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Elhakeem A, Frysz M, Goncalves Soares A, Bell JA, Cole TJ, Heron J, Howe LD, Sebert S, Tilling K, Timpson NJ, Lawlor DA. Evaluation and comparison of nine growth and development-based measures of pubertal timing. COMMUNICATIONS MEDICINE 2024; 4:159. [PMID: 39112679 PMCID: PMC11306255 DOI: 10.1038/s43856-024-00580-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 07/25/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND Pubertal timing is heritable, varies between individuals, and has implications for life-course health. There are many different indicators of pubertal timing, and how they relate to each other is unclear. Our aim was to quantitatively compare nine indicators of pubertal timing. METHODS We used data from questionnaires and height, weight, and bone measurements from ages 7-17 y in a population-based cohort of 4267 females and 4251 males to compare nine growth and development-based indicators of pubertal timing. We summarise age of each indicator, their phenotypic and genetic correlations, and how they relate to established genetic risk score (GRS) for puberty timing, and phenotypic childhood body composition measures. RESULTS We show that pubic hair in males (mean: 12.6 y) and breasts in females (11.5 y) are early indicators of puberty, and voice breaking (14.2 y) and menarche (12.7 y) are late indicators however, there is substantial variation between individuals in pubertal age. All indicators show evidence of positive phenotypic intercorrelations (e.g., r = 0.49: male genitalia and pubic hair ages), and positive genetic intercorrelations. An age at menarche GRS positively associates with all other pubertal age indicators (e.g., difference in female age at peak height velocity per SD higher GRS: 0.24 y, 95%CI: 0.21 to 0.26), as does an age at voice breaking GRS (e.g., difference in age at male axillary hair: 0.11 y, 0.07 to 0.15). Higher childhood fat mass and lean mass associated with earlier puberty timing. CONCLUSIONS Our findings provide insights into the measurements of the timing of pubertal growth and development and illustrate value of various pubertal timing indicators in life-course research.
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Affiliation(s)
- Ahmed Elhakeem
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK.
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Monika Frysz
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Ana Goncalves Soares
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
| | - Joshua A Bell
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
| | - Tim J Cole
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Jon Heron
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
| | - Laura D Howe
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sylvain Sebert
- Research Unit of Population Health, University of Oulu, Oulu, Finland
| | - Kate Tilling
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
| | - Nicholas J Timpson
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
| | - Deborah A Lawlor
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Bristol Biomedical Research Centre, Bristol, UK
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Kim SE, Kim S, Kim SH, Cho WK, Cho KS, Jung MH, Ahn MB. Causality between Sex Hormones and Bone Mineral Density in Childhood: Age- and Tanner-Stage-Matched Sex Hormone Level May Be an Early Indicator of Pediatric Bone Fragility. Biomedicines 2024; 12:1173. [PMID: 38927380 PMCID: PMC11200954 DOI: 10.3390/biomedicines12061173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/18/2024] [Accepted: 05/23/2024] [Indexed: 06/28/2024] Open
Abstract
This study aimed to investigate the impact of hypogonadism on bone mineral density (BMD) in children and adolescents with chronic diseases to determine the relationship between sex hormones and BMD. This retrospective study included 672 children and adolescents with chronic diseases such as hemato-oncologic, rheumatoid, gastrointestinal, and endocrinologic diseases. The relationship between the sex- and Tanner-stage-matched Z-scores for sex hormones and the sex- and age-matched lumbar spine BMD (LSBMD) Z-scores was evaluated. Adjustments were made for confounders such as underlying diseases, age at diagnosis, and age- and sex-matched body mass index Z-scores. Patients had a mean LSBMD Z-score of -0.55 ± 1.31. In the multivariate regression analysis, male testosterone showed a positive association with the LSBMD Z-score (p < 0.001), whereas female estradiol, luteinizing hormone, and follicular-stimulating hormone showed no significant association with the LSBMD Z-scores. In the male group, the testosterone level was associated with LSBMD Z-scores > -1.0 (p < 0.001), > -2.0 (p < 0.001), and > -3.0 (p = 0.002), while the estradiol level was associated with LSBMD Z-scores > -2.0 (p = 0.001) and > -3.0 (p = 0.002) in the female group. In conclusion, sex hormones are associated with BMD in children and adolescents with chronic diseases. Therefore, various measures may be necessary to predict future skeletal problems and improve bone health in these patients.
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Affiliation(s)
- Sung Eun Kim
- Department of Pediatrics, College of Medicine, Incheon St. Mary’s Hospital, The Catholic University of Korea, Seoul 06591, Republic of Korea; (S.E.K.); (S.-H.K.)
| | - Seulki Kim
- Department of Pediatrics, College of Medicine, Eunpyeong St. Mary’s Hospital, The Catholic University of Korea, Seoul 06591, Republic of Korea;
| | - Shin-Hee Kim
- Department of Pediatrics, College of Medicine, Incheon St. Mary’s Hospital, The Catholic University of Korea, Seoul 06591, Republic of Korea; (S.E.K.); (S.-H.K.)
| | - Won Kyoung Cho
- Department of Pediatrics, College of Medicine, St. Vincent’s Hospital, The Catholic University of Korea, Seoul 06591, Republic of Korea;
| | - Kyoung Soon Cho
- Department of Pediatrics, College of Medicine, Bucheon St. Mary’s Hospital, The Catholic University of Korea, Seoul 06591, Republic of Korea;
| | - Min Ho Jung
- Department of Pediatrics, College of Medicine, Yeouido St. Mary’s Hospital, The Catholic University of Korea, Seoul 06591, Republic of Korea;
| | - Moon Bae Ahn
- Department of Pediatrics, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul 06591, Republic of Korea
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3
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Wang Z, Asokan G, Onnela JP, Baird DD, Jukic AMZ, Wilcox AJ, Curry CL, Fischer-Colbrie T, Williams MA, Hauser R, Coull BA, Mahalingaiah S. Menarche and Time to Cycle Regularity Among Individuals Born Between 1950 and 2005 in the US. JAMA Netw Open 2024; 7:e2412854. [PMID: 38809557 PMCID: PMC11137638 DOI: 10.1001/jamanetworkopen.2024.12854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 03/01/2024] [Indexed: 05/30/2024] Open
Abstract
Importance Early menarche is associated with adverse health outcomes. Trends toward earlier menarche have been observed in the US, but data remain limited on differences by sociodemographic factors and body mass index (BMI). Time from menarche to cycle regularity is another understudied early-life characteristic with health implications. Objectives To evaluate the temporal trends and disparities in menarche and time to regularity and explore early-life BMI as a mediator. Design, Setting, and Participants This ongoing cohort study enrolled participants from an ongoing mobile application-based US cohort from November 14, 2019, to March 20, 2023. Exposures Birth year (categorized as 1950-1969, 1970-1979, 1980-1989, 1990-1999, and 2000-2005). Main Outcomes and Measures Main outcomes were age at menarche and time to regularity, which were self-recalled at enrollment. In addition, early (aged <11 years), very early (aged <9 years), and late (aged ≥16 years) age at menarche was assessed. Results Among the 71 341 female individuals who were analyzed (mean [SD] age at menarche, 12.2 [1.6] years; 2228 [3.1%] Asian, 3665 [5.1%] non-Hispanic Black, 4918 [6.9%] Hispanic, 49 518 [69.4%] non-Hispanic White, and 8461 [11.9%] other or multiple races or ethnicities), 5223 were born in 1950 to 1969, 12 226 in 1970 to 1979, 22 086 in 1980 to 1989, 23 894 in 1990 to 1999, and 7912 in 2000 to 2005. The mean (SD) age at menarche decreased from 12.5 (1.6) years in 1950 to 1969 to 11.9 (1.5) years in 2000 to 2005. The number of individuals experiencing early menarche increased from 449 (8.6%) to 1223 (15.5%), the number of individuals experiencing very early menarche increased from 31 (0.6%) to 110 (1.4%), and the number of individuals experiencing late menarche decreased from 286 (5.5%) to 137 (1.7%). For 61 932 participants with reported time to regularity, the number reaching regularity within 2 years decreased from 3463 (76.3%) to 4075 (56.0%), and the number not yet in regular cycles increased from 153 (3.4%) to 1375 (18.9%). The magnitude of the trend toward earlier menarche was greater among participants who self-identified as Asian, non-Hispanic Black, or other or multiple races (vs non-Hispanic White) (P = .003 for interaction) and among participants self-rated with low (vs high) socioeconomic status (P < .001 for interaction). Within a subset of 9865 participants with data on BMI at menarche, exploratory mediation analysis estimated that 46% (95% CI, 35%-61%) of the temporal trend in age at menarche was explained by BMI. Conclusions and Relevance In this cohort study of 71 341 individuals in the US, as birth year increased, mean age at menarche decreased and time to regularity increased. The trends were stronger among racial and ethnic minority groups and individuals of low self-rated socioeconomic status. These trends may contribute to the increase in adverse health outcomes and disparities in the US.
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Affiliation(s)
- Zifan Wang
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Gowtham Asokan
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Jukka-Pekka Onnela
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Donna D. Baird
- Epidemiology Branch, Division of Intramural Research, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, Durham, North Carolina
| | - Anne Marie Z. Jukic
- Epidemiology Branch, Division of Intramural Research, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, Durham, North Carolina
| | - Allen J. Wilcox
- Epidemiology Branch, Division of Intramural Research, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, Durham, North Carolina
| | | | | | - Michelle A. Williams
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Russ Hauser
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Brent A. Coull
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Shruthi Mahalingaiah
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Binney N. Reference-Class Problems Are Real: Health-Adjusted Reference Classes and Low Bone Mineral Density. THE JOURNAL OF MEDICINE AND PHILOSOPHY 2024; 49:128-146. [PMID: 38418083 PMCID: PMC10938540 DOI: 10.1093/jmp/jhae005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2024] Open
Abstract
Elselijn Kingma argues that Christopher Boorse's biostatistical theory (the BST) does not show how the reference classes it uses are objective and naturalistic. Recently, philosophers of medicine have attempted to rebut Kingma's concerns. I argue that these rebuttals are theoretically unconvincing, and that there are clear examples of physicians adjusting their reference classes according to their prior knowledge of health and disease. I focus on the use of age-adjusted reference classes to diagnose low bone mineral density in children. In addition to using the BST's age, sex, and species, physicians also choose to use other factors to define reference classes, such as pubertal status, bone age, body size, and muscle mass. I show that physicians calibrate the reference classes they use according to their prior knowledge of health and disease. Reference classes are also chosen for pragmatic reasons, such as to predict fragility fractures.
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Golding J, Iles-Caven Y, Northstone K, Fraser A, Heron J. Measures of puberty in the Avon Longitudinal Study of Parents and Children (ALSPAC) offspring cohort. Wellcome Open Res 2024; 8:453. [PMID: 38716046 PMCID: PMC11075130 DOI: 10.12688/wellcomeopenres.19793.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2024] [Indexed: 05/20/2024] Open
Abstract
Background When studying the development of children through the preteen years into adolescence, it is often important to link features of their physical and mental health to the stage of puberty at the time. This is complex since individuals vary substantially in the ages at which they reach different pubertal milestones. Methods The Avon Longitudinal Study of Parents and Children (ALSPAC) is an ongoing longitudinal cohort study based in southwest England that recruited over 14000 women in pregnancy, with expected dates of delivery between April 1991 and December 1992. From 1999, information on puberty was collected using a number of different methods : (a) A series of annual questionnaires were administered when the index children were aged between eight and 17 years; these were mainly concerned with the physical changes associated with puberty; (b) identification of the age at peak height growth using the SITAR methodology; and (c) retrospective information from the girls on their age at onset of menstruation (menarche). Results The advantages and disadvantages of each method are discussed. Conclusions The data are available for analysis by interested researchers.
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Affiliation(s)
- Jean Golding
- Bristol Medical School, University of Bristol, Bristol, Bristol, BS8 2BN, UK
| | - Yasmin Iles-Caven
- Bristol Medical School, University of Bristol, Bristol, Bristol, BS8 2BN, UK
| | - Kate Northstone
- Bristol Medical School, University of Bristol, Bristol, Bristol, BS8 2BN, UK
| | - Abigail Fraser
- Bristol Medical School, University of Bristol, Bristol, Bristol, BS8 2BN, UK
| | - Jon Heron
- Bristol Medical School, University of Bristol, Bristol, Bristol, BS8 2BN, UK
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6
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Vore AS, Marsland P, Barney TM, Varlinskaya EI, Landin JD, Healey KL, Kibble S, Swartzwelder HS, Chandler LJ, Deak T. Adolescent intermittent ethanol (AIE) produces lasting, sex-specific changes in rat body fat independent of changes in white blood cell composition. Front Physiol 2024; 15:1285376. [PMID: 38332987 PMCID: PMC10851431 DOI: 10.3389/fphys.2024.1285376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 01/10/2024] [Indexed: 02/10/2024] Open
Abstract
Early initiation of alcohol use during adolescence, and adolescent binge drinking are risk factors for the development of alcohol use disorder later in life. Adolescence is a time of rapid sex-dependent neural, physiological, and behavioral changes as well as a period of heightened vulnerability to many effects of alcohol. The goal of the present studies was to determine age-related changes in blood (leukocyte populations) and body composition across adolescence and early adulthood, and to investigate whether adolescent intermittent ethanol (AIE) exposure would alter the trajectory of adolescent development on these broad physiological parameters. We observed significant ontogenetic changes in leukocyte populations that were mirrored by an age-related increase in cytokine expression among mixed populations of circulating leukocytes. Despite these developmental changes, AIE did not significantly alter overall leukocyte numbers or cytokine gene expression. However, AIE led to sex-specific changes in body fat mass and fat percentage, with AIE-exposed male rats showing significantly decreased fat levels and female rats showing significantly increased fat levels relative to controls. These changes suggest that while AIE may not alter overall leukocyte levels, more complex phenotypic changes in leukocyte populations could underlie previously reported differences in cytokine expression. Coupled with long-term shifts in adipocyte levels, this could have long-lasting effects on innate immunity and the capacity of individuals to respond to later immunological and physiological threats.
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Affiliation(s)
- Andrew S. Vore
- Developmental Exposure Alcohol Research Center, Binghamton University-SUNY, Binghamton, NY, United States
| | - Paige Marsland
- Developmental Exposure Alcohol Research Center, Binghamton University-SUNY, Binghamton, NY, United States
| | - Thaddeus M. Barney
- Developmental Exposure Alcohol Research Center, Binghamton University-SUNY, Binghamton, NY, United States
| | - Elena I. Varlinskaya
- Developmental Exposure Alcohol Research Center, Binghamton University-SUNY, Binghamton, NY, United States
| | - Justine D. Landin
- Department of Neurosciences, Charleston Alcohol Research Center, Medical University of South Carolina, Charleston, SC, United States
| | - Kati L. Healey
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States
| | - Sandra Kibble
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States
| | - H. S. Swartzwelder
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States
| | - Lawrence J. Chandler
- Department of Neurosciences, Charleston Alcohol Research Center, Medical University of South Carolina, Charleston, SC, United States
| | - Terrence Deak
- Developmental Exposure Alcohol Research Center, Binghamton University-SUNY, Binghamton, NY, United States
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7
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Soliman AT, Alaaraj N, De Sanctis V, Hamed N, Alyafei F, Ahmed S. Long-term health consequences of central precocious/early puberty (CPP) and treatment with Gn-RH analogue: a short update. ACTA BIO-MEDICA : ATENEI PARMENSIS 2023; 94:e2023222. [PMID: 38054666 PMCID: PMC10734238 DOI: 10.23750/abm.v94i6.15316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 10/23/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND The relationship between precocious or early puberty and its treatment has received significant research attention, yielding diverse outcomes. This short review aims to comprehensively analyze and summarize research articles to elucidate the potential link between precocious or early pubertal onset (CPP) and crucial health factors. METHODS We conducted a systematic review of studies published from -January 2000 to March 2023, sourced from databases of Medline, PubMed, Google Scholar and Web of Science. We assessed the relationship between CPP and final adult height (FHt), bone health, reproductive function, body mass index, metabolic and cardiovascular abnormalities, and increased cancer risk. RESULTS Upon reviewing and analyzing selected studies, the following key findings emerged: (a) treating CPP in girls before age 6-7 and in boys before age 9 improves FHt; (b) bone mineral density (BMD) decreases during GnRHa treatment but normalizes afterward, with no lasting effects on peak bone mass during puberty; (c) GnRH treatment does not negatively affect menstrual cycles; however, untreated CPP increases the risk of premature or early-onset menopause; (d) the incidence of PCOS/hyperandrogenemia may be slightly elevated in women with a history of CPP, but overall reproductive function remains largely unaffected; (e) earlier thelarche and menarche may enhance susceptibility to breast carcinogenesis; (f) CPP contributes to an increased risk of obesity and type 2 diabetes in both genders; (g) early menarche may slightly increase the risk of coronary heart disease and ischemic strokes and (h) early pubertal timing increases the risk of depression and anxiety disorders. CONCLUSION Monitoring and early diagnosis of these conditions are of paramount importance for successful management.
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Affiliation(s)
| | - Nada Alaaraj
- Department of Pediatrics, Hamad General Hospital, Doha, Qatar.
| | - Vincenzo De Sanctis
- Pediatric and Adolescent Outpatient Clinic, Private Accredited Quisisana Hospital, Ferrara, Italy.
| | - Noor Hamed
- Department of Pediatrics, Hamad General Hospital, Doha, Qatar.
| | - Fawzia Alyafei
- Department of Pediatrics, Hamad General Hospital, Doha, Qatar.
| | - Shayma Ahmed
- Department of Pediatrics, Hamad General Hospital, Doha, Qatar.
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8
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Carson MD, Westwater C, Novince CM. Adolescence and the Microbiome: Implications for Healthy Growth and Maturation. THE AMERICAN JOURNAL OF PATHOLOGY 2023; 193:1900-1909. [PMID: 37673331 PMCID: PMC10699129 DOI: 10.1016/j.ajpath.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/19/2023] [Accepted: 07/26/2023] [Indexed: 09/08/2023]
Abstract
The gut microbiota was initially thought to develop into a stable, adult-like profile during early postnatal life. The formation of the gut microbiota during early life has been shown to contribute to healthy growth and has lifelong implications for host health. Adolescence, the developmental period between childhood and adulthood, is a critical window for healthy growth and maturation. The composition of the gut microbiota in adolescents is distinct from that of children and adults, which supports the premise that the gut microbiota continues to develop during adolescence toward an adult-like profile. Research has begun to shift its focus from understanding the gut microbiome at the extremes of the life span to evaluating the importance of the gut microbiome during adolescence and its role in healthy development. This article provides an overview of adolescent development, host-microbiota interactions, and experimental models used to discern effects of gut microbiota on health and disease. Herein, the role of the gut microbiota is reviewed as it relates to adolescent: i) brain development, cognition, and behavior; ii) metabolism and adiposity; and iii) skeletal growth and bone mass accrual. Future directions are addressed, including omics investigations defining mechanisms through which the gut microbiota influences adolescent development. Furthermore, we discuss advancing noninvasive interventions targeting the adolescent gut microbiota that could be employed to support healthy growth and maturation.
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Affiliation(s)
- Matthew D Carson
- Departments of Oral Health Sciences, College of Dental Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Caroline Westwater
- Departments of Oral Health Sciences, College of Dental Medicine, Medical University of South Carolina, Charleston, South Carolina; Department of Microbiology and Immunology, College of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Chad M Novince
- Departments of Oral Health Sciences, College of Dental Medicine, Medical University of South Carolina, Charleston, South Carolina; Division of Endocrinology, Department of Pediatrics, College of Medicine, Medical University of South Carolina, Charleston, South Carolina; Division of Periodontics, Department of Stomatology, College of Dental Medicine, Medical University of South Carolina, Charleston, South Carolina.
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9
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Bjelica M, Walker RG, Obeid J, Issenman RM, Timmons BW. A Pilot Study of Exercise Training for Children and Adolescents With Inflammatory Bowel Disease: An Evaluation of Feasibility, Safety, Satisfaction, and Efficacy. Pediatr Exerc Sci 2023; 35:239-248. [PMID: 37487583 DOI: 10.1123/pes.2022-0012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 01/10/2023] [Accepted: 02/13/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND Children with inflammatory bowel disease (IBD) experience extraintestinal side effects including altered body composition, impaired muscle strength, and aerobic capacity. Exercise training may remedy these issues. PURPOSE To assess the feasibility, safety, participant satisfaction, and efficacy of a training program for youth with IBD. METHODS Children with IBD completed 16 weeks of training (2 supervised + 1 home sessions per week). Feasibility was assessed by tracking recruitment, adherence, and compliance rates. Safety was assessed by tracking symptoms and adverse events. Posttraining interviews gauged satisfaction. Circulating inflammatory markers, body composition, muscle strength, aerobic fitness, and habitual physical activity were measured at baseline, midtraining (8 wk), and posttraining. RESULTS Eleven youth were recruited and 10 completed the study. Participants adhered to 28 (1) of 32 prescribed supervised sessions and 8 (4) of 16 prescribed home sessions. There were no adverse events, and overall feedback on training was positive. Posttraining, we observed an increase in lean mass (+2.4 [1.1] kg), bone density (+0.0124 [0.015] g·cm-2), aerobic fitness (+2.8 [5.7] mL·kg LM-1· min-1), and vigorous physical activity levels (+13.09 [8.95] min·h-1) but no change in inflammation or muscle strength. CONCLUSION Supervised exercise training is feasible, safe, and effective for youth with IBD and should be encouraged.
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Affiliation(s)
- Mila Bjelica
- Department of Pediatrics, McMaster University, Hamilton, ON,Canada
| | - Rachel G Walker
- Department of Pediatrics, McMaster University, Hamilton, ON,Canada
| | - Joyce Obeid
- Department of Pediatrics, McMaster University, Hamilton, ON,Canada
| | - Robert M Issenman
- Division of Pediatric Gastroenterology, McMaster University, Hamilton, ON,Canada
| | - Brian W Timmons
- Department of Pediatrics, McMaster University, Hamilton, ON,Canada
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10
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Diaz-Thomas AM, Golden SH, Dabelea DM, Grimberg A, Magge SN, Safer JD, Shumer DE, Stanford FC. Endocrine Health and Health Care Disparities in the Pediatric and Sexual and Gender Minority Populations: An Endocrine Society Scientific Statement. J Clin Endocrinol Metab 2023; 108:1533-1584. [PMID: 37191578 PMCID: PMC10653187 DOI: 10.1210/clinem/dgad124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Indexed: 05/17/2023]
Abstract
Endocrine care of pediatric and adult patients continues to be plagued by health and health care disparities that are perpetuated by the basic structures of our health systems and research modalities, as well as policies that impact access to care and social determinants of health. This scientific statement expands the Society's 2012 statement by focusing on endocrine disease disparities in the pediatric population and sexual and gender minority populations. These include pediatric and adult lesbian, gay, bisexual, transgender, queer, intersex, and asexual (LGBTQIA) persons. The writing group focused on highly prevalent conditions-growth disorders, puberty, metabolic bone disease, type 1 (T1D) and type 2 (T2D) diabetes mellitus, prediabetes, and obesity. Several important findings emerged. Compared with females and non-White children, non-Hispanic White males are more likely to come to medical attention for short stature. Racially and ethnically diverse populations and males are underrepresented in studies of pubertal development and attainment of peak bone mass, with current norms based on European populations. Like adults, racial and ethnic minority youth suffer a higher burden of disease from obesity, T1D and T2D, and have less access to diabetes treatment technologies and bariatric surgery. LGBTQIA youth and adults also face discrimination and multiple barriers to endocrine care due to pathologizing sexual orientation and gender identity, lack of culturally competent care providers, and policies. Multilevel interventions to address these disparities are required. Inclusion of racial, ethnic, and LGBTQIA populations in longitudinal life course studies is needed to assess growth, puberty, and attainment of peak bone mass. Growth and development charts may need to be adapted to non-European populations. In addition, extension of these studies will be required to understand the clinical and physiologic consequences of interventions to address abnormal development in these populations. Health policies should be recrafted to remove barriers in care for children with obesity and/or diabetes and for LGBTQIA children and adults to facilitate comprehensive access to care, therapeutics, and technological advances. Public health interventions encompassing collection of accurate demographic and social needs data, including the intersection of social determinants of health with health outcomes, and enactment of population health level interventions will be essential tools.
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Affiliation(s)
- Alicia M Diaz-Thomas
- Department of Pediatrics, Division of Endocrinology, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Sherita Hill Golden
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Dana M Dabelea
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Adda Grimberg
- Department of Pediatrics, Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Sheela N Magge
- Department of Pediatrics, Division of Pediatric Endocrinology and Diabetes, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Joshua D Safer
- Department of Medicine, Division of Endocrinology, Diabetes, and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, NY 10001, USA
| | - Daniel E Shumer
- Department of Pediatric Endocrinology, C.S. Mott Children's Hospital, University of Michigan School of Medicine, Ann Arbor, MI 48109, USA
| | - Fatima Cody Stanford
- Massachusetts General Hospital, Department of Medicine-Division of Endocrinology-Neuroendocrine, Department of Pediatrics-Division of Endocrinology, Nutrition Obesity Research Center at Harvard (NORCH), Boston, MA 02114, USA
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11
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Carson MD, Warner AJ, Hathaway-Schrader JD, Geiser VL, Kim J, Gerasco JE, Hill WD, Lemasters JJ, Alekseyenko AV, Wu Y, Yao H, Aguirre JI, Westwater C, Novince CM. Minocycline-induced disruption of the intestinal FXR/FGF15 axis impairs osteogenesis in mice. JCI Insight 2023; 8:160578. [PMID: 36413391 PMCID: PMC9870091 DOI: 10.1172/jci.insight.160578] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 11/16/2022] [Indexed: 11/24/2022] Open
Abstract
Antibiotic-induced shifts in the indigenous gut microbiota influence normal skeletal maturation. Current theory implies that gut microbiota actions on bone occur through a direct gut/bone signaling axis. However, our prior work supports that a gut/liver signaling axis contributes to gut microbiota effects on bone. Our purpose was to investigate the effects of minocycline, a systemic antibiotic treatment for adolescent acne, on pubertal/postpubertal skeletal maturation. Sex-matched specific pathogen-free (SPF) and germ-free (GF) C57BL/6T mice were administered a clinically relevant minocycline dose from age 6-12 weeks. Minocycline caused dysbiotic shifts in the gut bacteriome and impaired skeletal maturation in SPF mice but did not alter the skeletal phenotype in GF mice. Minocycline administration in SPF mice disrupted the intestinal farnesoid X receptor/fibroblast growth factor 15 axis, a gut/liver endocrine axis supporting systemic bile acid homeostasis. Minocycline-treated SPF mice had increased serum conjugated bile acids that were farnesoid X receptor (FXR) antagonists, suppressed osteoblast function, decreased bone mass, and impaired bone microarchitecture and fracture resistance. Stimulating osteoblasts with the serum bile acid profile from minocycline-treated SPF mice recapitulated the suppressed osteogenic phenotype found in vivo, which was mediated through attenuated FXR signaling. This work introduces bile acids as a potentially novel mediator of gut/liver signaling actions contributing to gut microbiota effects on bone.
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Affiliation(s)
- Matthew D Carson
- Department of Oral Health Sciences, College of Dental Medicine.,Department of Pediatrics, Division of Endocrinology, College of Medicine.,Department of Stomatology, Division of Periodontics, College of Dental Medicine
| | - Amy J Warner
- Department of Oral Health Sciences, College of Dental Medicine.,Department of Pediatrics, Division of Endocrinology, College of Medicine.,Department of Stomatology, Division of Periodontics, College of Dental Medicine
| | - Jessica D Hathaway-Schrader
- Department of Oral Health Sciences, College of Dental Medicine.,Department of Pediatrics, Division of Endocrinology, College of Medicine.,Department of Stomatology, Division of Periodontics, College of Dental Medicine
| | - Vincenza L Geiser
- Department of Oral Health Sciences, College of Dental Medicine.,Department of Pediatrics, Division of Endocrinology, College of Medicine.,Department of Stomatology, Division of Periodontics, College of Dental Medicine
| | - Joseph Kim
- Department of Oral Health Sciences, College of Dental Medicine.,Department of Pediatrics, Division of Endocrinology, College of Medicine.,Department of Stomatology, Division of Periodontics, College of Dental Medicine
| | - Joy E Gerasco
- Department of Oral Health Sciences, College of Dental Medicine.,Department of Drug Discovery & Biomedical Sciences, College of Pharmacy
| | - William D Hill
- Department of Pathology and Laboratory Medicine, College of Medicine
| | - John J Lemasters
- Department of Drug Discovery & Biomedical Sciences, College of Pharmacy.,Department of Biochemistry & Molecular Biology, College of Medicine
| | - Alexander V Alekseyenko
- Department of Oral Health Sciences, College of Dental Medicine.,Biomedical Informatics Center, Program for Human Microbiome Research, Department of Public Health Sciences, College of Medicine.,Department of Healthcare Leadership and Management, College of Health Professions; and
| | - Yongren Wu
- Department of Orthopedics & Physical Medicine, College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.,Department of Bioengineering, College of Engineering, Clemson University, Clemson, South Carolina, USA
| | - Hai Yao
- Department of Oral Health Sciences, College of Dental Medicine.,Department of Bioengineering, College of Engineering, Clemson University, Clemson, South Carolina, USA
| | - J Ignacio Aguirre
- Department of Physiological Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
| | - Caroline Westwater
- Department of Oral Health Sciences, College of Dental Medicine.,Department of Microbiology and Immunology, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Chad M Novince
- Department of Oral Health Sciences, College of Dental Medicine.,Department of Pediatrics, Division of Endocrinology, College of Medicine.,Department of Stomatology, Division of Periodontics, College of Dental Medicine
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12
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Fagundes U, Vancini RL, de Almeida AA, Nikolaidis PT, Weiss K, Knechtle B, Andrade MS, de Lira CAB. Reference values for bone mass in young athletes: a cross-sectional study in São Paulo, Brazil. Sci Rep 2023; 13:286. [PMID: 36609534 PMCID: PMC9822898 DOI: 10.1038/s41598-023-27582-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 01/04/2023] [Indexed: 01/09/2023] Open
Abstract
Reference values for bone mass in young athletes need to be used for screening purposes, and country/regional reference values should be used to improve precision of comparisons. The aim of the present study was to develop reference values for bone health variables in Brazilian young athletes. The bone mass content (BMC), bone mass density (BMD), and total body less head (TBLH) BMD using dual-energy X-ray absorptiometry were measured in 702 young athletes (327 men and 375 women) aged 8.5-18.5 years, divided into 5 groups, according to their age: group 1 (8.5-10.5 years), group 2 (10.6-12.5 years), group 3 (12.6-14.5 years), group 4 (14.6-16.5 years), and group 5 (16.6-18.5 years). Comparisons between the sexes and ages were performed and age-sex-smoothed reference values were constructed. Male athletes presented high BMC and BMD than female athletes in age groups 3, 4, and 5 (p < 0.005) and high TBLH BMD than female athletes in age groups 4 and 5 (p < 0.005). Reference values, including the percentiles are presented for the bone health variables of each sex and age group. The age-, sex-, and ethnic-specific reference data for bone variables presented in this study enabled more precise reference data for young Brazilian athletes. These data may assist in monitoring changes during an athletes' growth and different phases of athletic training.
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Affiliation(s)
- Ulysses Fagundes
- grid.411249.b0000 0001 0514 7202Graduate Program in Translational Medicine, Federal University of Sao Paulo, São Paulo, Brazil
| | - Rodrigo Luiz Vancini
- grid.412371.20000 0001 2167 4168Center of Physical Education and Sports, Federal University of Espírito Santo, São Paulo, Brazil
| | | | - Pantelis Theo Nikolaidis
- grid.499377.70000 0004 7222 9074School of Health and Caring Sciences, University of West Attica, Athens, Greece
| | - Katja Weiss
- grid.7400.30000 0004 1937 0650Institute of Primary Care, University of Zurich, Zurich, Switzerland
| | - Beat Knechtle
- Institute of Primary Care, University of Zurich, Zurich, Switzerland. .,Medbase St. Gallen Am Vadianplatz, St. Gallen, Switzerland.
| | - Marilia Santos Andrade
- grid.411249.b0000 0001 0514 7202Department of Physiology, Federal University of Sao Paulo, São Paulo, Brazil
| | - Claudio Andre Barbosa de Lira
- grid.411195.90000 0001 2192 5801Human and Exercise Physiology Division, Faculty of Physical Education and Dance, Federal University of Goiás, Goiânia, Brazil
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13
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Machado M, Koch AJ. Letter to Editor: The Combined Relationship of Vitamin D and Weight-Bearing Sports Participation on Areal Bone Density and Geometry Among Adolescentes. J Clin Densitom 2023; 26:55. [PMID: 36543668 DOI: 10.1016/j.jocd.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Marco Machado
- Universidade Iguaçu, Campus V, Itaperuna, RJ, Brazil.
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14
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Ahmed I, Amarnani R, Fisher C. The metabolic crossroad of the adolescent athlete: achieving peak bone mass during athletic development. Br J Sports Med 2022; 56:1330-1331. [PMID: 35902209 DOI: 10.1136/bjsports-2022-105685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2022] [Indexed: 11/03/2022]
Affiliation(s)
- Irfan Ahmed
- Sports Medicine Department, Homerton University Hospital, London, UK
| | - Raj Amarnani
- Sports Medicine Department, Imperial College Healthcare NHS Trust, London, UK
| | - Corinne Fisher
- Adolescent Rheumatology Department, University College London Hospitals NHS Foundation Trust, London, UK
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15
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Chen L, Su B, Zhang Y, Ma T, Liu J, Yang Z, Li Y, Gao D, Chen M, Ma Y, Wang X, Wen B, Jiang J, Dong Y, Song Y, Ma J. Association between height growth patterns in puberty and stature in late adolescence: A longitudinal analysis in chinese children and adolescents from 2006 to 2016. Front Endocrinol (Lausanne) 2022; 13:882840. [PMID: 35937794 PMCID: PMC9354934 DOI: 10.3389/fendo.2022.882840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 06/27/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction The relationship between the characteristics of puberty growth and the stature (height and overweight and obesity) in late adolescence was not clear. We aimed to explore the effects of puberty growth patterns on the stature in late adolescence. Methods A total of 13,143 children from a longitudinal cohort from 2006 to 2016 in Zhongshan city of China were included. The Preece-Baines growth curve was fitted for each individual child, and the age at peak height velocity (APHV), peak height velocity (PHV), and age at take-off (TOA) were obtained from the Preece-Baines model. To compare the difference in height in late adolescence (at 18 years old) at different pubertal height growth patterns (height spurt timing, intensity, and duration), the height at baseline was matched by using the propensity score matching. The log-binomial model was applied to assess the association between the three pubertal height growth patterns (timing, intensity, and duration) and overweight and obesity status in late adolescence, controlling the urbanity and body mass index (BMI) at baseline. Results After matching the baseline height, boys and girls in three pubertal patterns with early timing (P < 0.01), small intensity (P < 0.01), and short duration (P < 0.01) of height spurt had the lowest final height in the late adolescence. A 16% increase and 45% increase of risk for overweight and obesity were significantly associated with the early APHV in boys and girls, respectively, relative risk (RR) in boys, 1.16(95% confidence interval, CI: 1.03-1.30), P = 0.011; RR in girls, 1.45(1.21-1.75), P < 0.001. A 21% increase and 59% increase of risk for overweight and obesity were significantly associated with small PHV in boys and girls, respectively, RR in boys, 1.21(1.07-1.36), P < 0.001; RR in girls, 1.59(1.30-1.95), P < 0.001; and an 80% increase of risk for overweight and obesity with small spurt duration in girls (RR = 1.80; 95% CI: 1.49, 2.18; P < 0.001). Conclusion Pubertal growth patterns, including earlier puberty onset timing, smaller puberty intensity, and shorter puberty spurt duration, had a positive association with lower height risks and higher overweight and obesity risks in late adolescence.
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Affiliation(s)
- Li Chen
- Institute of Child and Adolescent Health, School of Public Health, Peking University; National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Binbin Su
- Institute of Population Research, Peking University Asia-Pacific Economic Cooperation (APEC) Health Science Academy, Beijing, China
| | - Yi Zhang
- Institute of Child and Adolescent Health, School of Public Health, Peking University; National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Tao Ma
- Institute of Child and Adolescent Health, School of Public Health, Peking University; National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Jieyu Liu
- Institute of Child and Adolescent Health, School of Public Health, Peking University; National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Zhaogeng Yang
- Institute of Child and Adolescent Health, School of Public Health, Peking University; National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Yanhui Li
- Institute of Child and Adolescent Health, School of Public Health, Peking University; National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Di Gao
- Institute of Child and Adolescent Health, School of Public Health, Peking University; National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Manman Chen
- Institute of Child and Adolescent Health, School of Public Health, Peking University; National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Ying Ma
- Institute of Child and Adolescent Health, School of Public Health, Peking University; National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Xijie Wang
- Institute of Child and Adolescent Health, School of Public Health, Peking University; National Health Commission Key Laboratory of Reproductive Health, Beijing, China
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Bo Wen
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Jun Jiang
- Department of Atmospheric and Oceanic Science, Earth System Science Interdisciplinary Center, University of Maryland, College Park, MD, United States
| | - Yanhui Dong
- Institute of Child and Adolescent Health, School of Public Health, Peking University; National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Yi Song
- Institute of Child and Adolescent Health, School of Public Health, Peking University; National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Jun Ma
- Institute of Child and Adolescent Health, School of Public Health, Peking University; National Health Commission Key Laboratory of Reproductive Health, Beijing, China
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16
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Hanafy NM, Elsehaimy LA, Alzokm SM, Abd El-Raheem SI. Bone mineral density and risk factors of osteoporosis in children. THE EGYPTIAN RHEUMATOLOGIST 2022; 44:257-260. [DOI: 10.1016/j.ejr.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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17
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Kajale N, Khadilkar A, Shah N, Padidela R, Mughal Z, Chiplonkar S, Ekbote V, Khadilkar V. Impact of Adolescent Pregnancy on Bone Density in Underprivileged Pre-Menopausal Indian Women. J Clin Densitom 2022; 25:178-188. [PMID: 34911660 DOI: 10.1016/j.jocd.2021.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 09/29/2021] [Accepted: 11/08/2021] [Indexed: 10/19/2022]
Abstract
High prevalence (31.5%) of adolescent pregnancies (AP) have been reported in India. Reports suggest that pregnancy during adolescence may have deleterious effects on peak bone mass. Very few studies have described the long-term effects of a history of AP on bone mass. The objective of this study was to compare bone mineral density (BMD) and bone geometry of premenopausal women with first childbirth during adolescence (i.e., before age of 19 years) or after 20 years. A cross-sectional study was conducted in 242 women (age 28.0-54.5 years) from Pune, India (November, 2015 to November, 2017). Women were divided into 2-groups: Group-1: women-who had 1st-pregnancy and childbirth before 19 years of age (AP n = 131) and Group-2: women-who had 1st pregnancy after 20 years of age (non-AP n = 111). Demographic data, anthropometric measurements, and biochemical tests were performed using standard protocols. Physical activity and nutrient intakes were recorded using validated questionnaires. Areal BMD and bone geometry were measured using Dual-Energy-Absorptiometry-DXA (Lunar-iDXA, GE Healthcare) and peripheral-quantitative-computed-tomography-pQCT (XCT2000, Stratec Inc.). Mean age of the study group was 37 ± 4.6 years; in women from group-1 mean age at first delivery was 16.9 ± 1.6 years as against 22.6 ± 3.1 years in group-2. Both groups were similar in body mass index and socioeconomic status. pQCT measured radial diaphyseal cortical thickness (1.97 ± 0.3 mm vs 1.88 ± 0.3 mm resp., p = 0.016, periosteal circumference (38.0 ± 3.6 mm vs 36.7 ± 2.5 mm, resp. p = 0.016), total bone area (114.3 ± 24.8 mm2 vs 108.7 ± 14.7 mm2 resp. p = 0.026) and stress-strain index (SSI = 217 ± 75 vs 201 ± 40 mm3 resp. p = 0.042) were significantly higher in group-1 than group-2. After adjusting for anthropometric and lifestyle parameters, pQCT measured cortical thickness (1.98 ± 0.03 mm in group-1, 1.87 ± 0.03 mm group-2, p = 0.01, mean ± SE) and iDXA derived aBMD at forearm were still significantly higher (0.599 ± 0.006 g/cm3 vs 0.580 ± 0.006 g/cm3, p = 0.023) in Group-1. Our data suggest that women with a history of adolescent pregnancy had better bone geometry and higher aBMD at radius in later years. We speculate that early exposure to pregnancy resulted in higher aBMD at the radius and induced changes at radial diaphysis with bones becoming thicker and wider among these women.
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Affiliation(s)
- Neha Kajale
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India
| | - Anuradha Khadilkar
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India.
| | - Nikhil Shah
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India; Department of Pediatrics, Cloudnine Hospital, Malad, Mumbai
| | - Raja Padidela
- Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Manchester University, Manchester
| | - Zulf Mughal
- Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Manchester University, Manchester
| | - Shashi Chiplonkar
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India
| | - Veena Ekbote
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India
| | - Vaman Khadilkar
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India
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18
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Elhakeem A, Hughes RA, Tilling K, Cousminer DL, Jackowski SA, Cole TJ, Kwong ASF, Li Z, Grant SFA, Baxter-Jones ADG, Zemel BS, Lawlor DA. Using linear and natural cubic splines, SITAR, and latent trajectory models to characterise nonlinear longitudinal growth trajectories in cohort studies. BMC Med Res Methodol 2022; 22:68. [PMID: 35291947 PMCID: PMC8925070 DOI: 10.1186/s12874-022-01542-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 02/11/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Longitudinal data analysis can improve our understanding of the influences on health trajectories across the life-course. There are a variety of statistical models which can be used, and their fitting and interpretation can be complex, particularly where there is a nonlinear trajectory. Our aim was to provide an accessible guide along with applied examples to using four sophisticated modelling procedures for describing nonlinear growth trajectories. METHODS This expository paper provides an illustrative guide to summarising nonlinear growth trajectories for repeatedly measured continuous outcomes using (i) linear spline and (ii) natural cubic spline linear mixed-effects (LME) models, (iii) Super Imposition by Translation and Rotation (SITAR) nonlinear mixed effects models, and (iv) latent trajectory models. The underlying model for each approach, their similarities and differences, and their advantages and disadvantages are described. Their application and correct interpretation of their results is illustrated by analysing repeated bone mass measures to characterise bone growth patterns and their sex differences in three cohort studies from the UK, USA, and Canada comprising 8500 individuals and 37,000 measurements from ages 5-40 years. Recommendations for choosing a modelling approach are provided along with a discussion and signposting on further modelling extensions for analysing trajectory exposures and outcomes, and multiple cohorts. RESULTS Linear and natural cubic spline LME models and SITAR provided similar summary of the mean bone growth trajectory and growth velocity, and the sex differences in growth patterns. Growth velocity (in grams/year) peaked during adolescence, and peaked earlier in females than males e.g., mean age at peak bone mineral content accrual from multicohort SITAR models was 12.2 years in females and 13.9 years in males. Latent trajectory models (with trajectory shapes estimated using a natural cubic spline) identified up to four subgroups of individuals with distinct trajectories throughout adolescence. CONCLUSIONS LME models with linear and natural cubic splines, SITAR, and latent trajectory models are useful for describing nonlinear growth trajectories, and these methods can be adapted for other complex traits. Choice of method depends on the research aims, complexity of the trajectory, and available data. Scripts and synthetic datasets are provided for readers to replicate trajectory modelling and visualisation using the R statistical computing software.
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Affiliation(s)
- Ahmed Elhakeem
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK.
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Rachael A Hughes
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Kate Tilling
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Diana L Cousminer
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Genetics, University of Pennsylvania, Philadelphia, PA, USA
- Center for Spatial and Functional Genomics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Stefan A Jackowski
- College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Tim J Cole
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Alex S F Kwong
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Zheyuan Li
- School of Mathematics and Statistics, Henan University, Kaifeng, Henan, China
- Department of Statistics and Actuarial Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Struan F A Grant
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Genetics, University of Pennsylvania, Philadelphia, PA, USA
- Center for Spatial and Functional Genomics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Babette S Zemel
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Deborah A Lawlor
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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19
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Ullal J, Kutney K, Williams KM, Weber DR. Treatment of cystic fibrosis related bone disease. J Clin Transl Endocrinol 2022; 27:100291. [PMID: 35059303 PMCID: PMC8760456 DOI: 10.1016/j.jcte.2021.100291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 12/03/2021] [Accepted: 12/04/2021] [Indexed: 11/29/2022] Open
Abstract
The advent of highly effective CFTR modulator therapies has slowed the progression of pulmonary complications in people with cystic fibrosis. There is increased interest in cystic fibrosis bone disease (CFBD) due to the increasing longevity of people with cystic fibrosis. CFBD is a complex and multifactorial disease. CFBD is a result of hypomineralized bone leading to poor strength, structure and quality leading to susceptibility to fractures. The development of CFBD spans different age groups. The management must be tailored to each group with nuance and based on available guidelines while balancing therapeutic benefits to risks of long-term use of bone-active medication. For now, the mainstay of treatment includes bisphosphonates. However, the long-term effects of bisphosphonate treatment in people with CF are not fully understood. We describe newer agents available for osteoporosis treatment. Still, the lack of data behooves trials of monoclonal antibodies treatments such as Denosumab and Romozosumab and anabolic bone therapy such as teriparatide and Abaloparatide. In this review, we also summarize screening and non-pharmacologic treatment of CFBD and describe the various options available for the pharmacotherapy of CFBD. We address the prospect of CFTR modulators on bone health while awaiting long-term trials to describe the effects of these medications on bone health.
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Affiliation(s)
- Jagdeesh Ullal
- UPMC Center for Diabetes and Endocrinology, University of Pittsburgh Medical Center, 3601 Fifth Ave, Suite 3B, Falk Medical Building, Pittsburgh, PA 15213, USA
- Corresponding author at: UPMC Center for Diabetes and Endocrinology, Falk Medical Building, 3601 Fifth Ave Suite 3B, Pittsburgh, PA 15213, USA. Tel.: 412-586-9700; Fax: 412-586-9724.
| | - Katherine Kutney
- Pediatric Endocrinology, Rainbow Babies and Children's Hospital, 11100 Euclid Ave, Suite 737, Cleveland, OH 44106, USA
| | - Kristen M. Williams
- Naomi Berrie Diabetes Center, Columbia University Irving Medical Center Division of Pediatric Endocrinology, Diabetes, and Metabolism, Columbia University Irving Medical Center, 1150 St Nicholas Avenue, New York, NY 10032, USA
| | - David R. Weber
- Division of Pediatric Endocrinology & Diabetes & Center for Bone Health, The Children’s Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania Roberts Clinical Research Bldg., Room 14361 415 Curie Boulevard, Philadelphia, PA 19104, USA
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20
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Baxter-Jones ADG, Jackowski SA. Sex differences in bone mineral content and bone geometry accrual: a review of the Paediatric Bone Mineral Accural Study (1991-2017). Ann Hum Biol 2022; 48:503-516. [PMID: 35105203 DOI: 10.1080/03014460.2021.2014568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
CONTEXT Girls' and boys' growth patterns differ in timing and tempo, and they have different lifestyles with regards to diet and physical activity. These factors have all been linked with bone mineral accrual. OBJECTIVE To identify the associations of boys' and girls' growth, maturation, and lifestyle choices relating to parameters of bone geometry and mineral accrual. METHODS Between 1991 and 1993, 251 children aged 8-15 years were recruited into a mixed-longitudinal cohort study (The Paediatric Bone Mineral Accrual Study (PBMAS)) and followed repeatedly over 26 years. RESULTS It was found that girls matured approximately two years earlier than boys (11.8 vs. 13.4 years) but on average were shorter, had less lean mass and had greater fat mass (p < 0.05). There was a dissociation between the growth of bone and its mineralisation in both sexes. Boys had greater bone mass and bone geometry (p < 0.05). Both a healthy childhood diet and high levels of physical activity were associated with improved bone parameters. CONCLUSIONS Most, but not all, of the sex differences observed, were explained by height and lean mass differences. The importance of diet and physical activity on obtaining optimal bone mass during adolescence in both sexes was also paramount.
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Affiliation(s)
| | - Stefan A Jackowski
- College of Kinesiology, University of Saskatchewan, Saskatoon, SK, Canada.,Research Institute, Children's Hospital of Eastern Ontario, Ottawa, Canada
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21
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Darawad MW, Shawashi TO, Al Duraidi H, Nofal B. Osteoporosis education: Evaluation of an awareness program among female university students. Int J Orthop Trauma Nurs 2022; 45:100926. [DOI: 10.1016/j.ijotn.2022.100926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 02/06/2022] [Accepted: 02/10/2022] [Indexed: 11/25/2022]
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22
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Kuiper JR, Braun JM, Calafat AM, Lanphear BP, Cecil KM, Chen A, Xu Y, Yolton K, Kalkwarf HJ, Buckley JP. Associations of pregnancy phthalate concentrations and their mixture with early adolescent bone mineral content and density: The Health Outcomes and Measures of the Environment (HOME) study. Bone 2022; 154:116251. [PMID: 34740813 PMCID: PMC8671261 DOI: 10.1016/j.bone.2021.116251] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/22/2021] [Accepted: 10/29/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND The developing fetus may be particularly susceptibility to environmental osteotoxicants, but studies of pregnancy phthalate exposures and childhood bone health are scarce. OBJECTIVES To examine relations of pregnancy phthalate exposure biomarkers with early adolescent bone mineral density (BMD) and bone mineral content (BMC) in a prospective birth cohort. METHODS We used data from 223 pregnant mothers and their children enrolled in a Cincinnati, OH area cohort from 2003 to 2006. We quantified monoethyl phthalate (MEP), monoisobutyl phthalate, monobutyl phthalate, monobenzyl phthalate, mono-(3-carboxypropyl) phthalate (MCPP), and four metabolites of di-2-ethylhexyl phthalate in maternal urine collected at 16 and 26 weeks gestation, and calculated the average of creatinine-standardized concentrations. Using dual x-ray absorptiometry measures at age 12 years, we calculated BMD and BMC Z-scores for six skeletal sites. In overall and sex-stratified models, we estimated covariate-adjusted associations per 2-fold increase in phthalate biomarker concentrations using linear regression, and estimated joint effects of the phthalate biomarkers mixture using Bayesian kernel machine regression (BKMR) and quantile g-computation. RESULTS In single phthalate models, several biomarkers were positively associated with BMC and BMD. For example, each doubling of MEP and MCPP, 1/3rd distal radius BMD Z-score increased by 0.09 (95% CI: 0.01, 0.17) and 0.16 (95% CI: 0.01, 0.31), respectively. For phthalate mixtures, associations were generally U-shaped among males and positive-linear among females, using both statistical methods. Mixture associations were strongest with forearm sites: in BKMR models, increasing all biomarkers from the 50th to 90th percentile was associated with a 0.64 (95% CI: 0.01, 1.28) greater 1/3rd distal radius BMD Z-score in males, and a 0.49 (95% CI: -0.13, 1.10) greater ultradistal radius BMD Z-score in females. DISCUSSION In this study, phthalate exposures during gestation were associated with increased BMD Z-scores in early adolescence, though further research is needed to determine implications for long-term skeletal health.
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Affiliation(s)
- Jordan R Kuiper
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Joseph M Braun
- Department of Epidemiology, Brown University, Providence, RI, USA
| | - Antonia M Calafat
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Bruce P Lanphear
- Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada
| | - Kim M Cecil
- Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Aimin Chen
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Yingying Xu
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Kimberly Yolton
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Heidi J Kalkwarf
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jessie P Buckley
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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23
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Örgel M, Zimmer G, Graulich T, Gräff P, Macke C, Krettek C, Winkelmann M, Neunaber C. The impact of lifestyle on forearm fractures in children: A retrospective cohort analysis. Bone 2021; 153:116149. [PMID: 34390887 DOI: 10.1016/j.bone.2021.116149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 07/31/2021] [Accepted: 08/07/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND OBJECTIVES Forearm fractures are frequent in children. It is important to identify predisposing factors for increased fracture risk. This retrospective analysis aimed to investigate the correlation between forearm fractures in children and co-factors such as age, TV consumption, consumption of soft drinks, the kind of soft drinks consumed as well as physical activity in daily life and BMI. METHODS This retrospective cohort analysis compared 355 participants at the age of 4 to 12 between 2017 and 2018 with and without forearm fractures in children. It was based on a questionnaire to assess the above-mentioned cofactors regarding behavior and lifestyles choices and aimed to identify whether or not these lead to an increased risk of forearm fractures. For statistical analysis logistic regression was used. RESULTS Logistic regression showed a significant effect on forearm fractures in children for the variables age (Odds ratio 3.3 [95% confidence interval 1.5-7.3], P = .003), TV consumption (Odds ratio 5.4 [95% confidence interval 2.5-22.6], P < .001), consumption of soft drinks (Odds ratio 2.6 [95% confidence interval 1.2-5.6], P = .013), and the kind of soft drinks consumed (Odds ratio 3.1 [95% confidence interval 1.5-6.3], P = .003), [Nagelkerkes-R2 = 0.458; Chi2 = 85.037; df = 6]) with a strong effect according to Cohen (f2 = 0.84). CONCLUSION The study showed a significant correlation between TV and soft drink consumption and increased risk for forearm fractures in children. TV consumption and consumption of soft drinks should be reduced in children to prevent forearm fractures.
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Affiliation(s)
- Marcus Örgel
- Trauma Department, Hannover Medical School (MHH), Carl-Neuberg-Straße 1, 30625 Hannover, Germany.
| | - Giulia Zimmer
- Trauma Department, Hannover Medical School (MHH), Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Tilman Graulich
- Trauma Department, Hannover Medical School (MHH), Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Pascal Gräff
- Trauma Department, Hannover Medical School (MHH), Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Christian Macke
- Trauma Department, Hannover Medical School (MHH), Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Christian Krettek
- Trauma Department, Hannover Medical School (MHH), Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Marcel Winkelmann
- Trauma Department, Hannover Medical School (MHH), Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Claudia Neunaber
- Trauma Department, Hannover Medical School (MHH), Carl-Neuberg-Straße 1, 30625 Hannover, Germany
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24
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Abstract
BACKGROUND This review paper aims to report on the last 5 years of relevant research on pediatric bone health in regard to nutrition and obesity, ethnic disparities, common orthopaedic conditions, trauma, spine, and sports medicine. METHODS A search of the PubMed database was completed using the following terms: bone health, Vitamin D, pediatric, adolescent, sports medicine, fractures, spine, scoliosis, race, ethnicity, obesity, Slipped Capital Femoral Epiphysis, Osteogenesis Imperfecta, Duchenne's Muscular Dystrophy, neuromuscular, and cancer. Resultant papers were reviewed by study authors and determined to be of quality and relevance for description in this review. Papers from January 1, 2015 to August 31, 2020 were included. RESULTS A total of 85 papers were selected for review. General results include 7 key findings. (1) Obesity inhibits pediatric bone health with leptin playing a major role in the process. (2) Socioeconomic and demographic disparities have shown to have a direct influence on bone health. (3) Vitamin D deficiency has been linked to an increased fracture risk and severity in children. (4) Formal vitamin D monitoring can aid with patient compliance with treatment. (5) Patients with chronic medical conditions are impacted by low vitamin D and need ongoing monitoring of their bone health to decrease their fracture risk. (6) Vitamin D deficiency in pediatrics has been correlated to low back pain, spondylolysis, and adolescent idiopathic scoliosis. Osteopenic patients with AIS have an increased risk of curve progression requiring surgery. Before spine fusion, preoperative screening for vitamin D deficiency may reduce complications of fractures, insufficient tissue repair, loosening hardware, and postoperative back pain. (7) Increasing youth sports participation has resulted in increased bone health related injuries. However, improved understanding of Relative Energy Deficiency in Sport effects on bone health has recently occurred. CONCLUSIONS Increasing awareness of bone health issues in children will improve their recognition and treatment. Further research is needed on diagnosis, treatment, outcomes, and most importantly prevention of pediatric bone health diseases.
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Affiliation(s)
| | - Susan T Mahan
- Boston Children's Hospital/Harvard Medical School, Boston, MA
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25
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Varimo T, Miettinen PJ, Laine T, Salonen P, Tenhola S, Voutilainen R, Huopio H, Hero M, Raivio T. Bone structure assessed with pQCT in prepubertal males with delayed puberty or congenital hypogonadotropic hypogonadism. Clin Endocrinol (Oxf) 2021; 95:107-116. [PMID: 33738832 DOI: 10.1111/cen.14466] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/12/2021] [Accepted: 03/14/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Congenital hypogonadotropic hypogonadism (CHH) is associated with impaired bone mineral density in adulthood, whereas the estimates on bone structure in adolescents with CHH has not been previously evaluated. This study describes bone structure in CHH patients and compares it to that in boys with constitutional delay of growth and puberty (CDGP). DESIGN A cross-sectional study. METHODS Peripheral quantitative computed tomography (pQCT) of non-dominant arm and left leg were performed. Volumetric bone mineral density (BMD), bone mineral content, and area in trabecular and cortical bone compartments were evaluated, and bone age-adjusted Z-scores for the bone parameters were determined. RESULTS The participants with CHH had more advanced bone age and were older, taller and heavier than the CDGP boys, yet they had lower trabecular BMD in distal radius (147.7 mg/mm3 [95% CI, 128-168 mg/mm3 ] vs. 181.2 mg/mm3 [172-192 mg/mm3 ], p = .002) and distal tibia (167.6 mg/mm3 [145-190 mg/mm3 ] vs. 207.2 mg/mm3 [187-227 mg/mm3 ], p = .012), respectively. CHH males had lower cortical thickness at diaphyseal tibia than the participants with CDGP (p = .001). These between-group differences remained significant in corresponding Z-scores adjusted for bone age and height (p = .001). In CDGP group, serum testosterone correlated positively with trabecular BMD (r = 0.51, p = .013) at distal radius, and estradiol levels correlated positively with trabecular BMD at the distal site of tibia (r = 0.58, p = .004). CONCLUSIONS Five treatment-naïve male patients with CHH exhibited poorer trabecular BMD than untreated males with CDGP. We speculate that timely low-dose sex steroid replacement in CHH males may benefit skeletal health in adulthood.
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Affiliation(s)
- Tero Varimo
- New Children's Hospital, Pediatric Research Center, Helsinki University Hospital, Helsinki, Finland
| | - Päivi J Miettinen
- New Children's Hospital, Pediatric Research Center, Helsinki University Hospital, Helsinki, Finland
| | - Tiina Laine
- New Children's Hospital, Pediatric Research Center, Helsinki University Hospital, Helsinki, Finland
| | - Pia Salonen
- Päijät-Häme Central Hospital, Lahti, Finland
| | | | - Raimo Voutilainen
- Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland
| | - Hanna Huopio
- Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland
| | - Matti Hero
- New Children's Hospital, Pediatric Research Center, Helsinki University Hospital, Helsinki, Finland
| | - Taneli Raivio
- New Children's Hospital, Pediatric Research Center, Helsinki University Hospital, Helsinki, Finland
- Translational Stem Cell Biology and Metabolism Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
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26
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Marstein HS, Godang K, Flatø B, Sjaastad I, Bollerslev J, Sanner H. Bone mineral density and explanatory factors in children and adults with juvenile dermatomyositis at long term follow-up; a cross sectional study. Pediatr Rheumatol Online J 2021; 19:56. [PMID: 33902632 PMCID: PMC8077908 DOI: 10.1186/s12969-021-00543-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 04/14/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Juvenile dermatomyositis (JDM) is the most common idiopathic inflammatory myopathy in children and adolescents. Both the disease and its treatment with glucocorticoids may negatively impact bone formation. In this study we compare BMD in patients (children/adolescence and adults) with long-standing JDM with matched controls; and in patients, explore how general/disease characteristics and bone turnover markers are associated with BMD. METHODS JDM patients (n = 59) were examined median 16.8y (range 6.6-27.0y) after disease onset and compared with 59 age/sex-matched controls. Dual-energy X-ray absorptiometry (DXA) was used to measure BMD of the whole body and lumbar spine (spine) in all participants, and of ultra-distal radius, forearm and total hip in participants ≥20y only. Markers of bone turnover were analysed, and associations with outcomes explored. RESULTS Reduced BMD Z-scores (<-1SD) were found in 19 and 29% of patients and 7 and 9% of controls in whole body and spine, respectively (p-values < 0.05). BMD and BMD Z-scores for whole body and spine were lower in all patients and for < 20y compared with their respective controls. In participants ≥20y, only BMD and BMD Z-score of forearm were lower in the patients versus controls. In patients, BMD Z-scores for whole body and/or spine were found to correlate negatively with prednisolone use at follow-up (yes/no) (age < 20y), inflammatory markers (age ≥ 20y) and levels of interferon gamma-induced protein 10 (IP-10) (both age groups). In all patients, prednisolone use at follow-up (yes/no) and age ≥ 20y were independent correlates of lower BMD Z-scores for whole body and spine, respectively. CONCLUSION In long-term JDM, children have more impairment of BMD than adults in spine and whole-body. Associations with BMD were found for both prednisolone and inflammatory markers, and a novel association was discovered with the biomarker of JDM activity, IP-10.
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Affiliation(s)
- Henriette Schermacher Marstein
- Institute for Experimental Medical Research and KG Jebsen Center for Cardiac Research, University of Oslo and Oslo University Hospital, Ullevål, 0027, Oslo, Norway. .,Bjørknes University College, Oslo, Norway.
| | - Kristin Godang
- grid.55325.340000 0004 0389 8485Section of Specialized Endocrinology, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Medical Clinic, Oslo University Hospital, Oslo, Norway
| | - Berit Flatø
- grid.5510.10000 0004 1936 8921Institute for Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway ,grid.55325.340000 0004 0389 8485Department of Rheumatology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Ivar Sjaastad
- grid.5510.10000 0004 1936 8921Institute for Experimental Medical Research and KG Jebsen Center for Cardiac Research, University of Oslo and Oslo University Hospital, Ullevål, 0027 Oslo, Norway ,grid.55325.340000 0004 0389 8485Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway
| | - Jens Bollerslev
- grid.55325.340000 0004 0389 8485Section of Specialized Endocrinology, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Medical Clinic, Oslo University Hospital, Oslo, Norway ,grid.5510.10000 0004 1936 8921Institute for Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway
| | - Helga Sanner
- grid.510411.00000 0004 0578 6882Bjørknes University College, Oslo, Norway ,grid.55325.340000 0004 0389 8485Department of Rheumatology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
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27
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Messina M, Mejia SB, Cassidy A, Duncan A, Kurzer M, Nagato C, Ronis M, Rowland I, Sievenpiper J, Barnes S. Neither soyfoods nor isoflavones warrant classification as endocrine disruptors: a technical review of the observational and clinical data. Crit Rev Food Sci Nutr 2021; 62:5824-5885. [PMID: 33775173 DOI: 10.1080/10408398.2021.1895054] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Soybeans are a rich source of isoflavones, which are classified as phytoestrogens. Despite numerous proposed benefits, isoflavones are often classified as endocrine disruptors, based primarily on animal studies. However, there are ample human data regarding the health effects of isoflavones. We conducted a technical review, systematically searching Medline, EMBASE, and the Cochrane Library (from inception through January 2021). We included clinical studies, observational studies, and systematic reviews and meta-analyses (SRMA) that examined the relationship between soy and/or isoflavone intake and endocrine-related endpoints. 417 reports (229 observational studies, 157 clinical studies and 32 SRMAs) met our eligibility criteria. The available evidence indicates that isoflavone intake does not adversely affect thyroid function. Adverse effects are also not seen on breast or endometrial tissue or estrogen levels in women, or testosterone or estrogen levels, or sperm or semen parameters in men. Although menstrual cycle length may be slightly increased, ovulation is not prevented. Limited insight could be gained about possible impacts of in utero isoflavone exposure, but the existing data are reassuring. Adverse effects of isoflavone intake were not identified in children, but limited research has been conducted. After extensive review, the evidence does not support classifying isoflavones as endocrine disruptors.
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Affiliation(s)
- Mark Messina
- Department of Nutrition, Loma Linda University, Loma Linda, California, USA
| | - Sonia Blanco Mejia
- Department of Nutritional Sciences, University of Toronto, Toronto, Canada
| | - Aedin Cassidy
- Nutrition and Preventive Medicine, Queen's University, Belfast, Northern Ireland, UK
| | - Alison Duncan
- College of Biological Sciences, University of Guelph, Guelph, Canada
| | - Mindy Kurzer
- Department of Food Science and Nutrition, University of Minnesota, Minneapolis, Minnesota, USA
| | - Chisato Nagato
- Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Martin Ronis
- Health Sciences Center, Louisiana State University Health Sciences Center, Baton Rouge, New Orleans, USA
| | - Ian Rowland
- Human Nutrition, University of Reading, Reading, England, UK
| | | | - Stephen Barnes
- Department of Pharmacology and Toxicology, University of Alabama, Alabama, USA
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28
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Rinonapoli G, Ruggiero C, Meccariello L, Bisaccia M, Ceccarini P, Caraffa A. Osteoporosis in Men: A Review of an Underestimated Bone Condition. Int J Mol Sci 2021; 22:2105. [PMID: 33672656 PMCID: PMC7924179 DOI: 10.3390/ijms22042105] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/17/2021] [Accepted: 02/17/2021] [Indexed: 02/06/2023] Open
Abstract
Osteoporosis is called the 'silent disease' because, although it does not give significant symptoms when it is not complicated, can cause fragility fractures, with serious consequences and death. Furthermore, the consequences of osteoporosis have been calculated to weigh heavily on the costs of health systems in all the countries. Osteoporosis is considered a female disease. Actually, the hormonal changes that occur after menopause certainly determine a significant increase in osteoporosis and the risk of fractures in women. However, while there is no doubt that women are more exposed to osteoporosis and fragility fractures, the literature clearly indicates that physicians tend to underestimate the osteoporosis in men. The review of the literature done by the authors shows that osteoporosis and fragility fractures have a high incidence also in men; and, furthermore, the risk of fatal complications in hip fractured men is higher than that for women. The authors report the evidence of the literature on male osteoporosis, dwelling on epidemiology, causes of osteoporosis in men, diagnosis, and treatment. The analysis of the literature shows that male osteoporosis is underscreened, underdiagnosed, and undertreated, both in primary and secondary prevention of fragility fractures.
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Affiliation(s)
- Giuseppe Rinonapoli
- Orthopaedic and Traumatology Department, University of Perugia, Ospedale S.Maria della Misericordia, S. Andrea delle Fratte, 06156 Perugia, Italy; (M.B.); (P.C.); (A.C.)
| | - Carmelinda Ruggiero
- Orthogeriatric Service, Geriatric Unit, Institute of Gerontology and Geriatrics, Department of Medicine, University of Perugia, Ospedale S.Maria della Misericordia, S. Andrea delle Fratte, 06156 Perugia, Italy;
| | - Luigi Meccariello
- Department of Orthopaedics and Traumatology, AORN San Pio “Gaetano Rummo Hospital”, via R.Delcogliano, 82100 Benevento (BN), Italy;
| | - Michele Bisaccia
- Orthopaedic and Traumatology Department, University of Perugia, Ospedale S.Maria della Misericordia, S. Andrea delle Fratte, 06156 Perugia, Italy; (M.B.); (P.C.); (A.C.)
| | - Paolo Ceccarini
- Orthopaedic and Traumatology Department, University of Perugia, Ospedale S.Maria della Misericordia, S. Andrea delle Fratte, 06156 Perugia, Italy; (M.B.); (P.C.); (A.C.)
| | - Auro Caraffa
- Orthopaedic and Traumatology Department, University of Perugia, Ospedale S.Maria della Misericordia, S. Andrea delle Fratte, 06156 Perugia, Italy; (M.B.); (P.C.); (A.C.)
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29
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Misakian A, McLoughlin M, Pyle LC, Kolon TF, Kelly A, Vogiatzi MG. Case Report: Low Bone and Normal Lean Mass in Adolescents With Complete Androgen Insensitivity Syndrome. Front Endocrinol (Lausanne) 2021; 12:727131. [PMID: 34526969 PMCID: PMC8435790 DOI: 10.3389/fendo.2021.727131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 07/22/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Osteopenia and osteoporosis have been reported in adults with Complete Androgen Insensitivity Syndrome (CAIS). Little is known about changes in bone mineral density (BMD) in adolescents with CAIS and whether it is affected by early gonadectomy. Body composition data have not been reported. METHODS Single-center, retrospective study of CAIS adolescents who underwent dual-energy x-ray absorptiometry (DXA) (Hologic, Horizon A). Body composition is presented as lean and fat mass indices (LMI, FMI). Z-scores for lumbar spine areal BMD (LBMD), total body less head (TBLH), bone mineral content (BMC), LMI, and FMI were calculated using female normative data. Results are expressed as median and min, max. RESULTS Six females with genetically confirmed CAIS were identified-one with intact gonads and five with history of gonadectomy at 2-11 months. In the subject with intact gonads, LBMD-Z and TBLH BMC-Z were -1.56 and -1.26, respectively, at age 16 years. Among those with gonadectomy, LBMD-Z was -1.8 (-3.59 to 0.49) at age 15.6 years (12-16.8) and decreased in all three subjects who had longitudinal follow-up despite hormone replacement therapy (HRT). Adherence to HRT was intermittent. LMI-Z and FMI-Z were 0.1 (-1.39 to 0.7) and 1.0 (0.22 to 1.49), respectively. CONCLUSIONS These limited data indicate that adolescents with CAIS have bone mass deficit. Further studies are needed to understand the extent of BMD abnormalities and the effect of gonadectomy, especially early in childhood, and to establish the optimal HRT regimen for bone accrual. Data on lean mass are reassuring.
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Affiliation(s)
- Aaron Misakian
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- *Correspondence: Aaron Misakian,
| | - Michelle McLoughlin
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Louisa C. Pyle
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Thomas F. Kolon
- Division of Urology, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Andrea Kelly
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Maria G. Vogiatzi
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
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30
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de Almeida-Neto PF, Arrais RF, de Matos DG, Cesário TM, Bulhões-Correia A, Silva LF, Aidar FJ, Santana EE, Silva Dantas PM, Cabral BG. The influence of biological maturation and neuromuscular performance on peak bone mineral density in children. J Sports Med Phys Fitness 2020; 61:829-835. [PMID: 33146496 DOI: 10.23736/s0022-4707.20.11497-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSIONS BMD has a strong correlation with the neuromuscular performance of upper and lower limbs of children of both sexes.
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Affiliation(s)
- Paulo F de Almeida-Neto
- Department of Physical Education, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil -
| | - Ricardo F Arrais
- Department of Pediatrics, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil
| | - Dihogo G de Matos
- Research Center in Sports Sciences, Health Sciences and Human Development (CIDESD), Trás os Montes and Alto Douro University, Vila Real, Portugal.,Group of Studies and Research of Performance, Sport, Health and Paralympic Sports (GEPEPS), Federal University of Sergipe (UFS), São Cristovão, Sergipe, Brazil
| | - Tatianny M Cesário
- Department of Physical Education, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil
| | | | - Luíz F Silva
- Department of Physical Education, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil
| | - Felipe J Aidar
- Group of Studies and Research of Performance, Sport, Health and Paralympic Sports (GEPEPS), Federal University of Sergipe (UFS), São Cristovão, Sergipe, Brazil.,Department of Physical Education, Federal University of Sergipe (UFS), São Cristovão, Sergipe, Brazil
| | - Eduardo E Santana
- Department of Physical Education, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil
| | - Paulo M Silva Dantas
- Department of Physical Education, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil
| | - Breno G Cabral
- Department of Physical Education, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil
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Lee JY, Finlayson C, Olson-Kennedy J, Garofalo R, Chan YM, Glidden DV, Rosenthal SM. Low Bone Mineral Density in Early Pubertal Transgender/Gender Diverse Youth: Findings From the Trans Youth Care Study. J Endocr Soc 2020; 4:bvaa065. [PMID: 32832823 PMCID: PMC7433770 DOI: 10.1210/jendso/bvaa065] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 05/29/2020] [Indexed: 11/29/2022] Open
Abstract
CONTEXT Transgender youth may initiate GnRH agonists (GnRHa) to suppress puberty, a critical period for bone-mass accrual. Low bone mineral density (BMD) has been reported in late-pubertal transgender girls before gender-affirming therapy, but little is known about BMD in early-pubertal transgender youth. OBJECTIVE To describe BMD in early-pubertal transgender youth. DESIGN Cross-sectional analysis of the prospective, observational, longitudinal Trans Youth Care Study cohort. SETTING Four multidisciplinary academic pediatric gender centers in the United States. PARTICIPANTS Early-pubertal transgender youth initiating GnRHa. MAIN OUTCOME MEASURES Areal and volumetric BMD Z-scores. RESULTS Designated males at birth (DMAB) had below-average BMD Z-scores when compared with male reference standards, and designated females at birth (DFAB) had below-average BMD Z-scores when compared with female reference standards except at hip sites. At least 1 BMD Z-score was < -2 in 30% of DMAB and 13% of DFAB. Youth with low BMD scored lower on the Physical Activity Questionnaire for Older Children than youth with normal BMD, 2.32 ± 0.71 vs. 2.76 ± 0.61 (P = 0.01). There were no significant deficiencies in vitamin D, but dietary calcium intake was suboptimal in all youth. CONCLUSIONS In early-pubertal transgender youth, BMD was lower than reference standards for sex designated at birth. This lower BMD may be explained, in part, by suboptimal calcium intake and decreased physical activity-potential targets for intervention. Our results suggest a potential need for assessment of BMD in prepubertal gender-diverse youth and continued monitoring of BMD throughout the pubertal period of gender-affirming therapy.
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Affiliation(s)
- Janet Y Lee
- Division of Pediatric Endocrinology, Department of Pediatrics, University of California, San Francisco, San Francisco, California
- Division of Endocrinology and Metabolism, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Courtney Finlayson
- Division of Endocrinology, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Johanna Olson-Kennedy
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Keck School of Medicine of University of Southern California, Los Angeles, California
| | - Robert Garofalo
- Division of Adolescent Medicine, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Yee-Ming Chan
- Division of Endocrinology, Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts
| | - David V Glidden
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Stephen M Rosenthal
- Division of Pediatric Endocrinology, Department of Pediatrics, University of California, San Francisco, San Francisco, California
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Abstract
IMPORTANCE Peak bone strength, which occurs in early adulthood, is an important marker of the future risk of osteoporosis. It is therefore important to identify modifiable early life factors that are associated with the attainment of peak hip strength. OBJECTIVE To investigate the association of time spent in moderate to vigorous-intensity and light-intensity physical activity throughout adolescence with peak hip strength in adulthood. DESIGN, SETTING, AND PARTICIPANTS The Avon Longitudinal Study of Parents and Children is a prospective birth cohort study that initially recruited all pregnant women residing within the catchment area of 3 health authorities in southwest England who had an expected delivery date between April 1, 1991, and December 31, 1992. In total, 15 454 eligible pregnant women were enrolled, and 15 589 infants were delivered. Of those, 14 901 infants were alive at age 1 year. The present analysis examined 2569 healthy offspring who had valid physical activity measurements obtained during a clinical assessment for at least 1 age (12, 14, 16, and/or 25 years), with up to 4 repeated accelerometer assessments performed (1 per age-associated clinical visit). Data were analyzed from June 2019 to June 2020. EXPOSURES Trajectories of accelerometer-assessed time spent in moderate to vigorous-intensity and light-intensity physical activity at ages 12, 14, 16, and 25 years (measured in minutes per day) were identified using latent trajectory modeling. Moderate to vigorous-intensity and light-intensity physical activity were determined using established thresholds of acceleration counts per minute. MAIN OUTCOMES AND MEASURES Femur neck bone mineral density (BMD; measured in g/cm2) at age 25 years assessed by dual-energy radiography absorptiometry scans of the hip. RESULTS A total of 2569 participants (1588 female participants [62%]) were included in the analysis. Male participants spent more time in moderate to vigorous-intensity activity at each age and had greater adult femur neck BMD than female participants. For each sex, 3 moderate to vigorous-intensity trajectory subgroups and 3 light-intensity trajectory subgroups were identified. With regard to the moderate to vigorous-intensity trajectories, most male participants (85%) were in the low adolescent subgroup, with only 6% and 9% in the high early-adolescent and high mid-adolescent subgroups, respectively. Moderate to vigorous-intensity trajectories in female participants were divided into low adolescent-low adult (73%), low adolescent-high adult (8%), and high adolescent (19%) subgroups. Light-intensity physical activity trajectories were classified into low nonlinear, moderate decreasing, and high decreasing subgroups for both sexes. Femur neck BMD in male participants was greater in the high early-adolescent subgroup (0.38 g/cm2; 95% CI, 0.11-0.66 g/cm2) and the high mid-adolescent subgroup (0.33 g/cm2; 95% CI, 0.07-0.60 g/cm2) compared with the low adolescent (reference) subgroup. Femur neck BMD in female participants was greater in the high adolescent subgroup (0.28 g/cm2; 95% CI, 0.15-0.41 g/cm2) but not in the low adolescent-high adult subgroup (-0.12 g/cm2; 95% CI, -0.44 to 0.20 g/cm2) compared with the low adolescent-low adult (reference) subgroup. A sensitivity analysis using a negative-outcome control variable to explore unmeasured confounding supported these findings. The light-intensity trajectories were not associated with femur neck BMD; for example, differences in femur neck BMD between the high decreasing and low nonlinear subgroups were 0.16 g/cm2 (95% CI, -0.08 to 0.40 g/cm2) in male participants and 0.20 g/cm2 (95% CI, -0.05 to 0.44 g/cm2) in female participants. CONCLUSIONS AND RELEVANCE Supporting high-intensity physical activity throughout early life may help to maximize peak hip strength and prevent osteoporosis in later life. Replication of our findings in independent studies will be important.
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Affiliation(s)
- Ahmed Elhakeem
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Jon Heron
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Jon H. Tobias
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Deborah A. Lawlor
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
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Campisi SC, Marchand JD, Siddiqui FJ, Islam M, Bhutta ZA, Palmert MR. Can we rely on adolescents to self-assess puberty stage? A systematic review and meta-analysis. J Clin Endocrinol Metab 2020; 105:5807960. [PMID: 32179891 DOI: 10.1210/clinem/dgaa135] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 03/11/2020] [Indexed: 11/19/2022]
Abstract
CONTEXT Clinicians, researchers, and global health advocates often include pubertal development in outcomes. However, assessments of pubertal stage can be challenging because of the sensitive nature and feasibility of clinical examinations, especially in larger settings. OBJECTIVE To determine the accuracy of self-assessed Tanner staging when compared with physically assessed Tanner stages by a clinician. DATA SOURCES MEDLINE, PubMed, Embase, Web of Science, Scopus, the Cochrane Library, CINAHL. STUDY SELECTION Studies were included if they reported 5 × 5 tables of self-assessment compared to clinician-assessment for the 5-stage Tanner scale. DATA EXTRACTION We extracted data to generate complete 5 × 5 tables for each study, including any subgroup eligible for the analysis, such as overweight/obese youth. DATA SYNTHESIS After screening, 22 studies representing 21,801 participants met our inclusion criteria for the meta-analysis. Overall agreement was moderate or substantial between the 2 assessments, with breast stage 1, female pubic hair 1, male pubic hair 1, and male pubic hair 5 having the highest agreement. When stages were collapsed into pre- (Tanner stage 1), in (stages 2,3), and completing (stages 4,5) puberty, levels of agreement improved, especially for pre- and completing pubertal development. Most included studies comprised Caucasian youth. More studies are needed which include a broader range of geographic and socioeconomic settings, as well as a greater diversity of racial/ethnic groups. CONCLUSIONS Self-assessment of puberty is most accurate when identifying Tanner stage 1, Tanner stage 5 and when development is categorized into prepuberty, in, and completing puberty phases. Use of self-assessment data should be structured accordingly. PROTOCOL REGISTRATION PROSPERO # CRD42018100205.
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Affiliation(s)
- Susan C Campisi
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
| | - Josée D Marchand
- Division of Endocrinology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Fahad Javaid Siddiqui
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Muhammad Islam
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
- Centre of Excellence in Women and Child Health, The Aga Khan University South-Central Asia, East Africa & United Kingdom
| | - Mark R Palmert
- Division of Endocrinology, The Hospital for Sick Children, Toronto, ON, Canada
- Departments of Pediatrics and Physiology, University of Toronto, Toronto, ON, Canada
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Bone Mineral Reference Values for Athletes 11 to 20 Years of Age. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17144930. [PMID: 32650565 PMCID: PMC7400360 DOI: 10.3390/ijerph17144930] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/05/2020] [Accepted: 07/06/2020] [Indexed: 12/22/2022]
Abstract
Objectives. Training for sport is associated with the development of bone minerals, and the need for reference data based on athletes is often indicated. The purpose of this study was to develop a reference for bone mineral density (BMD) and content (BMC) specific for youth athletes of both sexes participating in several sports. Methods DEXA (dual energy X-ray absorptiometry) was used for total body measurements of bone minerals in 1385 athletes 11 to 20 years, 1019 males and 366 females. The athletes were training in several sports at Hungarian academies. Reference values for total bone mineral density and bone mineral content, and also BMD excluding the head (total body less head, TBLH) were developed using the LMS chartmaker pro version 2.3. Results. The centile distributions for BMD and BMC of the athletes differed significantly from those of the age- and sex-specific references for the general population. The youth athletes had higher BMD and BMC than those of the reference for the general population. Conclusion. The potential utility of the DEXA reference for male and female youth athletes may assist in monitoring changes in the BMC and BMD associated with normal growth and maturation, and perhaps more importantly, may be useful in monitoring changes specific to different phases of sport-specific training protocols.
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Xue S, Kemal O, Lu M, Lix LM, Leslie WD, Yang S. Age at attainment of peak bone mineral density and its associated factors: The National Health and Nutrition Examination Survey 2005-2014. Bone 2020; 131:115163. [PMID: 31760214 DOI: 10.1016/j.bone.2019.115163] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 11/12/2019] [Accepted: 11/20/2019] [Indexed: 10/25/2022]
Abstract
Osteoporosis is a major public health problem worldwide. Lower peak bone mineral density (BMD) in youth may be the single most important factor leading to the development of osteoporosis in the elderly. Using cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) 2005-2014, we included 18,713 individuals with complete and valid data on femoral neck, total hip and lumbar spine BMD. Generalized additive models were used to estimate the age at attainment of peak BMD and 95% confidence intervals (95%Cls); model covariates were sex, race, body mass index (BMI) and we also examine factors potentially affecting age at attainment of peak BMD. This study clearly stated that age at attainment of peak femoral neck, total hip and lumbar spine BMD were 20.5 years, 21.2 years and 23.6 years in males, and 18.7 years, 19.0 years and 20.1 years in females, respectively and age at attainment of peak BMD varied by skeletal sites and sex. The study also found that females achieved peak femoral neck, total hip and lumbar spine BMD earlier than males (all P < 0.001); race and BMI were not associated with the age at attainment of peak BMD (all P > 0.05). These results suggested that improving bone health among individuals before 20 years old may be useful for reducing future risk of osteoporosis and osteoporotic fractures.
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Affiliation(s)
- Shanshan Xue
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Oumer Kemal
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Meihan Lu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Lisa M Lix
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - William D Leslie
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Shuman Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China.
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Kralick AE, Zemel BS. Evolutionary Perspectives on the Developing Skeleton and Implications for Lifelong Health. Front Endocrinol (Lausanne) 2020; 11:99. [PMID: 32194504 PMCID: PMC7064470 DOI: 10.3389/fendo.2020.00099] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 02/17/2020] [Indexed: 12/17/2022] Open
Abstract
Osteoporosis is a significant cause of morbidity and mortality in contemporary populations. This common disease of aging results from a state of bone fragility that occurs with low bone mass and loss of bone quality. Osteoporosis is thought to have origins in childhood. During growth and development, there are rapid gains in bone dimensions, mass, and strength. Peak bone mass is attained in young adulthood, well after the cessation of linear growth, and is a major determinant of osteoporosis later in life. Here we discuss the evolutionary implications of osteoporosis as a disease with developmental origins that is shaped by the interaction among genes, behavior, health status, and the environment during the attainment of peak bone mass. Studies of contemporary populations show that growth, body composition, sexual maturation, physical activity, nutritional status, and dietary intake are determinants of childhood bone accretion, and provide context for interpreting bone strength and osteoporosis in skeletal populations. Studies of skeletal populations demonstrate the role of subsistence strategies, social context, and occupation in the development of skeletal strength. Comparisons of contemporary living populations and archeological skeletal populations suggest declines in bone density and strength that have been occurring since the Pleistocene. Aspects of western lifestyles carry implications for optimal peak bone mass attainment and lifelong skeletal health, from increased longevity to circumstances during development such as obesity and sedentism. In light of these considerations, osteoporosis is a disease of contemporary human evolution and evolutionary perspectives provide a key lens for interpreting the changing global patterns of osteoporosis in human health.
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Affiliation(s)
- Alexandra E. Kralick
- Department of Anthropology, University of Pennsylvania, Philadelphia, PA, United States
| | - Babette S. Zemel
- Division of Gastroenterology, Hepatology and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
- Department of Pediatrics, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
- *Correspondence: Babette S. Zemel
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Pubertal timing and adult fracture risk in men: A population-based cohort study. PLoS Med 2019; 16:e1002986. [PMID: 31790400 PMCID: PMC6886748 DOI: 10.1371/journal.pmed.1002986] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 11/04/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Puberty is a critical period for bone mass accrual, and late puberty in boys is associated with reduced bone mass in adult men. The role of variations in pubertal timing within the normal range for adult fracture risk in men is, however, unknown. We, therefore, assessed the association between age at peak height velocity (PHV), an objective measure of pubertal timing, and fracture risk in adult men. METHODS AND FINDINGS In the BMI Epidemiology Study Gothenburg, 31,971 Swedish men born between January 1, 1945, and December 31, 1961, with detailed growth data (height and weight) available from centrally archived school healthcare records and the conscription register were followed until December 31, 2016. Age at PHV was calculated according to a modified infancy-childhood-puberty model, and fracture information was retrieved from the Swedish National Patient Register. The mean ± SD age at PHV was 14.1 ± 1.1 years. In total, 5,872 men (18.4%) sustained at least 1 fracture after 20 years of age and 5,731 men (17.9%) sustained a non-vertebral fracture after 20 years of age during a mean ± SD follow-up of 37.3 ± 11.7 years. Cox proportional hazards models adjusted for birth year and country of origin revealed that age at PHV was associated with the risk of any fracture and non-vertebral fracture. Participants with age at PHV in the highest tertile (after 14.5 years of age) were at greater risk of any fracture (hazard ratio [HR] 1.15, 95% confidence interval [CI] 1.08-1.22, P < 0.001) and non-vertebral fracture (HR 1.16, 95% CI 1.09-1.24, P < 0.001) compared with those with age at PHV in the lowest tertile (at 13.6 years of age or younger). Additional adjustments for birthweight, childhood BMI, adult educational level, and young adult height did not attenuate the associations between age at PHV and adult fracture risk. Limitations of this study include the inability to adjust for important risk factors for fracture, inadequate power to assess the relation between pubertal timing and specific fracture types, and the limited generalizability to other populations. CONCLUSIONS In this study, we observed that late pubertal timing was associated with increased adult fracture risk in men. These findings suggest that information on pubertal timing might aid in the identification of those men at greatest risk of fracture.
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