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Cowgill L, Harrington L, MacKinnon M, Kurki HK. Gains in relative cortical area during growth and their relationship to nutrition, body size, and physical activity. AMERICAN JOURNAL OF BIOLOGICAL ANTHROPOLOGY 2023; 182:177-193. [PMID: 37377180 DOI: 10.1002/ajpa.24805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 03/17/2023] [Accepted: 05/27/2023] [Indexed: 06/29/2023]
Abstract
OBJECTIVES In studies of growth in the past, low percentage of cortical area (%CA) is commonly attributed to poor general health, due to factors including poor nutrition, low socioeconomic status, or other physiological stressors. What constitutes low relative cortical dimensions has not been established across a diverse range of human skeletal samples. This study examines %CA in a large immature skeletal sample to establish typical variation in humans with consideration of both body mass and subsistence strategy. MATERIALS AND METHODS Percentage of cortical area was calculated at the midshaft of the humerus, femur, and tibia in seven skeletal samples. Age at death was estimated from dental development, and body mass from bone dimensions. Patterns of %CA with age and log-transformed body mass were examined in the pooled sample and compared among samples using LOESS regression, Welch's ANOVA, and Kruskal-Wallis tests. RESULTS Across all samples, %CA displays a generally non-linear pattern, but variation in %CA with age was high, particularly in samples with lower levels of %CA. There was no relationship between %CA and age-adjusted body mass. DISCUSSION The lack of a relationship between %CA and body mass suggests that %CA should not be used as an indicator of mechanical loading. The variation present across samples implies that appositional bone growth is affected by physiological stress in varying ways. Without a deeper understanding of what is "typical" for long bone development, it is impossible to draw conclusions about individual or population level health.
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Affiliation(s)
- Libby Cowgill
- Department of Anthropology, University of Missouri, Columbia, Missouri, USA
| | - Lesley Harrington
- Department of Anthropology, University of Alberta, Edmonton, Alberta, Canada
| | - Marla MacKinnon
- Department of Anthropology, University of Victoria, Victoria, British Columbia, Canada
| | - Helen K Kurki
- Department of Anthropology, University of Victoria, Victoria, British Columbia, Canada
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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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Schoenbuchner SM, Pettifor JM, Norris SA, Micklesfield LK, Prentice A, Ward KA. Ethnic Differences in Peripheral Skeletal Development Among Urban South African Adolescents: A Ten-Year Longitudinal pQCT Study. J Bone Miner Res 2017; 32:2355-2366. [PMID: 28834567 PMCID: PMC5947614 DOI: 10.1002/jbmr.3279] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 08/15/2017] [Accepted: 08/22/2017] [Indexed: 11/10/2022]
Abstract
There are no longitudinal pQCT data of bone growth and development from sub-Saharan Africa, where rapid environmental, societal, and economic transitions are occurring, and where fracture rates are predicted to rise. The aim of this study was to compare skeletal development in black and white South African adolescents using longitudinal data from the Birth to Twenty study. The Birth to Twenty Bone Health subcohort consisted of 543 adolescents (261 [178 black] girls, 282 [201 black] boys). Annual pQCT measurements of the radial and tibial metaphysis and diaphysis were obtained between ages 12 and 22 years (distal metaphysis: cross-sectional area [CSA] and trabecular bone mineral density [BMD]; diaphysis: total and cortical CSA, cortical BMD, and polar stress-strain index [SSIp]). Age at peak height velocity (APHV) was calculated to account for differences in maturational timing between ethnic groups and sexes. Mixed-effects models were used to describe trajectories for each pQCT outcome. Likelihood-ratio tests were used to summarize the overall difference in trajectories between black and white participants within each sex. APHV (mean ± SD years) was similar in black (11.8 ± 0.8) and white (12.2 ± 1.0) girls, but delayed in black (14.2 ± 1.0) relative to white boys (13.3 ± 0.8). By 4 years post-APHV, white adolescents had significantly greater cortical CSA and SSIp than black adolescents at the radius. There were no significant differences at the radial metaphysis but there was some divergence, such that black adolescents had greater radial trabecular BMD by the end of follow-up. At the tibia, white adolescents had lower diaphyseal CSA and SSIp, and greater metaphyseal CSA. There was no ethnic difference in tibial trabecular BMD. There are ethnic differences in bone growth and development, independent of maturation, in South African adolescents. This work gives new insights into the possible etiology of childhood fractures, which occur most commonly as peripheral sites. © 2017 The Authors. Journal of Bone and Mineral Research Published by Wiley Periodicals Inc.
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Affiliation(s)
- Simon M Schoenbuchner
- Medical Research Council (MRC) Elsie Widdowson Laboratory, Cambridge, UK.,South African Medical Research Council (SAMRC)/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - John M Pettifor
- South African Medical Research Council (SAMRC)/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Shane A Norris
- South African Medical Research Council (SAMRC)/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Lisa K Micklesfield
- South African Medical Research Council (SAMRC)/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Ann Prentice
- Medical Research Council (MRC) Elsie Widdowson Laboratory, Cambridge, UK.,South African Medical Research Council (SAMRC)/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Kate A Ward
- Medical Research Council (MRC) Elsie Widdowson Laboratory, Cambridge, UK.,Medical Research Council (MRC) Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
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Magan A, Nyati LH, Micklesfield LK, Norris SA, Pettifor JM. Metacarpal Growth During Adolescence in a Longitudinal South African Cohort. J Bone Miner Res 2017; 32:1926-1934. [PMID: 28548290 DOI: 10.1002/jbmr.3179] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 05/20/2017] [Accepted: 05/25/2017] [Indexed: 01/30/2023]
Abstract
To monitor the drift of the periosteal and endocortical surfaces during metacarpal growth longitudinally, radiogrammetry was carried out on hand-wrist X-rays of 572 children from the Birth to Twenty Bone Health Cohort annually from ages 9 to 21 years. This is the largest collection of longitudinal X-rays in African children. The second metacarpal bone length, bone width, and medullary width were measured using digital vernier calipers on a total of 4730 X-rays. Superimposition by Translation and Rotation (SITAR) was used to obtain age at peak metacarpal length velocity (PLV). Bone width and medullary width were modeled using SITAR against both chronological age and age from PLV. In black and white females, tempo and velocity of metacarpal length growth was synchronized. Black males, however, attained PLV 7 months later than white males (p < 0.0001). Compared to white males, black males had a longer second metacarpal (p < 0.05), and greater bone width size (p < 0.02), tempo (p < 0.0009), and velocity (p < 0.0001). Medullary width growth velocity in black participants peaked 2 years prior to attainment of PLV and exceeded that of their white peers (p < 0.0001) in whom it peaked 6 to 12 months post-PLV attainment. Black adolescents therefore had wider bones with relatively thinner cortices and wider medullary cavities than their white peers. Ethnic and sex differences also occurred in the timing of medullary width contraction that accompanied expansion in bone width and cortical thickness. In black males, medullary width contraction commenced approximately 3 years later than in black females, whereas in white males this occurred a year later than in white females. The ethnic and sex differences in bone acquisition reported in this study may differentially affect bone mass in later life. © 2017 American Society for Bone and Mineral Research.
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Affiliation(s)
- Ansuyah Magan
- South African Medical Research Council/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lukhanyo H Nyati
- South African Medical Research Council/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lisa K Micklesfield
- South African Medical Research Council/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shane A Norris
- South African Medical Research Council/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - John M Pettifor
- South African Medical Research Council/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Abstract
BACKGROUND We investigate if switching from a ritonavir-boosted lopinavir (LPV/r)-based to an efavirenz-based antiretroviral therapy (ART) regimen is associated with beneficial bone development. METHODS The CHANGES Bone Study follows HIV-infected children who participated in a noninferiority randomized trial in Johannesburg, South Africa evaluating the safety and efficacy of preemptive switching to efavirenz (n = 106) compared with remaining on LPV/r (n = 113). HIV-uninfected children were also recruited. Whole-body and lumbar spine bone mineral content (BMC) were assessed by dual-energy X-ray absorptiometry at a cross-sectional visit. BMC Z-scores adjusted for sex, age, and height were generated. Physical activity and dietary intake were assessed. CD4 percentage and viral load were measured. We compared bone indices of HIV-infected with HIV-uninfected children and LPV/r with efavirenz by intent-to-treat. RESULTS The 219 HIV-infected (52% boys) and 219 HIV-uninfected (55% boys) children were 6.4 and 7.0 years of age, respectively. Mean ART duration for HIV-infected children was 5.7 years. Whole-body BMC Z-score was 0.17 lower for HIV-infected children compared with HIV-uninfected children after adjustment for physical activity, dietary vitamin D and calcium (P = 0.03). Whole-body BMC Z-score was 0.55 higher for HIV-infected children switched to efavirenz compared with those remaining on LPV/r after adjustment for physical activity, dietary vitamin D and calcium, CD4 percentage, and viral load (P < 0.0001). CONCLUSION South African HIV-infected children receiving ART have lower bone mass compared with HIV-uninfected controls. Accrued bone mass is positively associated with switching to efavirenz-based ART compared with remaining on LPV/r, providing additional rationale for limiting LPV/r exposure once viral suppression has been achieved.
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Wong M, Shiau S, Yin MT, Strehlau R, Patel F, Coovadia A, Micklesfield LK, Kuhn L, Arpadi S. Decreased Vigorous Physical Activity in School-Aged Children with Human Immunodeficiency Virus in Johannesburg, South Africa. J Pediatr 2016; 172:103-9. [PMID: 26922104 PMCID: PMC4846500 DOI: 10.1016/j.jpeds.2016.01.034] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 12/14/2015] [Accepted: 01/12/2016] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To describe physical activity in South African children with and without HIV. STUDY DESIGN Study measurements were obtained in 218 children with perinatal HIV and 180 children without HIV aged 5-9 years in a study conducted in Johannesburg, South Africa. Weight-for-age z-score, height-for-age z-score, frequency and duration of moderate and vigorous physical activity, and sedentary behaviors were obtained. These measurements were compared between children with and without HIV. RESULTS Weight-for-age z-score and height-for-age z-score were significantly lower for children with HIV compared with those without HIV. Among children who attended school, fewer children with HIV than children without HIV participated in physical education (41% vs 64%; P = .0003) and organized after-school sports (38% vs 64%; P < .001). The proportion of children in both groups meeting World Health Organization recommendations for physical activity was similar (84% overall); however, girls with HIV spent less time in vigorous physical activity than girls without HIV (420 vs 780 minutes/week; P = .001). This difference remained significant even when girls with a medical condition with the potential to limit physical activity were excluded, and after adjusting for age. Time spent in sedentary behaviors did not differ significantly between the two groups. CONCLUSION Although children with HIV with well-controlled disease after initiating antiretroviral therapy early in life achieve high levels of physical activity, vigorous physical activity is lower in girls with HIV than in healthy controls. This finding may reflect lower participation in school-based physical education and organized after-school physical activity.
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Affiliation(s)
- Marcia Wong
- Columbia University Medical Center, New York, NY, USA
| | | | | | - Renate Strehlau
- Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Faeezah Patel
- Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ashraf Coovadia
- Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lisa K. Micklesfield
- MRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Louise Kuhn
- Columbia University Medical Center, New York, NY, USA
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Physical activity and bone health in schoolchildren: the mediating role of fitness and body fat. PLoS One 2015; 10:e0123797. [PMID: 25915941 PMCID: PMC4411135 DOI: 10.1371/journal.pone.0123797] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 03/06/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The relationship between physical activity (PA) and bone health is well known, although the role of percent body fat (%BF) and fitness as confounders or mediators in this relationship remains uncertain. OBJECTIVE To examine whether the association between PA and bone mineral content (BMC) is mediated by %BF and cardiorespiratory fitness (CRF). METHODS In this cross sectional study, BMC, total %BF (by DXA), vigorous PA (VPA), CRF, age and height were measured in 132 schoolchildren (62 boys, aged 8-11 years). ANCOVA was used to test differences in BMC by %BF, CRF and VPA, controlling for different sets of confounders. Simple mediation analyses and serial multiple mediation analyses were fitted to examine whether the relationship between PA and BMC is mediated by %BF and fitness. RESULTS Children with high %BF had higher total body BMC than their peers after controlling for all sets of confounders. Children with good CRF or VPA had significantly less total body BMC after controlling for age and sex but in children with good CRF this inverse relation disappeared after adjusting by %BF. %BF and CRF both act as a full mediator in the association between VPA and BMC, after inclusion of the potential confounders in the models. CONCLUSION Fitness and %BF seem to have a mediator role on the relationship between physical activity and bone mass.
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Julián-Almárcegui C, Gómez-Cabello A, Huybrechts I, González-Agüero A, Kaufman JM, Casajús JA, Vicente-Rodríguez G. Combined effects of interaction between physical activity and nutrition on bone health in children and adolescents: a systematic review. Nutr Rev 2015; 73:127-39. [PMID: 26024536 DOI: 10.1093/nutrit/nuu065] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
CONTEXT Osteoporosis is a major public health concern worldwide. Understanding the roles of diet and physical activity in ensuring adequate bone mass accrual during childhood and adolescence may help identify strategies to reduce the risk of osteoporotic fractures later in life. OBJECTIVE The present systematic review was conducted to provide an overview of the current knowledge of the combined effects of physical activity and diet on bone mass accrual in children and adolescents. DATA SOURCES Data were obtained via searches of the PubMed, EMBASE, SPORTDiscus, and ISI Web of Science databases. STUDY SELECTION Studies published in English and Spanish between 1887 and August 2013 were eligible for inclusion. Two investigators evaluated the studies against the inclusion and exclusion criteria. A total of 14 studies (7 cross-sectional and 7 experimental) were included in the review. DATA EXTRACTION The Pedro score and the Black and Down's checklist were used to evaluate the methodological quality of the experimental and the cross-sectional studies, respectively. Study characteristics were summarized in accordance with the review's PICO criteria. DATA SYNTHESIS Significant exercise-by-calcium interaction was detected at several different bone sites. CONCLUSIONS Although the results of cross-sectional studies were inconsistent, the results of randomized controlled trials showed that exercise has the potential to improve bone health under conditions of adequate calcium intake.
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Affiliation(s)
- C Julián-Almárcegui
- C. Julián-Almárcegui, A. Gómez-Cabello, A. González-Agüero A, J.A. Casajús, and Germán Vicente-Rodríguez are with the GENUD "Growth, Exercise, NUtrition and Development" Research Group, University of Zaragoza, Zaragoza, Spain. C. Julián-Almárcegui and I. Huybrechts are with the Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium. A. Gómez-Cabello is with the Centro Universitario de la Defensa, Zaragoza, Spain. I. Huybrechts is with the International Agency for Research on Cancer, Dietary Exposure Assessment Group, Lyon, France. A. González-Agüero is with the Department of Sport and Exercise Science, Aberystwyth University, Aberystwyth, United Kingdom. J.M. Kaufman is with the Department of Endocrinology, Ghent University Hospital, Ghent, Belgium. J.A. Casajús and Germán Vicente-Rodríguez are with the Department of Physiatry and Nursing, Faculty of Health and Sport Science (FCSD), University of Zaragoza, Zaragoza, Spain
| | - A Gómez-Cabello
- C. Julián-Almárcegui, A. Gómez-Cabello, A. González-Agüero A, J.A. Casajús, and Germán Vicente-Rodríguez are with the GENUD "Growth, Exercise, NUtrition and Development" Research Group, University of Zaragoza, Zaragoza, Spain. C. Julián-Almárcegui and I. Huybrechts are with the Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium. A. Gómez-Cabello is with the Centro Universitario de la Defensa, Zaragoza, Spain. I. Huybrechts is with the International Agency for Research on Cancer, Dietary Exposure Assessment Group, Lyon, France. A. González-Agüero is with the Department of Sport and Exercise Science, Aberystwyth University, Aberystwyth, United Kingdom. J.M. Kaufman is with the Department of Endocrinology, Ghent University Hospital, Ghent, Belgium. J.A. Casajús and Germán Vicente-Rodríguez are with the Department of Physiatry and Nursing, Faculty of Health and Sport Science (FCSD), University of Zaragoza, Zaragoza, Spain
| | - I Huybrechts
- C. Julián-Almárcegui, A. Gómez-Cabello, A. González-Agüero A, J.A. Casajús, and Germán Vicente-Rodríguez are with the GENUD "Growth, Exercise, NUtrition and Development" Research Group, University of Zaragoza, Zaragoza, Spain. C. Julián-Almárcegui and I. Huybrechts are with the Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium. A. Gómez-Cabello is with the Centro Universitario de la Defensa, Zaragoza, Spain. I. Huybrechts is with the International Agency for Research on Cancer, Dietary Exposure Assessment Group, Lyon, France. A. González-Agüero is with the Department of Sport and Exercise Science, Aberystwyth University, Aberystwyth, United Kingdom. J.M. Kaufman is with the Department of Endocrinology, Ghent University Hospital, Ghent, Belgium. J.A. Casajús and Germán Vicente-Rodríguez are with the Department of Physiatry and Nursing, Faculty of Health and Sport Science (FCSD), University of Zaragoza, Zaragoza, Spain
| | - A González-Agüero
- C. Julián-Almárcegui, A. Gómez-Cabello, A. González-Agüero A, J.A. Casajús, and Germán Vicente-Rodríguez are with the GENUD "Growth, Exercise, NUtrition and Development" Research Group, University of Zaragoza, Zaragoza, Spain. C. Julián-Almárcegui and I. Huybrechts are with the Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium. A. Gómez-Cabello is with the Centro Universitario de la Defensa, Zaragoza, Spain. I. Huybrechts is with the International Agency for Research on Cancer, Dietary Exposure Assessment Group, Lyon, France. A. González-Agüero is with the Department of Sport and Exercise Science, Aberystwyth University, Aberystwyth, United Kingdom. J.M. Kaufman is with the Department of Endocrinology, Ghent University Hospital, Ghent, Belgium. J.A. Casajús and Germán Vicente-Rodríguez are with the Department of Physiatry and Nursing, Faculty of Health and Sport Science (FCSD), University of Zaragoza, Zaragoza, Spain
| | - J M Kaufman
- C. Julián-Almárcegui, A. Gómez-Cabello, A. González-Agüero A, J.A. Casajús, and Germán Vicente-Rodríguez are with the GENUD "Growth, Exercise, NUtrition and Development" Research Group, University of Zaragoza, Zaragoza, Spain. C. Julián-Almárcegui and I. Huybrechts are with the Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium. A. Gómez-Cabello is with the Centro Universitario de la Defensa, Zaragoza, Spain. I. Huybrechts is with the International Agency for Research on Cancer, Dietary Exposure Assessment Group, Lyon, France. A. González-Agüero is with the Department of Sport and Exercise Science, Aberystwyth University, Aberystwyth, United Kingdom. J.M. Kaufman is with the Department of Endocrinology, Ghent University Hospital, Ghent, Belgium. J.A. Casajús and Germán Vicente-Rodríguez are with the Department of Physiatry and Nursing, Faculty of Health and Sport Science (FCSD), University of Zaragoza, Zaragoza, Spain
| | - J A Casajús
- C. Julián-Almárcegui, A. Gómez-Cabello, A. González-Agüero A, J.A. Casajús, and Germán Vicente-Rodríguez are with the GENUD "Growth, Exercise, NUtrition and Development" Research Group, University of Zaragoza, Zaragoza, Spain. C. Julián-Almárcegui and I. Huybrechts are with the Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium. A. Gómez-Cabello is with the Centro Universitario de la Defensa, Zaragoza, Spain. I. Huybrechts is with the International Agency for Research on Cancer, Dietary Exposure Assessment Group, Lyon, France. A. González-Agüero is with the Department of Sport and Exercise Science, Aberystwyth University, Aberystwyth, United Kingdom. J.M. Kaufman is with the Department of Endocrinology, Ghent University Hospital, Ghent, Belgium. J.A. Casajús and Germán Vicente-Rodríguez are with the Department of Physiatry and Nursing, Faculty of Health and Sport Science (FCSD), University of Zaragoza, Zaragoza, Spain
| | - G Vicente-Rodríguez
- C. Julián-Almárcegui, A. Gómez-Cabello, A. González-Agüero A, J.A. Casajús, and Germán Vicente-Rodríguez are with the GENUD "Growth, Exercise, NUtrition and Development" Research Group, University of Zaragoza, Zaragoza, Spain. C. Julián-Almárcegui and I. Huybrechts are with the Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium. A. Gómez-Cabello is with the Centro Universitario de la Defensa, Zaragoza, Spain. I. Huybrechts is with the International Agency for Research on Cancer, Dietary Exposure Assessment Group, Lyon, France. A. González-Agüero is with the Department of Sport and Exercise Science, Aberystwyth University, Aberystwyth, United Kingdom. J.M. Kaufman is with the Department of Endocrinology, Ghent University Hospital, Ghent, Belgium. J.A. Casajús and Germán Vicente-Rodríguez are with the Department of Physiatry and Nursing, Faculty of Health and Sport Science (FCSD), University of Zaragoza, Zaragoza, Spain.
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Meiring RM, Avidon I, Norris SA, McVeigh JA. A two-year history of high bone loading physical activity attenuates ethnic differences in bone strength and geometry in pre-/early pubertal children from a low-middle income country. Bone 2013; 57:522-30. [PMID: 24012701 DOI: 10.1016/j.bone.2013.08.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 08/12/2013] [Accepted: 08/30/2013] [Indexed: 11/19/2022]
Abstract
We examined the interplay between ethnicity and weight-bearing physical activity on the content and volumetric properties of bone in a pre- to early pubertal South African Black and White population. Sixty six children [Black boys, 10.4 (1.4)yrs, n=15; Black girls, 10.1 (1.2)yrs, n=27; White boys, 10.1 (1.1)yrs, n=7; White girls, 9.6 (1.3)yrs, n=17] reported on all their physical activities over the past two years in an interviewer administered physical activity questionnaire (PAQ). All participants underwent a whole body and site-specific DXA scan and we also assessed bone structure and estimated bone strength with pQCT. Children were classified as being either high or low bone loaders based on the cohort's median peak bone strain score estimated from the PAQ. In the low bone loading group, Black children had greater femoral neck bone mineral content (BMC) (2.9 (0.08)g) than White children (2.4 (0.11)g; p=0.05). There were no ethnic differences in the high bone loaders for femoral neck BMC. At the cortical site, the Black low bone loaders had a greater radius area (97.3 (1.3) vs 88.8 (2.6)mm(2); p=0.05) and a greater tibia total area (475.5 (8.7) vs. 397.3 (14.0)mm(2); p=0.001) and strength (1633.7 (60.1) vs. 1271.8 (98.6)mm(3); p=0.04) compared to the White low bone loaders. These measures were not different between the Black low and high bone loaders or between the Black and White high bone loaders. In conclusion, the present study shows that there may be ethnic and physical activity associations in the bone health of Black and White pre-pubertal children and further prospective studies are required to determine the possible ethnic specific response to mechanical loading.
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Affiliation(s)
- Rebecca M Meiring
- Exercise Laboratory, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
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10
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Liberato SC, Bressan J, Hills AP. The role of physical activity and diet on bone mineral indices in young men: a cross-sectional study. J Int Soc Sports Nutr 2013; 10:43. [PMID: 24066848 PMCID: PMC3849504 DOI: 10.1186/1550-2783-10-43] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 09/22/2013] [Indexed: 11/17/2022] Open
Abstract
Background Osteoporotic fractures are a significant cause of morbidity and mortality, particularly in developed countries. Increasing peak bone mass in young people may be the most important primary prevention strategy to reduce the risk of osteoporosis. This study aimed to examine the relationship between dietary factors and physical activity on bone mineralization in young men. Methods Thirty-five healthy men aged 18–25 y had anthropometric measures, body composition, resting metabolic rate, blood pressure, blood lipids, food intake, physical activity and cardiorespiratory fitness assessed. Results Participants who consumed more than 1000 mg/d of calcium were taller and had higher levels of whole body mineral content than participants who consumed less than 1000 mg/d of calcium. Similarly, participants who expended more than 20% of total daily energy engaged in moderate- to vigorous-intensity physical activity had higher cardiorespiratory fitness and higher levels of body mass adjusted bone mineral content than participants who did not meet this level of energy expenditure. There were no differences in blood pressure or blood lipids between participants in calcium or in physical activity energy expenditure categories. Conclusions A high intake of dietary calcium and high daily energy expenditure engaged in moderate- to vigorous-intensity physical activity were positively associated with bone mineralization in young men, particularly in the lumbar region.
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Affiliation(s)
- Selma C Liberato
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.
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11
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Jamal SA, Moe SM. Calcium Builds Strong Bones, and More Is Better—Correct? Well, Maybe Not. Clin J Am Soc Nephrol 2012; 7:1877-83. [DOI: 10.2215/cjn.04880512] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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12
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Thandrayen K, Norris SA, Micklesfield LK, Pettifor JM. Heterogeneity of fracture pathogenesis in urban South African children: the birth to twenty cohort. J Bone Miner Res 2011; 26:2834-42. [PMID: 21898589 DOI: 10.1002/jbmr.491] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
South African black children fracture less than white children. Differences in bone mass, body composition, and physical activity may be contributing risk factors. This study aimed to investigate the association between fracture prevalence, bone mass, and physical activity in South African children. Using the Bone Health cohort of the Birth to Twenty longitudinal study, we retrospectively obtained information of lifetime fractures until age 15 years in 533 subjects. Whole-body bone mineral content (BMC), bone area (BA), fat mass (FM), and lean mass (LM) (measured by dual-energy X-ray absorptiometry [DXA]), anthropometric data, physical activity scores, and skeletal maturity were obtained at ages 10 and 15 years. Nonfracturing black females were used as the control group and comparisons were made between those who did and did not fracture within the same sex and ethnic groups. Of the 533 subjects, 130 (24%) reported a fracture (black, 15%; white, 41.5%; p < 0.001). White males who fractured were significantly taller (10 years, p < 0.01), more physically active (15 years, p < 0.05) and had higher LM (10 years, p = 0.01; 15 years, p < 0.001), whereas white females who fractured were fatter (10 and 15 years, p = 0.05 and p < 0.05, respectively), than their nonfracturing peers. White males who fractured had greater BA and BMC at all sites at 10 and 15 years compared to their nonfracturing peers after adjusting for differences in height and weight; BA and BMC were similar in each of the other sex and ethnic groups. No anthropometric or bone mass differences were found between black children with and without fractures. The factor associated with fractures in white males appears to be participation in sports activities, while in white females obesity appears to play a role. No contributing factors in black males and females were found, and needs further elucidation.
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Affiliation(s)
- Kebashni Thandrayen
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
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13
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Reid IR, Bolland MJ, Sambrook PN, Grey A. Calcium supplementation: balancing the cardiovascular risks. Maturitas 2011; 69:289-95. [PMID: 21621353 DOI: 10.1016/j.maturitas.2011.04.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Accepted: 04/27/2011] [Indexed: 01/07/2023]
Abstract
Calcium supplementation has been widely accepted as a key strategy in the prevention and treatment of osteoporosis. Its role has been undermined, to some extent, by its disappointing effects on fracture in randomised controlled trials, but its use has continued to be encouraged on the grounds that it is physiologically appealing, and is unlikely to cause harm. The latter assumption is now under threat from accumulating evidence that calcium supplement use is associated with an increased risk of myocardial infarction and, possibly, stroke. The latest data, based on meta-analysis of trials involving 29,000 participants, indicate that this risk is not mitigated by co-administration of vitamin D, and that the number of cardiovascular events caused is likely to be greater than the number of fractures prevented. These findings indicate that calcium supplementation probably does not have a role as a routine preventative agent and that dietary advice is the appropriate way to attain an adequate calcium intake in most situations. Patients at high risk of fracture need to take interventions of proven anti-fracture efficacy. Available evidence suggests that this efficacy is not dependent on the co-administration of calcium supplements.
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Affiliation(s)
- Ian R Reid
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
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14
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Micklesfield LK, Norris SA, Pettifor JM. Ethnicity and bone: a South African perspective. J Bone Miner Metab 2011; 29:257-67. [PMID: 21516522 DOI: 10.1007/s00774-011-0269-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Accepted: 03/31/2011] [Indexed: 11/25/2022]
Affiliation(s)
- Lisa K Micklesfield
- Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, 7 York Rd, Parktown, Johannesburg 2193, South Africa.
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15
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Micklesfield LK, Norris SA, Pettifor JM. Determinants of bone size and strength in 13-year-old South African children: the influence of ethnicity, sex and pubertal maturation. Bone 2011; 48:777-85. [PMID: 21199696 DOI: 10.1016/j.bone.2010.12.032] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2010] [Revised: 12/22/2010] [Accepted: 12/27/2010] [Indexed: 11/24/2022]
Abstract
We have previously shown ethnic differences in bone mass between pre-pubertal black and white children using DXA. To investigate these ethnic differences further, using pQCT, and to determine the influence of sex and pubertal development, we measured appendicular bone variables in 13-year-old children using pQCT. We collected pQCT data on a cohort of 471 black and white children at age 13years. Black boys and girls were shorter and had less lean mass than their white peers, and black boys were lighter than white boys at an earlier stage of pubertal development. Metaphyseal (4%) radial trabecular density was greater in the black girls than their white peers (239.5±49.5 vs. 222.7±34.2 mg/cm(3); p<0.05). Bone strength index was not different between the ethnic groups. All metaphyseal measures were 3-41% greater in boys than girls, after adjusting for height where appropriate. Diaphyseal (38%) tibial values, including total area, endosteal diameter, tibial diameter, periosteal circumference and polar strength-strain index were 4-22% greater in the black than white children and in boys than in girls. Cortical density was greater in black than white boys (1079.0±39.4 vs. 1058.7±34.5 mg/mm(3); p<0.001) and greater in the girls than boys (black: 1129.3±33.7 vs. 1079.0±39.4 mg/mm(3); p<0.001; white: 1126.8±28.3 vs. 1058.7±34.5mg/mm(3); p<0.001). Cortical thickness was less in the black groups. Lower leg muscle cross-sectional area (MCSA) was higher in white than black children, and forearm MCSA was higher in white than black boys. There was no difference in fat cross-sectional area between the ethnic groups. In conclusion, ethnic and sex differences in both metaphyseal and diaphyseal bone parameters exist during puberty, which are not accounted for by differences in body size or skeletal maturity. South African black children have wider diaphyseal regions of appendicular bones with greater measures of bone strength.
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Affiliation(s)
- Lisa K Micklesfield
- MRC Mineral Metabolism Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
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16
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Factors influencing the vitamin D status of 10-year-old urban South African children. Public Health Nutr 2010; 14:334-9. [PMID: 20804632 DOI: 10.1017/s136898001000234x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Assessment of vitamin D status in a cohort of healthy 10-year-old urban children and the factors that influence vitamin D status in these children. DESIGN A cross-sectional study. Blood samples were collected across four seasons of the year for the biochemical determination of serum 25-hydroxyvitamin D [25(OH)D]. Anthropometric measurements (height and weight), BMI and total fat and lean mass (determined by the dual energy X-ray absorptiometry) were measured. 25(OH)D concentrations were assessed by chemiluminescent assay. SETTING Study of children in the Greater Johannesburg area of South Africa who form the Bone Health sub-cohort of the longitudinal Birth to Twenty cohort. SUBJECTS Three hundred and eighty-five children who form the Bone Health sub-cohort of the longitudinal Birth to Twenty cohort. RESULTS White children had significantly higher 25(OH)D than their black peers (120·0 (sd 36·6) nmol/l v. 93·3 (sd 34·0) nmol/l, respectively). Seasonal variations in 25(OH)D levels were found only in white children, with 25(OH)D levels being significantly higher in white than in black children during the autumn and summer months. In multiple regression analysis, season, ethnicity, sex and total fat mass were the factors found to have an influence on 25(OH)D. Vitamin D deficiency (7 %) and insufficiency (19 %) were uncommon among the 10-year-old children. CONCLUSIONS Vitamin D supplementation or fortification is not warranted in healthy children living in Johannesburg. However, further studies need to confirm this in other regions of the country, especially in those living further south and with less sunshine during the winter months.
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Lloyd R, Hind K, Micklesfield LK, Carroll S, Truscott JG, Parr B, Davies S, Cooke C. A pilot investigation of load-carrying on the head and bone mineral density in premenopausal, black African women. J Bone Miner Metab 2010; 28:185-90. [PMID: 19629620 DOI: 10.1007/s00774-009-0113-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2009] [Accepted: 06/22/2009] [Indexed: 11/29/2022]
Abstract
Although the influence of weight-bearing activity on bone mass has been widely investigated in white women, few studies have been conducted in black, African populations. We investigated bone mineral density (BMD) in black South African women, with and without a history of load-carrying on the head. We also investigated whether load carrying may offer protection against low BMD in users of injectable progestin contraception (IPC). Participants were 32 black, South African women (22.4 +/- 3.2 years). Load carrying history was determined by questionnaire and interview; participants were grouped as load carriers (LC; n = 18) or non-load carriers (NLC; n = 14). Ten women were using IPC and 6 were load-carriers. Total body (TB), lumbar spine (LS) and total hip (H) BMD were measured by dual energy X-ray absorptiometry. There were no differences in BMD between LC and NLC, and after controlling for age and BMI using two-tailed partial correlations. IPC users had lower BMD at all sites compared to non-IPC users (p < 0.05) and there were no associations between load carrying and BMD in this group. When IPC users were excluded from analysis, LC had higher LS BMD than NLC (p < 0.005). Correlations were found between the weight of load carried and LS BMD (r = 0.743, p < 0.005), and between years of load carrying and LS and TB BMD (r = 0.563, r = 0.538, respectively; both p < 0.05). Load carrying on the head may offer osteogenic benefits to the spine but these benefits did not appear in women using IPC.
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Affiliation(s)
- Ray Lloyd
- University of Abertay, Dundee, DD1 1HG, UK
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18
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Affiliation(s)
- Amelia Guadalupe-Grau
- Department of Physical Education, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Canary Islands, Spain
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19
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Thandrayen K, Norris SA, Pettifor JM. Fracture rates in urban South African children of different ethnic origins: the Birth to Twenty cohort. Osteoporos Int 2009; 20:47-52. [PMID: 18465189 PMCID: PMC2859163 DOI: 10.1007/s00198-008-0627-x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2007] [Accepted: 03/28/2008] [Indexed: 12/21/2022]
Abstract
UNLABELLED Fracture rates were compared in children of different ethnic backgrounds from Johannesburg, South Africa. More white children fracture than black and mixed ancestry children. Reasons for this may be due to greater sports participation by whites and genetic protective factors in blacks. This has to be further investigated. INTRODUCTION Fracture rates in childhood are as high as those in the elderly. Recent research has been undertaken to understand the reasons for this, but there is little information available on ethnic differences in childhood fracture rates. METHODS Using the birth to twenty longitudinal cohort of children, we retrospectively obtained information on fractures and their sites from birth to 14.9 years of age on 2031 participants. The ethnic breakdown of the children was black (B) 78%, white (W) 9%, mixed ancestry (MA) 10.5% and Indian (I) 1.5%. RESULTS Four hundred and forty-one (22%) children had sustained a fracture one or more times during their lifetime (males 27.5% and females 16.3%; p < 0.001). The percentage of children fracturing differed between the ethnic groups (W 41.5%, B 19%, MA 21%, I 30%; p < 0.001). Of the 441 children reporting fractures, 89(20%) sustained multiple fractures. The most common site of fracture was the upper limb (57%). CONCLUSION More white children fracture than black and mixed ancestry children. This is the first study to show ethnic differences in fracture rates among children. The reasons for these differences have to be further elucidated. Greater sports participation by whites and genetic protective factors in blacks may be contributing factors.
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Affiliation(s)
- K Thandrayen
- MRC Mineral Metabolism Research Unit, Department of Paediatrics, Chris Hani Baragwanath Hospital, PO Bertsham, Johannesburg, 2013, South Africa.
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Ribeiro RR, Guerra-Junior G, de Azevedo Barros-Filho A. Bone mass in schoolchildren in Brazil: the effect of racial miscegenation, pubertal stage, and socioeconomic differences. J Bone Miner Metab 2009; 27:494-501. [PMID: 19283337 DOI: 10.1007/s00774-009-0062-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2008] [Accepted: 11/05/2008] [Indexed: 11/29/2022]
Abstract
The purpose of this study was to evaluate bone mass by phalanges ultrasound in healthy white and black schoolchildren in relationship to socioeconomic level, pubertal stage, and body composition. Included were 1,356 healthy schoolchildren aged from 6 to 11 years from different socioeconomic levels and both genders; all were placed into white and black groups. Weight, height, body mass index, fat percentage, fat mass, and lean mass were evaluated by anthropometric methods, and AD-SoS bone quantity and UBPI bone quality were evaluated using a third-generation IGEA phalanges DBM Sonic BP ultrasound. Data were compared using the Mann-Whitney, chi-squared, correlation coefficient, and analyses of multiple linear regression statistical tests with 5% significance. Black schoolchildren predominated in the low socioeconomic levels. Higher values of weight and height for black boys and girls were observed in the lean mass in relation to white children of the same gender and age. An increasing variation in the bone quantity mean was observed from 6 to 11 years of age and with pubertal stage for both genders and skin color. The white schoolchildren presented higher values of bone quantity and quality in relation to the black children. The anthropometric, gender, and socioeconomic level variables explained only 16 and 11% of the variability of bone quantity and quality, respectively. As such, the present study, carried out with healthy black and white Brazilian schoolchildren, demonstrated higher bone mass, as evaluated by ultrasound, in white than in black schoolchildren.
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Affiliation(s)
- Roberto Regis Ribeiro
- Department of Pediatrics, Center of Investigation in Pediatrics, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP, 13083-970, Brazil
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Constant D, Rosenberg L, Zhang Y, Cooper D, Kalla AA, Micklesfield L, Hoffman M. Quantitative ultrasound in relation to risk factors for low bone mineral density in South African pre-menopausal women. Arch Osteoporos 2009; 4:55-65. [PMID: 20234859 PMCID: PMC2836751 DOI: 10.1007/s11657-009-0029-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2009] [Accepted: 09/02/2009] [Indexed: 02/03/2023]
Abstract
SUMMARY: The study describes the association between risk factors and quantitative ultrasound bone measures in black and mixed-race pre-menopausal South African women. Despite some differences between the two study groups, the findings generally lend support to the use of ultrasound for epidemiological studies of bone mass in resource-limited settings. INTRODUCTION: Quantitative ultrasound at the calcaneus is a convenient and inexpensive method of estimating bone strength well suited to community-based research in countries with limited resources. This study determines, in a large sample of pre-menopausal South African women, whether characteristics associated with quantitative ultrasound measures are similar to those shown to be associated with bone mineral density as measured by dual X-ray absorptiometry. METHODS: This cross-sectional study included 3,493 women (1,598 black and 1,895 mixed race), aged 18-44 living in Cape Town. Study nurses administered structured interviews on reproductive history, lifestyle factors, and measured height and weight. Calcaneus quantitative ultrasound measurements were obtained using the Sahara device. Adjusted means of ultrasound measures according to categories of risk factors were obtained using multivariable regression analysis. RESULTS: Associations between quantitative ultrasound measures and age, body mass index, age at menarche, parity, and primary school physical activity were similar to those known for bone mineral density as measured by dual X-ray absorptiometry. There were no clear associations between quantitative ultrasound measures and educational level, alcohol use, cigarette smoking, and current calcium intake. CONCLUSION: The data give qualified support to the use of quantitative ultrasound as an epidemiological tool in large studies of bone strength in pre-menopausal women.
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Affiliation(s)
- Deborah Constant
- Women’s Health Research Unit, Department of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Observatory, 7925 Cape Town, Western Cape South Africa
| | - Lynn Rosenberg
- Slone Epidemiology Center, Boston University, Boston, MA USA
| | - Yuqing Zhang
- Slone Epidemiology Center, Boston University, Boston, MA USA
| | - Diane Cooper
- Women’s Health Research Unit, Department of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Observatory, 7925 Cape Town, Western Cape South Africa
| | - Asgar A. Kalla
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Observatory, 7925 Cape Town, Western Cape, South Africa
| | - Lisa Micklesfield
- Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Observatory, 7925 Cape Town, Western Cape, South Africa
| | - Margaret Hoffman
- Women’s Health Research Unit, Department of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Observatory, 7925 Cape Town, Western Cape South Africa
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