (FM), lean mass (LM), regional adipose tissue distribution, and peak BMD across a cohort of young Chinese adults. Methods Dual-energy X-ray absorptiometry (DXA) scans were performed on 786 men and 825 women aged from 20 to 40 years old to measure the markers for whole-body LM, FM, and BMD in the lumbar spine (LS), femoral neck (FN), and total hip (TH) areas. The android/gynoid FM ratio (A/G FMR) based on the DXA scans was calculated as an indicator of adipose tissue distribution. Pearson's correlation and multivariable linear regression analyses were conducted to determine the body composition relationships between adipose tissue distribution and BMD of each skeletal site. Results The body composition characteristics were different in young males and females: a higher body FM percentage was found in females, while males had higher LM and A/G FMR. The markers for WBLM and WBFM had significant positive correlations with BMD among the linear regression analyses in both genders, while the relationships between A/G FMR and BMD were different in males and females; significant inverse associations were showed in all skeletal sites for women (standard β ranged from -0.266 to -0.170, P < 0.001 for all), but no significant relationships were found in men except for an inverse association in the LS skeletal site (standard β with -0.115, P = 0.016). Conclusions In this sample of young Chinese adults, both whole-body lean mass and fat mass had significant positive relationships with BMD in both genders. The A/G FMR, as an indicator of central adipose tissue distribution, was inversely associated with BMD, especially in females.