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Christ SE, Arnold G, Lichter-Konecki U, Berry GT, Grange DK, Harding CO, Jurecki E, Levy H, Longo N, Morotti H, Sacharow S, Thomas J, White DA. Initial results from the PHEFREE longitudinal natural history study: Cross-sectional observations in a cohort of individuals with phenylalanine hydroxylase (PAH) deficiency. Mol Genet Metab 2024; 143:108541. [PMID: 39059270 DOI: 10.1016/j.ymgme.2024.108541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Revised: 07/16/2024] [Accepted: 07/16/2024] [Indexed: 07/28/2024]
Abstract
Over fifty years have passed since the last large scale longitudinal study of individuals with PAH deficiency in the U.S. Since then, there have been significant changes in terms of treatment recommendations as well as treatment options. The Phenylalanine Families and Researchers Exploring Evidence (PHEFREE) Consortium was recently established to collect a more up-to-date and extensive longitudinal natural history in individuals with phenylketonuria across the lifespan. In the present paper, we describe the structure and methods of the PHEFREE longitudinal study protocol and report cross-sectional data from an initial sample of 73 individuals (5 months to 54 years of age) with PAH deficiency who have enrolled. Looking forward, the study holds the promise for advancing the field on several fronts including the validation of novel neurocognitive tools for assessment in individuals with PKU as well as evaluation of the long-term effects of changes in metabolic control (e.g., effects of Phe-lowering therapies) on outcome.
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Affiliation(s)
- Shawn E Christ
- University of Missouri, Columbia, MO, United States of America
| | | | | | - Gerard T Berry
- Boston Children's Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Dorothy K Grange
- Washington University School of Medicine, St. Louis, MO, United States of America
| | - Cary O Harding
- Oregon Health & Science University, Portland, OR, United States of America.
| | - Elaina Jurecki
- National PKU Alliance, San Ramon, CA, United States of America
| | - Harvey Levy
- Boston Children's Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Nicola Longo
- University of Utah, Salt Lake City, UT, United States of America
| | - Hadley Morotti
- Oregon Health & Science University, Portland, OR, United States of America
| | - Stephanie Sacharow
- Boston Children's Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Janet Thomas
- Children's Hospital of Colorado, University of Colorado School of Medicine, Aurora, CO, United States of America
| | - Desiree A White
- Washington University in St. Louis, St. Louis, MO, United States of America
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Wang J, Jiang C, Wang S, Feng L, Zhang Y, Guo Y, Liu G, Li X, Zhang G, Zhu X, Ren F, Guan L, Chen J, Gao Y, Chen M, Darwish N, Mottaz SC, Horcajada MN, Bonnet N, Dogra SK, Wang D. Cohort profile of an early life observational cohort in China: Bone and MicroBiOme onset (BAMBOO) study. BMJ Open 2024; 14:e075417. [PMID: 38760054 PMCID: PMC11103194 DOI: 10.1136/bmjopen-2023-075417] [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: 05/07/2023] [Accepted: 04/12/2024] [Indexed: 05/19/2024] Open
Abstract
PURPOSE The Bone And MicroBiOme Onset (BAMBOO) study is an ongoing prospective observational cohort study conducted in Tianjin, China, aiming to determine age-appropriate trajectories for microbiome maturation and bone development and to identify the influence of dietary factors in the process. PARTICIPANTS The recruitment started in September 2021 and was completed in February 2023. A total of 1380 subjects were recruited, 690 at birth (group 1) and 690 at 6 months of age (group 2). Groups 1 and 2 will be followed up for 12 months and 36 months, respectively. FINDINGS TO DATE The age of the mothers was 31.1±3.7 (mean±SD), and the birth weight of infants was 3.3±0.5 kg with an incidence of caesarean section 50.4%. Food diary information of the first 100 subjects showed that 64 food items were introduced by 6 months. A pilot microbiome analysis revealed that at the species level, bacterial communities were composed of mostly Bacteroides dorei, Bacteroides vulgatus and Escherichia coli, which were consistent with that of previous reports. Feasibility assessments of breast milk vitamin D and human milk oligosaccharides were validated through certified reference measurements. The early data assessment showed a high reliability of the data generated from this study. FUTURE PLANS Data collection will be completed in August 2025. Four stage-statistical analyses will be performed as the cohort reaches certain age thresholds before the final report. Analysis of BAMBOO data will be used to develop age-appropriate trajectories for microbiome maturation and bone development for children aged 0-3 years and investigate the contribution of dietary factors in the process. TRIAL REGISTRATION NUMBER ChiCTR2100049972.
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Affiliation(s)
- Jing Wang
- Tianjin Women's and Children's Health Center, Tianjin, China
| | - Chang Jiang
- Tianjin Women's and Children's Health Center, Tianjin, China
| | - Shuo Wang
- Tianjin Women's and Children's Health Center, Tianjin, China
| | - Lingyan Feng
- Tianjin Women's and Children's Health Center, Tianjin, China
| | - Yu Zhang
- Tianjin Women's and Children's Health Center, Tianjin, China
| | - Yuanyuan Guo
- Tianjin Women's and Children's Health Center, Tianjin, China
| | - Gongshu Liu
- Tianjin Women's and Children's Health Center, Tianjin, China
| | - Xi Li
- BGI Research, Wuhan, China
- BGI Research, Shenzhen, China
- Shenzhen Engineering Laboratory for Birth Defects Screening, BGl Research, Shenzhen, China
| | - Guohong Zhang
- BGI Research, Shenzhen, China
- Shenzhen Engineering Laboratory for Birth Defects Screening, BGl Research, Shenzhen, China
| | | | - Fangyi Ren
- BGI Research, Shenzhen, China
- China National GeneBank, Shenzhen, Guangdong, China
| | - Lingyao Guan
- BGI Research, Shenzhen, China
- China National GeneBank, Shenzhen, Guangdong, China
| | - Jiayu Chen
- BGI Research, Shenzhen, China
- China National GeneBank, Shenzhen, Guangdong, China
| | - Ya Gao
- BGI Research, Shenzhen, China
- Shenzhen Engineering Laboratory for Birth Defects Screening, BGl Research, Shenzhen, China
| | - Mo Chen
- Nestlé Institute of Health Sciences, Nestlé Research, Lausanne, Switzerland
| | - Noura Darwish
- Clinical Research Unit, Nestlé Research, Lausanne, Switzerland
| | | | | | - Nicolas Bonnet
- Nestlé Institute of Health Sciences, Nestlé Research, Lausanne, Switzerland
| | | | - Dantong Wang
- Nestlé Institute of Health Sciences, Nestlé Research, Lausanne, Switzerland
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Tabaie SA, O'Mara AE, Sheppard ED, Tosi LL. A Comprehensive Review of Bone Health in a Child: From Birth to Adulthood. J Am Acad Orthop Surg 2024; 32:363-372. [PMID: 38261781 DOI: 10.5435/jaaos-d-23-00853] [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: 09/10/2023] [Accepted: 12/17/2023] [Indexed: 01/25/2024] Open
Abstract
Bone health is critical for growth and development during childhood. Although fractures are common in children, fractures occurring in the absence of trauma should prompt physicians to consider underlying bone health disorders. This article provides an overview of the current definition of osteoporosis in children, highlighting its limitations and the potential for underdiagnosis. It also discusses the timing of screening initiation and various techniques used to assess bone health, along with their respective benefits and limitations. In addition, this article identifies several causes of primary and secondary osteoporosis in children, shedding light on previously overlooked disorders that can contribute to poor bone quality. The article emphasizes the importance of a multidisciplinary approach to therapeutic management and aims to optimize patient outcomes and improve the overall care of pediatric bone health disorders.
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Affiliation(s)
- Sean A Tabaie
- From the Division of Orthopaedic Surgery and Sports Medicine, Children's National Hospital (Tabaie, Sheppard, and Tosi), and Department of Orthopaedic Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC (O'Mara)
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Beglarian E, Costello E, Walker DI, Wang H, Alderete TL, Chen Z, Valvi D, Baumert BO, Rock S, Rubbo B, Aung MT, Gilliland FD, Goran MI, Jones DP, McConnell R, Eckel SP, Conti DV, Goodrich JA, Chatzi L. Exposure to perfluoroalkyl substances and longitudinal changes in bone mineral density in adolescents and young adults: A multi-cohort study. ENVIRONMENTAL RESEARCH 2024; 244:117611. [PMID: 38061983 PMCID: PMC10922273 DOI: 10.1016/j.envres.2023.117611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/26/2023] [Accepted: 11/05/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND Per- and polyfluoroalkyl substances (PFAS) may impair bone development in adolescence, which impacts life-long bone health. No previous studies have examined prospective associations of individual PFAS and their mixture with bone mineral density (BMD) changes in Hispanic young persons, a population at high risk of osteoporosis in adulthood. OBJECTIVES To examine associations of individual PFAS and PFAS mixtures with longitudinal changes in BMD in an adolescent Hispanic cohort and examine generalizability of findings in a mixed-ethnicity young adult cohort (58.4% Hispanic). METHODS Overweight/obese adolescents from the Study of Latino Adolescents at Risk of Type 2 Diabetes (SOLAR; n = 304; mean follow-up = 1.4 years) and young adults from the Southern California Children's Health Study (CHS; n = 137; mean follow-up = 4.1 years) were included in this study. Plasma PFAS were measured at baseline and dual x-ray absorptiometry scans were performed at baseline and follow-up to measure BMD. We estimated longitudinal associations between BMD and five PFAS via separate covariate-adjusted linear mixed effects models, and between BMD and the PFAS mixture via quantile g-computation. RESULTS In SOLAR adolescents, baseline plasma perfluorooctanesulfonic acid (PFOS) was associated with longitudinal changes in BMD. Each doubling of PFOS was associated with an average -0.003 g/cm2 difference in change in trunk BMD per year over follow-up (95% CI: -0.005, -0.0002). Associations with PFOS persisted in CHS young adults, where each doubling of plasma PFOS was associated with an average -0.032 g/cm2 difference in total BMD at baseline (95% CI -0.062, -0.003), though longitudinal associations were non-significant. We did not find associations of other PFAS with BMD; associations of the PFAS mixture with BMD outcomes were primarily negative though non-significant. DISCUSSION PFOS exposure was associated with lower BMD in adolescence and young adulthood, important periods for bone development, which may have implications on future bone health and risk of osteoporosis in adulthood.
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Affiliation(s)
- Emily Beglarian
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States.
| | - Elizabeth Costello
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Douglas I Walker
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Hongxu Wang
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Tanya L Alderete
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, United States
| | - Zhanghua Chen
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Damaskini Valvi
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Brittney O Baumert
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Sarah Rock
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Bruna Rubbo
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Max T Aung
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Frank D Gilliland
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Michael I Goran
- Department of Pediatrics, Children's Hospital Los Angeles, The Saban Research Institute, Los Angeles, CA, United States
| | - Dean P Jones
- Clinical Biomarkers Laboratory, Division of Pulmonary, Allergy Critical Care and Sleep Medicine, Emory University, Atlanta, GA, United States
| | - Rob McConnell
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Sandrah P Eckel
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - David V Conti
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Jesse A Goodrich
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Lida Chatzi
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
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Søeby M, Gribsholt SB, Clausen L, Richelsen B. Fracture Risk in Patients with Anorexia Nervosa Over a 40-Year Period. J Bone Miner Res 2023; 38:1586-1593. [PMID: 37578122 DOI: 10.1002/jbmr.4901] [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: 04/27/2023] [Revised: 08/03/2023] [Accepted: 08/09/2023] [Indexed: 08/15/2023]
Abstract
Researchers have reported increased fracture risk in patients with anorexia nervosa (AN), but more knowledge on the long-term risk and the effects of age, male sex, and time-related changes is still needed. We examined the long-term (up to 40 years) fracture risk among patients with AN compared to a matched comparison cohort from the general population. We utilized data from the Danish Health Care Registers to identify 14,414 patients with AN (13,474 females and 940 males) diagnosed between 1977 and 2018, with a median age of 18.6 years and median follow-up time of 9.65 years. We calculated adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) using Cox regression analysis for overall and site-specific fracture risks. The overall aHR of any fracture was 1.46 [95% CI: 1.36 to 1.48], with an aHR of 1.50 [95% CI: 1.43 to 1.57] for females and 0.95 [95% CI: 0.82 to 1.1] for males. For specific fractures we found an association with femur fractures both in females 4.06 [95% CI: 3.39 to 4.46] and in males 2.79 [95% CI: 1.45 to 2.37] and for fractures of the spine (females 2.38 [95% CI: 2.00 to 2.84], males 2.31 [95% CI: 1.20 to 4.42]). The aHR of any fracture decreased from 1.66 [95% CI: 1.52 to 1.81] in the period from 1977 to 1997 to 1.40 [95% CI: 1.33 to 1.40] from 1998 to 2018. In conclusion, we found that AN was associated with a 46% increased risk of any fracture up to 40 years after diagnosis. We found no overall increased risk in males, but in both sexes we found a particularly high site-specific fracture risk in the spine and femur. Fracture risk decreased in recent decades, indicating that more patients with AN have been diagnosed with presumably less severe disease and that the earlier detection and intervention of AN in recent years may translate into a lower facture risk. © 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Mette Søeby
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Sigrid Bjerge Gribsholt
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Loa Clausen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Aarhus, Denmark
| | - Bjørn Richelsen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Matovu FK, Kateera BA. Association between low bone mass and fracture prevalence among children living with HIV in Africa. AIDS 2023; 37:1323-1324. [PMID: 37930312 DOI: 10.1097/qad.0000000000003538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
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Matkovic V, Goel P, Mobley SL, Badenhop-Stevens NE, Ha EJ, Li B, Skugor M, Clairmont A. Decreased bone mass in adolescents with bone fragility fracture but not in young children: a case-control study. Front Endocrinol (Lausanne) 2023; 14:1124896. [PMID: 37223040 PMCID: PMC10200873 DOI: 10.3389/fendo.2023.1124896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 04/07/2023] [Indexed: 05/25/2023] Open
Abstract
Background The incidence of distal forearm fracture due to minimal/moderate trauma shows a bimodal distribution for age at event, with one peak occurring during early adolescence, in both boys and girls and the other one in postmenopausal females. The aim of this study was, therefore, to document whether the relationship between bone mineral density and fracture is different in young children compared with adolescents. Methods A matched-pair, case-control study has been conducted to evaluate bone mineral density in 469 young children and 387 adolescents of both sexes, with/without fracture due to minimal/moderate trauma with assurance that the compared groups were equally susceptible to the outcome event. All fractures were radiographically confirmed. The study utilized bone mineral areal density of the total body, spine, hips, and forearm; volumetric bone mineral density of the forearm; and metacarpal radiogrammetry measurements. The study controlled for skeletal development, bone geometry, body composition, hand grip strength, calcium intake, and vitamin D status. Results Adolescents with distal forearm fracture have reduced bone mineral density at multiple skeletal regions of interest. This was documented by the bone mineral areal density measurements at multiple skeletal sites (p < 0.001), volumetric bone mineral density measurements of the forearm (p < 0.0001), and metacarpal radiogrammetry (p < 0.001). Adolescent females with fracture had reduced cross-sectional areas of the radius and metacarpals. The bone status of young female and male children with fracture was no different to its controls. Increased body fatness was more prevalent among fracture cases than in controls. Around 72% of young female and male children with fracture had serum 25-hydroxyvitamin D levels below the threshold of 31 ng/ml, compared with only 42% of female controls and to 51% of male controls. Conclusions Adolescents with bone fragility fracture had reduced bone mineral density at multiple skeletal regions of interest, whereas this was not the case with younger children. The results of the study may have implications for the prevention of bone fragility in this segment of the pediatric population.
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Affiliation(s)
- Velimir Matkovic
- Bone and Mineral Metabolism Laboratory, Departments of Physical Medicine and Rehabilitation (PMR), Medicine, and Nutrition, The Ohio State University, Columbus, OH, United States
| | - Prem Goel
- Bone and Mineral Metabolism Laboratory, Departments of Physical Medicine and Rehabilitation (PMR), Medicine, and Nutrition, The Ohio State University, Columbus, OH, United States
| | - Stacey L. Mobley
- Department of Statistics, The Ohio State University, Columbus, OH, United States
| | - Nancy E. Badenhop-Stevens
- Bone and Mineral Metabolism Laboratory, Departments of Physical Medicine and Rehabilitation (PMR), Medicine, and Nutrition, The Ohio State University, Columbus, OH, United States
| | - Eun-Jeong Ha
- Food Sciences and Human Nutrition Department, University of Florida, Gainesville, FL, United States
| | - Bin Li
- Department of Nutrition, Kent State University, Kent, OH, United States
| | - Mario Skugor
- Department of Experimental Statistics, Louisiana State University, Baton Rouge, LA, United States
| | - Albert Clairmont
- Department of Endocrinology, Cleveland Clinic, Cleveland, OH, United States
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Xiao X, Ding Y, Zheng Y, Gao Y, Li H, Liu R, Xu R, Hong P. Epidemiological Investigation of Pediatric Fractures-A Retrospective Cohort Study of 1129 Patients. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59040788. [PMID: 37109745 PMCID: PMC10144156 DOI: 10.3390/medicina59040788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 03/15/2023] [Accepted: 03/23/2023] [Indexed: 04/29/2023]
Abstract
Background and Objectives: Fractures are common in pediatric trauma, and they are caused by a broad spectrum of factors. Only a few studies have discussed the mechanisms of injury and their relationships to different types of fractures. The most frequent type of fractures in different age groups remains unclear. Therefore, we aim to summarize the epidemiological characteristics of pediatric fractures in a medical center in Zhuhai, China from 2006 to 2021 and analyze the causes of fractures with the highest frequency in different age groups. Materials and Methods: We extracted the information from the Zhuhai Center for Maternal and Child Health Care of those under 14 years old who had fractures from 2006 to 2021. Results: We reviewed the information of 1145 children. The number of patients increased during the 15 years (p < 0.0001). The number of patients was significantly different between genders after Y2 (p = 0.014). In addition, more than two-thirds of patients (71.3%) had upper limb fractures, and all types of falls were the most common cause of fractures (83.6%). The incidence demonstrated an insignificant difference in age groups except for the fractures of humerus and radius. Moreover, we discovered that the prevalence of fall-related injuries decreased with age, while that of sports-related injuries increased with age. Conclusions: Our study demonstrates that the prevalence of fall-related injuries decreases with age, and that of sports-related injuries increases with age. Most patients have upper limb fractures, and all types of falls are the most common cause of fractures. Fracture types with the highest frequency differ in each age group. These findings might supplement current epidemiological knowledge of childhood fracture and provide references for decision-making in children's health policies.
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Affiliation(s)
- Xiaoliang Xiao
- Department of Orthopaedic Surgery, Zhuhai Center for Maternal and Child Health Care, Zhuhai 519000, China
| | - Yuhong Ding
- Second Clinical School, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Yiqiu Zheng
- Basic Medical School, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Yun Gao
- Department of Orthopaedic Surgery, Zhuhai Center for Maternal and Child Health Care, Zhuhai 519000, China
| | - Huaqing Li
- Department of Orthopaedic Surgery, Zhuhai Center for Maternal and Child Health Care, Zhuhai 519000, China
| | - Ruikang Liu
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Ruijing Xu
- Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Pan Hong
- Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430074, China
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Rukuni R, Simms V, Rehman AM, Mukwasi-Kahari C, Mujuru H, Ferrand RA, Gregson CL. Fracture prevalence and its association with bone density among children living with HIV in Zimbabwe. AIDS 2023; 37:759-767. [PMID: 36728418 PMCID: PMC9994799 DOI: 10.1097/qad.0000000000003477] [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] [Received: 07/20/2022] [Accepted: 12/26/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVES HIV infection impairs bone density in children living with HIV (CLWH). We aimed to determine the prevalence of self-reported fracture (past or current), associated risk factors and disability, by HIV status in Zimbabwean children. DESIGN Cross-sectional study. METHODS We recruited CLWH aged 8-16 years taking antiretroviral therapy (ART) for ≥2 years from HIV clinics, and HIV-uninfected children from schools in Harare. Interviewer-administered questionnaires collected data on fracture site and management, sociodemographics, dietary calcium and vitamin D, physical activity and HIV history. Dual-energy X-ray absorptiometry (DXA) measured size-adjusted bone density. RESULTS We recruited 303 CLWH [mean (SD) age 12.5 (2.5) years; 50% female] and 306 children without HIV [12.5 (2.5) years; 51% female]. Median age at HIV diagnosis in CLWH was 3.0 years [interquartile range (IQR) 1.2, 5.9], and median ART duration 8.1 years [IQR 6.2, 9.5]. 53.8% CLWH had self-reported disability and/or functional impairment, vs. 29.4% children without HIV. Fracture prevalence was 5.9% with no difference by HIV status [21/306 (6.9%) vs. 14/303 (4.6%), P = 0.24]. Male sex was associated with fractures. Low size-adjusted bone density ( Z -score < -2) was associated with prevalent fractures in CLWH {risk ratio [RR] 1.14 (95% confidence interval (CI) -0.02, 2.29]}, but not in children without HIV [RR -0.04 (-2.00, 1.91)], P -interaction = 0.27. All sought medical attention for their fracture(s), but CLWH were less often admitted to hospital [2/14 (14.3%) vs. 7/21 (33.3%)]. CONCLUSION Prevalent fractures may be associated with low lumbar spine bone density in CLWH. Fracture surveillance and strategies to reduce future fracture risk are warranted as CLWH enter adulthood.
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Affiliation(s)
- Ruramayi Rukuni
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Victoria Simms
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
- MRC International Statistics and Epidemiology Group, Faculty of Epidemiology and Population Health
| | - Andrea M. Rehman
- MRC International Statistics and Epidemiology Group, Faculty of Epidemiology and Population Health
| | - Cynthia Mukwasi-Kahari
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Hilda Mujuru
- Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Rashida A. Ferrand
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Celia L. Gregson
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Abstract
Changes in bone architecture and metabolism with aging increase the likelihood of osteoporosis and fracture. Age-onset osteoporosis is multifactorial, with contributory extrinsic and intrinsic factors including certain medical problems, specific prescription drugs, estrogen loss, secondary hyperparathyroidism, microenvironmental and cellular alterations in bone tissue, and mechanical unloading or immobilization. At the histological level, there are changes in trabecular and cortical bone as well as marrow cellularity, lineage switching of mesenchymal stem cells to an adipogenic fate, inadequate transduction of signals during skeletal loading, and predisposition toward senescent cell accumulation with production of a senescence-associated secretory phenotype. Cumulatively, these changes result in bone remodeling abnormalities that over time cause net bone loss typically seen in older adults. Age-related osteoporosis is a geriatric syndrome due to the multiple etiologies that converge upon the skeleton to produce the ultimate phenotypic changes that manifest as bone fragility. Bone tissue is dynamic but with tendencies toward poor osteoblastic bone formation and relative osteoclastic bone resorption with aging. Interactions with other aging physiologic systems, such as muscle, may also confer detrimental effects on the aging skeleton. Conversely, individuals who maintain their BMD experience a lower risk of fractures, disability, and mortality, suggesting that this phenotype may be a marker of successful aging. © 2023 American Physiological Society. Compr Physiol 13:4355-4386, 2023.
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Affiliation(s)
- Robert J Pignolo
- Department of Medicine, Divisions of Geriatric Medicine and Gerontology, Endocrinology, and Hospital Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.,The Department of Physiology and Biomedical Engineering, and the Robert and Arlene Kogod Center on Aging, Mayo Clinic, Rochester, Minnesota, USA
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11
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Kuiper JR, Vuong AM, Lanphear BP, Calafat AM, Ospina M, Cecil KM, Xu Y, Yolton K, Kalkwarf HJ, Braun JM, Chen A, Buckley JP. Early life organophosphate ester exposures and bone health at age 12 years: The Health Outcomes and Measures of the Environment (HOME) Study. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 851:158246. [PMID: 36030851 PMCID: PMC9606835 DOI: 10.1016/j.scitotenv.2022.158246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/19/2022] [Accepted: 08/19/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND No human studies have evaluated early life organophosphate ester (OPE) exposures with bone health outcomes, despite evidence of osteotoxicity. OBJECTIVES We assessed associations of urinary OPE metabolites measured across early life with areal bone mineral density (aBMD) and bone mineral content (BMC) at age 12 years. METHODS Among 223 mother-child dyads enrolled in the Health Outcomes and Measures of the Environment (HOME) Study, we quantified concentrations of bis-2-chloroethyl phosphate (BCEP), bis-(1,3-dichloro-2-propyl) (BDCIPP), di-n-butyl phosphate (DnBP), and diphenyl phosphate (DPHP) in urine collected from mothers during pregnancy and children at ages 1, 2, 3, 5, and 8 years. At age 12 years, we performed dual energy x-ray absorptiometry and calculated aBMD and BMC z-scores at six skeletal sites. We estimated overall and sex-stratified BMD/BMC z-score differences per interquartile range (IQR) increase in OPE concentrations at multiple exposure timepoints: gestation (average) and 1-3 (average), 5, and 8 years. RESULTS In adjusted models, overall associations of BCEP and BDCIPP with total hip and 1/3rd distal radius aBMD and BMC varied significantly by exposure timepoint, as did BDCIPP with whole body aBMD. For example, differences (95 % CI) in total hip aBMD z-score per IQR increase in BDCIPP were 0.33 (0.01, 0.64), -0.10 (-0.34, 0.14), -0.18 (-0.40, 0.05), and 0.14 (-0.09, 0.38) for concentrations during gestation and at 1-3, 5, and 8 years, respectively. Overall DnBP and DPHP associations were generally null at all timepoints. We observed sex-specific associations for some timepoints and skeletal sites. For example, an IQR increase in 8-year DPHP was associated with a 0.21 (0.05, 0.38) greater total hip aBMD z-score among females but -0.19 (-0.43, 0.05) lower z-score among males. DISCUSSION Early life OPE exposures may be associated with sex- and exposure period-dependent alterations in early adolescent bone mineral accrual and strength.
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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
| | - Ann M Vuong
- Department of Epidemiology and Biostatistics, School of Public Health, University of Nevada, Las Vegas, Las Vegas, NV, USA
| | - Bruce P Lanphear
- Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada
| | - Antonia M Calafat
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Maria Ospina
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kim M Cecil
- Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, 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
| | - Joseph M Braun
- Department of Epidemiology, Brown University, Providence, RI, USA
| | - Aimin Chen
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Jessie P Buckley
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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12
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Jois A, Perera S, Simm P, Alex G. Use of Dual-Energy X-ray Absorptiometry in Children with Inflammatory Bowel Disease: A Large Single Centre Study. Pediatr Gastroenterol Hepatol Nutr 2022; 25:473-480. [PMID: 36451689 PMCID: PMC9679306 DOI: 10.5223/pghn.2022.25.6.473] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 05/28/2022] [Accepted: 08/23/2022] [Indexed: 11/22/2022] Open
Abstract
PURPOSE Low bone mineral density (BMD) is a complication in children with inflammatory bowel disease (IBD). There are limited data evaluating dual-energy x-ray absorptiometry (DXA) as a screening tool for low BMD in children with IBD. We performed a single site retrospective analysis of DXA use. METHODS Children aged 5-18 years with IBD diagnosed between 2013 to 2017 at the Royal Children's Hospital, Australia, were included. Patient demographics, measures of disease activity, DXA scores, and factors related to BMD were collected. RESULTS Over a median follow up of 5.1 (4-6.4) years, 72/239 (30.1%) children underwent DXA, and 28/239 (11.7%) children had a second DXA. Our DXA practice differed to consensus guidelines regarding initial screening based on height and/or body mass index (BMI) z-score (8/17 [47.1%]), and repeat surveillance (13/42 [31.0%]). Children had a median lumbar spine (LS) z-score -0.80 (-1.65-0.075). Children with LS z-score≤-2.0 (n=14) had lower weight (6.57 [1.78-23.7] vs. 51.1 [26.5-68.7], p=0.0002) and height centiles (3.62 [1.17-17.1] vs. 42 [16.9-67.1], p=0.0001), and higher faecal calprotectin (FCP) (3041 [1182-4192] vs. 585 [139-2419], p=0.009) compared to children with LS z-score>-2.0. No fractures were reported. Of 28 children who underwent a second DXA 1.6 (1.1-2.2) years following initial DXA, no significant change in z-scores occurred. CONCLUSION Children with IBD had low BMD. In addition to height centile and weight centile, FCP was associated with lower BMD, and should be considered in DXA screening guidelines. Greater clinician awareness of DXA consensus guidelines is required. Future prospective studies are required.
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Affiliation(s)
- Asha Jois
- Department of Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Victoria, Australia
| | - Sajini Perera
- General Medicine, Royal Children's Hospital, Victoria, Australia
| | - Peter Simm
- Department of Endocrinology, Royal Children's Hospital, Victoria, Australia
| | - George Alex
- Department of Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Victoria, Australia
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13
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Zheng Y, Rostami Haji Abadi M, Ghafouri Z, Meira Goes S, Johnston JJD, Nour M, Kontulainen S. Bone deficits in children and youth with type 1 diabetes: A systematic review and meta-analysis. Bone 2022; 163:116509. [PMID: 35914713 DOI: 10.1016/j.bone.2022.116509] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 07/13/2022] [Accepted: 07/26/2022] [Indexed: 11/26/2022]
Abstract
Deficits in bone mineral and weaker bone structure in children with type 1 diabetes (T1D) may contribute to a lifelong risk of fracture. However, there is no meta-analysis comparing bone properties beyond density between children with T1D and typically developing children (TDC). This meta-analysis aimed to assess differences and related factors in bone mineral content (BMC), density, area, micro-architecture and estimated strength between children with T1D and TDC. We systematically searched MEDLINE, Embase, CINAHL, Web of Science, Scopus, Cochrane Library databases, and included 36 in the meta-analysis (2222 children and youth with T1D, 2316 TDC; mean age ≤18 yrs., range 1-24). We estimated standardized mean differences (SMD) using random-effects models and explored the role of age, body size, sex ratio, disease duration, hemoglobin A1c in relation to BMC and areal density (aBMD) SMD using meta-regressions. Children and youth with T1D had lower total body BMC (SMD: -0.21, 95% CI: -0.37 to -0.05), aBMD (-0.30, -0.50 to -0.11); lumbar spine BMC (-0.17, -0.28 to -0.06), aBMD (-0.20, -0.32 to -0.08), bone mineral apparent density (-0.30, -0.48 to -0.13); femoral neck aBMD (-0.21, -0.33 to -0.09); distal radius and tibia trabecular density (-0.38, -0.64 to -0.12 and -0.35, -0.51 to -0.18, respectively) and bone volume fraction (-0.33, -0.56 to -0.09 and -0.37, -0.60 to -0.14, respectively); distal tibia trabecular thickness (-0.41, -0.67 to -0.16); and tibia shaft cortical content (-0.33, -0.56 to -0.10). Advanced age was associated with larger SMD in total body BMC (-0.13, -0.21 to -0.04) and aBMD (-0.09; -0.17 to -0.01) and longer disease duration with larger SMD in total body aBMD (-0.14; -0.24 to -0.04). Children and youth with T1D have lower BMC, aBMD and deficits in trabecular density and micro-architecture. Deficits in BMC and aBMD appeared to increase with age and disease duration. Bone deficits may contribute to fracture risk and require attention in diabetes research and care. STUDY REGISTRATION: PROSPERO (CRD42020200819).
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Affiliation(s)
- Yuwen Zheng
- College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada S7N 5B2
| | | | - Zahra Ghafouri
- College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada S7N 5B2
| | - Suelen Meira Goes
- College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada S7N 5B2; College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada S7N 5E5
| | - James J D Johnston
- College of Engineering, University of Saskatchewan, Saskatoon, Saskatchewan, Canada S7N 5A9
| | - Munier Nour
- College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada S7N 5E5
| | - Saija Kontulainen
- College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada S7N 5B2.
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14
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Shawar RS, Puyau M, Shypailo R, Musaad S, Butte NF, Bacha F. Adiposity, Insulin Resistance, Cardiorespiratory Fitness, and Bone Health in Hispanic Children. J Clin Endocrinol Metab 2022; 107:e3797-e3804. [PMID: 35662345 PMCID: PMC9387690 DOI: 10.1210/clinem/dgac344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Indexed: 11/19/2022]
Abstract
CONTEXT Childhood obesity disproportionately affects Hispanic youth. The skeletal system appears to be a target organ of the adverse effects of obesity. Yet, the relationship between adiposity and bone health in youth and the modulating factors are not well understood. OBJECTIVE This work aims to examine the relationship between adiposity, insulin resistance (IR), cardiorespiratory fitness (CRF), and bone mass in Hispanic youth. METHODS A total of 951 Hispanic youth (50% male), aged 4 to 19 years, participated in this cross-sectional design study from the Viva La Familia Study at Children's Nutrition Research Center. Bone mineral content (BMC) and density (BMD), lean mass (LM), total body fat mass (FM), truncal FM were obtained using dual-energy x-ray absorptiometry. Fasting glucose and insulin were obtained and the homeostasis model assessment of insulin resistance (HOMA-IR) was calculated. CRF was measured using a treadmill ramp protocol. We applied linear regression models and mediation analyses. RESULTS Adiposity measures were negatively related to BMC and BMD after accounting for LM and sex. IR negatively contributed whereas CRF positively contributed to the variance in BMC and BMD, more notably in the pubertal age group. In mediation analysis, HOMA-IR partially mediated the negative relationship of adiposity to BMC (standardized indirect effect [IE] = -0.0382; 95% CI, -0.0515 to -0.0264) whereas the sequential IE of HOMA-IR and CRF partially attenuated (IE = -0.0026; 95% CI, -0.0053 to -0.0005) this relationship. Similar findings were seen with BMD as the primary outcome. CONCLUSION IR mediates the negative relationship between adiposity and bone mass whereas CRF may partially attenuate it.
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Affiliation(s)
- Reem S Shawar
- USDA/ARS Children’s Nutrition Research Center, Baylor College of Medicine, Houston, Texas 77030, USA
- Division of Pediatric Endocrinology and Diabetes, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas 77030, USA
| | - Maurice Puyau
- USDA/ARS Children’s Nutrition Research Center, Baylor College of Medicine, Houston, Texas 77030, USA
| | - Roman Shypailo
- USDA/ARS Children’s Nutrition Research Center, Baylor College of Medicine, Houston, Texas 77030, USA
| | - Salma Musaad
- USDA/ARS Children’s Nutrition Research Center, Baylor College of Medicine, Houston, Texas 77030, USA
| | - Nancy F Butte
- USDA/ARS Children’s Nutrition Research Center, Baylor College of Medicine, Houston, Texas 77030, USA
| | - Fida Bacha
- Correspondence: Fida Bacha, MD, USDA/ARS Children’s Nutrition Research Center, Baylor College of Medicine, 1100 Bates S, Houston, TX 77030, USA.
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15
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Janner M, Saner C. Impact of Type 1 Diabetes Mellitus on Bone Health in Children. Horm Res Paediatr 2022; 95:205-214. [PMID: 34937025 DOI: 10.1159/000521627] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 12/17/2021] [Indexed: 11/19/2022] Open
Abstract
This paper gives an overview of the impact of type 1 diabetes on bone health in children and adolescents. Firstly, we analyse studies using dual X-ray absorptiometry to assess bone mineral content and bone mineral density. Then, we discuss modern, non-invasive techniques including peripheral quantitative computer tomography (pQCT) and high-resolution pQCT for the detailed assessment of bone health aspects including bone mass, bone geometry, bone microarchitecture, and bone strength. Thereafter, we explore some of the mechanisms that are responsible for diabetic bone disease in children, like low bone turnover and high sclerostin levels. Finally, we summarize some of the evidence for the importance of microvascular disease in the pathophysiology of diabetic bone disease.
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Affiliation(s)
- Marco Janner
- Division of Paediatric Endocrinology, Diabetology and Metabolism, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christoph Saner
- Division of Paediatric Endocrinology, Diabetology and Metabolism, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Biomedical Research (DBMR), University of Bern, Bern, Switzerland
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16
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Vitamin D: Before, during and after Pregnancy: Effect on Neonates and Children. Nutrients 2022; 14:nu14091900. [PMID: 35565867 PMCID: PMC9105305 DOI: 10.3390/nu14091900] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 04/18/2022] [Accepted: 04/25/2022] [Indexed: 02/06/2023] Open
Abstract
A worldwide high prevalence of vitamin D (VD) deficiency has become of growing concern because of potential adverse effects on human health, including pregnant women and their offsprings. Beyond its classical function as a regulator of calcium and phosphate metabolism, together with its fundamental role in bone health in every stage of life, its deficiency has been associated to multiple adverse health effects. The classic effects of VD deficiency in pregnancy and neonates have been late hypocalcemia and nutritional rickets. Nevertheless, recent studies have linked VD to fertility and 25(OH)D with several clinical conditions in pregnancy: preeclampsia, gestational diabetes, higher incidence of cesarean section and preterm birth, while in infants, the clinical conditions are low birth weight, lower bone mass and possible relationship with the development of such diseases as bronchiolitis, asthma, type 1 diabetes, multiple sclerosis and autism included as VD non-classical actions. The supplementation with Vitamin D and achievement of optimal levels reduce maternal-fetal and newborn complications. Supplementation in children with VD deficiency reduces the risk of respiratory infections and possibly autoimmune diseases and autism. This review emphasizes the roles of Vitamin D deficiency and the consequences of intervention from preconception to infancy.
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17
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Varkal MA, Gulenc B, Yildiz I, Kandemir I, Bilgili F, Toprak S, Kilic A, Unuvar E. Vitamin D level, body mass index and fracture risk in children: vitamin D deficiency and fracture risk. J Pediatr Orthop B 2022; 31:e264-e270. [PMID: 33741834 DOI: 10.1097/bpb.0000000000000867] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The objective of this study was to determine the impacts of preventable causes of fracture, such as vitamin D deficiency, disturbed calcium homeostasis and obesity on fracture occurrence in minor traumas. In this way, the effects of relevant parameters on fracture may be further elucidated. A prospective case-control study in children aged 2-18 years children with and without fractures was performed. Participants with a pediatric trauma score higher than 10 presenting to minor trauma were included to exclude the significant impact of severe trauma on fracture. The effects of obesity, parameters associated with vitamin D and Ca homeostasis on fracture occurrence were evaluated. Univariate and multivariate analyses were used to test for associations between fracture status and the assessed variables. The relationships between the variables and the odds of fracture occurrence were examined using logistic regression models. The sample consisted of 76 patients and 50 controls. There were no significant differences between the patients and controls in terms of age, sex, trauma type and pubertal period. The patients had a significantly higher mean BMI percentile (61.2 ± 30.7, 36.7 ± 30.7; P < 0.001). Likewise, patients were more likely than controls to have a lower mean 25(OH)D level and mean phosphorus level (respectively, 13.4 ± 7.0, 17.3 ± 7.8; P = 0.004, and 4.6 ± 0.7, 5.1 ± 0.8; P < 0.001). Moreover, fractures were substantially more frequent in children with vitamin D deficiency (<20 ng/mL, χ2: 7.781, df: 1, P = 0.005). In the multivariate logistic model, BMI percentile and vitamin D levels remained significantly associated with increased odds of fracture [1.02 (1.01-1.04), P < 0.001 and 0.93 (0.89-0.98), P = 0.01]. The present study supports an association of high BMI and vitamin D deficiency with an increased odds of fracture occurrence in children. The findings may help physicians to reduce the risk factors of fracture by preventive efforts. Thus, unexpected health costs and morbidity may be minimized.
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Affiliation(s)
| | | | | | | | | | - Sadik Toprak
- Department of Forensic Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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18
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Glycomacropeptide in PKU-Does It Live Up to Its Potential? Nutrients 2022; 14:nu14040807. [PMID: 35215457 PMCID: PMC8875363 DOI: 10.3390/nu14040807] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/30/2022] [Accepted: 02/07/2022] [Indexed: 02/01/2023] Open
Abstract
The use of casein glycomacropeptide (CGMP) as a protein substitute in phenylketonuria (PKU) has grown in popularity. CGMP is derived from κ casein and is a sialic-rich glycophosphopeptide, formed by the action of chymosin during the production of cheese. It comprises 20–25% of total protein in whey products and has key biomodulatory properties. In PKU, the amino acid sequence of CGMP has been adapted by adding the amino acids histidine, leucine, methionine, tyrosine and tryptophan naturally low in CGMP. The use of CGMP compared to mono amino acids (L-AAs) as a protein substitute in the treatment of PKU promises several potential clinical benefits, although any advantage is supported only by evidence from non-PKU conditions or PKU animal models. This review examines if there is sufficient evidence to support the bioactive properties of CGMP leading to physiological benefits when compared to L-AAs in PKU, with a focus on blood phenylalanine control and stability, body composition, growth, bone density, breath odour and palatability.
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19
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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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20
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Rosengren BE, Rempe J, Jehpsson L, Dencker M, Karlsson MK. Physical Activity at Growth Induces Bone Mass Benefits Into Adulthood – A Fifteen‐Year Prospective Controlled Study. JBMR Plus 2021; 6:e10566. [PMID: 35079677 PMCID: PMC8770997 DOI: 10.1002/jbm4.10566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 09/29/2021] [Indexed: 12/17/2022] Open
Abstract
Daily school physical activity (PA) improves musculoskeletal traits. Whether or not benefits remain in adulthood is debated. We included in this study 131 children that took part in an intervention with 40 minutes of PA per school day (200 minutes per week) from age 6 to 9 years (grade one) to age 14 to 16 years (grade nine), whereas 78 children continued with national recommended school physical education of 60 minutes per week. Measurements were done with dual‐energy X‐ray absorptiometry (bone mineral content [BMC], bone mineral density [BMD], and bone area), and a computerized knee dynamometer (peak torque muscle strength) at study start, at the end of the intervention, and 7 years after the intervention. Group differences from study start and end of the intervention to 7 years thereafter were estimated by analyses of covariance (adjusted for sex and follow‐up time). Musculoskeletal gains from study start to 7 years after termination of the intervention were higher in the intervention group (total body less head BMC +182.5 g [95% confidence interval {CI}, 55.1–309.9] and BMD +0.03 g/cm2 [95% CI, 0.003–0.05], femoral neck area + 0.2 cm2 [95% CI, 0.1–0.4], and knee flexion peak torque muscle strength at 60 degrees per second +9.2 Nm [95% CI, 2.9–15.5]). There was no attenuation during the 7 years that followed termination of the intervention (all group comparisons p > 0.05). Benefits in musculoskeletal gains remain 7 years after termination of a daily school‐based PA program, without attenuation after termination of the program. Daily school PA may counteract low bone mass and inferior muscle strength in adulthood. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Björn E Rosengren
- Clinical and Molecular Osteoporosis Research Unit, Department of Orthopedics and Clinical Sciences, Skane University Hospital Malmo Lund University Malmo Sweden
| | - Jakob Rempe
- Department of Orthopedics, Helsingborg Hospital Lund University Helsingborg Sweden
| | - Lars Jehpsson
- Clinical and Molecular Osteoporosis Research Unit, Department of Orthopedics and Clinical Sciences, Skane University Hospital Malmo Lund University Malmo Sweden
| | - Magnus Dencker
- Department of Physiology and Clinical Sciences, Skane University Hospital Malmo Lund University Malmo Sweden
| | - Magnus K Karlsson
- Clinical and Molecular Osteoporosis Research Unit, Department of Orthopedics and Clinical Sciences, Skane University Hospital Malmo Lund University Malmo Sweden
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21
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Rosengren BE, Bergman E, Karlsson J, Ahlborg H, Jehpsson L, Karlsson MK. Downturn in Childhood Bone Mass: A
Cross‐Sectional
Study Over Four Decades. JBMR Plus 2021; 6:e10564. [PMID: 35079676 PMCID: PMC8770995 DOI: 10.1002/jbm4.10564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 09/26/2011] [Indexed: 11/17/2022] Open
Abstract
Screen time and physical inactivity have increased among children. As physical activity is a determinant of bone mass, there is a concern that children today have lower bone mass than earlier. If this is true, fractures may become more common in the future. In 2017–2018, we used single‐photon absorptiometry (SPA) to measure distal forearm bone mineral density (BMD; mg/cm2) in a normative cohort of 238 boys and 204 girls aged 7 to 15 years. We compared these results to BMD in a normative cohort collected in 1979–1981 (55 boys and 61 girls aged 7 to 15 years) measured by the same scanner. To investigate difference between the two cohorts, we used multiple linear regression with age, sex, and cohort as predictors. Predicted bone density at age 16 years was estimated through the slope values. The bone density‐age slope was flatter in the cohort measured in 2017–2018 than in the cohort measured 1979–1981 (−5.6 mg/cm2/yr [95% confidence interval −9.6 to −1.5]). Predicted bone density was at age 16 years in 2017–2018 in boys was 10% lower (−0.9 SD) and in girls 11% lower (−1.1 SD) than in their counterparts measured in 1979–1981. We found indications that children nowadays develop lower bone mass than four decades ago, giving concern that they may have a higher risk of osteoporosis and fragility fractures as they grow old. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Björn E Rosengren
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics Lund University, Skåne University Hospital Malmö Sweden
| | - Erika Bergman
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics Lund University, Skåne University Hospital Malmö Sweden
| | - Jessica Karlsson
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics Lund University, Skåne University Hospital Malmö Sweden
| | - Henrik Ahlborg
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics Lund University, Skåne University Hospital Malmö Sweden
| | - Lars Jehpsson
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics Lund University, Skåne University Hospital Malmö Sweden
| | - Magnus K Karlsson
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics Lund University, Skåne University Hospital Malmö Sweden
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22
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Role of Polyphenols in the Metabolism of the Skeletal System in Humans and Animals – A Review. ANNALS OF ANIMAL SCIENCE 2021. [DOI: 10.2478/aoas-2021-0040] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Abstract
Polyphenols are a group of compounds arousing enormous interest due to their multiple effects on both human and animal health and omnipresence in plants. A number of in vitro and animal model studies have shown that all polyphenols exhibit anti-inflammatory and antioxidant activities, and play a significant role against oxidative stress-related pathologies. They also exert gut promotory effects and prevent chronic degenerative diseases. However, less attention has been paid to the potential influence of polyphenols on bone properties and metabolism. It is well known that proper growth and functioning of the organism depend largely on bone growth and health. Therefore, understanding the action of substances (including polyphenols) that may improve the health and functioning of the skeletal system and bone metabolism is extremely important for the health of the present and future generations of both humans and farm animals. This review provides a comprehensive summary of literature related to causes of bone loss during ageing of the organism (in both humans and animals) and possible effects of dietary polyphenols preventing bone loss and diseases. In particular, the underlying cellular and molecular mechanisms that can modulate skeletal homeostasis and influence the bone modeling and remodeling processes are presented.
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23
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Velentza L, Zaman F, Sävendahl L. Bone health in glucocorticoid-treated childhood acute lymphoblastic leukemia. Crit Rev Oncol Hematol 2021; 168:103492. [PMID: 34655742 DOI: 10.1016/j.critrevonc.2021.103492] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 08/05/2021] [Accepted: 09/08/2021] [Indexed: 12/30/2022] Open
Abstract
Glucocorticoids (GCs) are widely used in the treatment of childhood acute lymphoblastic leukemia (ALL), but their long-term use is also associated with bone-related morbidities. Among others, growth deficit, decreased bone mineral density (BMD) and increased fracture rate are well-documented and severely impact quality of life. Unfortunately, no efficient treatment for the management of bone health impairment in patients and survivors is currently available. The overall goal of this review is to discuss the existing data on how GCs impair bone health in pediatric ALL and attempts made to minimize these side effects.
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Affiliation(s)
- Lilly Velentza
- Division of Pediatric Endocrinology, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
| | - Farasat Zaman
- Division of Pediatric Endocrinology, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Lars Sävendahl
- Division of Pediatric Endocrinology, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Pediatric Endocrinology Unit, Karolinska University Hospital, Stockholm, Sweden
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24
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Rosengren BE, Lindgren E, Jehpsson L, Dencker M, Karlsson MK. Musculoskeletal Benefits from a Physical Activity Program in Primary School are Retained 4 Years after the Program is Terminated. Calcif Tissue Int 2021; 109:405-414. [PMID: 33914096 PMCID: PMC8429376 DOI: 10.1007/s00223-021-00853-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 04/16/2021] [Indexed: 11/26/2022]
Abstract
Daily school physical activity (PA) improves musculoskeletal traits. This study evaluates whether the benefits remain 4 years after the intervention. We followed 45 boys and 36 girls who had had 40 min PA/school day during the nine compulsory school years and 21 boys and 22 girls who had had 60 min PA/school week (reference), with measurements at baseline and 4 years after the program terminated. Bone mineral content (BMC; g) and bone mineral density (BMD; g/cm2) were measured by dual-energy X-ray absorptiometry and knee flexion peak torque relative to total body weight (PTflexTBW) at a speed of 180 degrees/second with a computerized dynamometer. Group differences are presented as mean differences (adjusted for sex and duration of follow-up period) with 95% confidence intervals. The total gain bone mass [mean difference in spine BMC +32.0 g (14.6, 49.4) and in arms BMD of +0.06 g/cm2 (0.02, 0.09)] and gain in muscle strength [mean difference in PTflex180TBW +12.1 (2.0, 22.2)] were greater in the intervention than in the control group. There are still 4 years after the intervention indications of benefits in both bone mass and muscle strength gain. Daily school PA may counteract low bone mass and inferior muscle strength in adult life. ClinicalTrials.gov.NCT000633828 retrospectively registered 2008-11-03.
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Affiliation(s)
- Björn E Rosengren
- Clinical and Molecular Osteoporosis Research Unit, Department of Orthopedics, Skane University Hospital (SUS), 20502, Malmo, Sweden
| | - Erik Lindgren
- Clinical and Molecular Osteoporosis Research Unit, Department of Orthopedics, Skane University Hospital (SUS), 20502, Malmo, Sweden
| | - Lars Jehpsson
- Clinical and Molecular Osteoporosis Research Unit, Department of Orthopedics, Skane University Hospital (SUS), 20502, Malmo, Sweden
| | - Magnus Dencker
- Department of Physiology, Clinical Sciences, Lund University, Skane University Hospital, Malmo, Sweden
| | - Magnus K Karlsson
- Clinical and Molecular Osteoporosis Research Unit, Department of Orthopedics, Skane University Hospital (SUS), 20502, Malmo, Sweden.
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25
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Buckley JP, Kuiper JR, Lanphear BP, Calafat AM, Cecil KM, Chen A, Xu Y, Yolton K, Kalkwarf HJ, Braun JM. Associations of Maternal Serum Perfluoroalkyl Substances Concentrations with Early Adolescent Bone Mineral Content and Density: The Health Outcomes and Measures of the Environment (HOME) Study. ENVIRONMENTAL HEALTH PERSPECTIVES 2021; 129:97011. [PMID: 34585601 PMCID: PMC8480151 DOI: 10.1289/ehp9424] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 09/01/2021] [Accepted: 09/13/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Per- and polyfluoroalkyl substances (PFAS) may impair bone accrual and strength via endocrine disruption and nuclear receptor agonism, but human studies are primarily of adults or cross-sectional. OBJECTIVES We assessed associations of individual PFAS and their mixture during pregnancy with child bone mineral content (BMC) and areal bone mineral density (aBMD) at age 12 y. METHODS Among 206 mother-child pairs enrolled in a prospective cohort (2003-2006), we quantified perfluorooctanoic acid (PFOA), perfluorononanoic acid (PFNA), perfluorohexane sulfonic acid (PFHxS), and perfluorooctane sulfonic acid (PFOS) in maternal serum collected during gestation or delivery. When children were age 12 y, we performed dual energy X-ray absorptiometry and calculated BMC, aBMD, and bone mineral apparent density (BMAD) z -scores for six skeletal sites. We estimated covariate-adjusted z -score differences per doubling of individual PFAS using linear regression and assessed the PFAS mixture using quantile g-computation and Bayesian kernel machine regression. We explored whether associations were modified by child's sex or mediated by whole-body lean mass. RESULTS In covariate-adjusted models, we found that higher maternal serum concentrations of PFOA, PFNA, and the PFAS mixture were associated with lower total hip and forearm (one-third distal radius) BMC z -scores in children. Differences in forearm BMC z -scores were - 0.17 [95% confidence interval (CI): - 0.35 , 0.01] and - 0.24 (95% CI: - 0.44 , - 0.05 ) per doubling of PFOA and PFNA, respectively, and - 0.18 (95% CI: - 0.34 , - 0.02 ) per quartile increase in the PFAS mixture. Child's sex modified PFOA associations for some skeletal sites; for example, differences in spine BMAD z -score per doubling were - 0.31 (95% CI: - 0.58 , - 0.03 ) among males and 0.07 (95% CI: - 0.16 , 0.30) among females (modification p = 0.04 ). Except for PFNA among females, these associations were not mediated by whole-body lean mass. DISCUSSION Maternal PFAS concentrations during pregnancy may be associated with lower bone mineral accrual and strength in early adolescence. https://doi.org/10.1289/EHP9424.
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Affiliation(s)
- Jessie P. Buckley
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jordan R. Kuiper
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Bruce P. Lanphear
- Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Antonia M. Calafat
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kim M. Cecil
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Aimin Chen
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Philadelphia, Pennsylvania, USA
| | - Yingying Xu
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Kimberly Yolton
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Heidi J. Kalkwarf
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Joseph M. Braun
- Department of Epidemiology, Brown University, Providence, Rhode Island, USA
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26
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Rostami Haji Abadi M, Neumeyer A, Misra M, Kontulainen S. Bone health in children and youth with ASD: a systematic review and meta-analysis. Osteoporos Int 2021; 32:1679-1691. [PMID: 33928402 DOI: 10.1007/s00198-021-05931-5] [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: 10/27/2020] [Accepted: 03/17/2021] [Indexed: 10/21/2022]
Abstract
Higher risk of fracture reported in individuals with autism spectrum disorder (ASD) might be linked to poor bone health and development in childhood. This study aimed to systematically review studies comparing imaged bone outcomes between children with ASD and typically developing children (TDC) or reference data, and to perform a meta-analysis comparing commonly reported bone outcomes. We searched articles published since August 2020 from PubMed, Cochrane Library, Web of Science, EMBASE, and Scopus databases. We included studies comparing areal bone mineral density (aBMD) between children with ASD and TDC in the qualitative analysis (meta-analysis), and evaluated other imaged bone outcomes qualitatively. Seven publications were identified for the systematic review, and four studies were included in the meta-analysis. The meta-analysis indicated lower aBMD at the total body (standardized mean difference = - 0.77; 95% CI, - 1.26 to - 0.28), lumbar spine (- 0.69; - 1.00 to - 0.39), total hip (- 1.00; - 1.82 to - 0.17), and femoral neck (- 1.07; - 1.54 to - 0.60) in children with ASD compared to TDC. Based on our qualitative review, limited evidence suggested 13% lower bone mineral content at the total body and 10-20% lower cortical area, cortical and trabecular thickness, and bone strength at the distal radius and tibia in children with ASD. Children with ASD have lower aBMD at the total body, lumbar spine, and hip and femoral neck compared to TDC. Limited evidence also suggests deficits in bone mineral content, micro-architecture, and strength in children with ASD.
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Affiliation(s)
| | - A Neumeyer
- Lurie Center for Autism, Department of Pediatrics, Massachusetts General Hospital Harvard Medical School, Boston, MA, USA
| | - M Misra
- Division of Pediatric Endocrinology Department of Pediatrics, Massachusetts General Hospital Harvard Medical School, Boston, MA, USA
| | - S Kontulainen
- University of Saskatchewan College of Kinesiology, Saskatoon, Canada.
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27
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Constable AM, Vlachopoulos D, Barker AR, Moore SA, Soininen S, Haapala EA, Väistö J, Westgate K, Brage S, Mahonen A, Lakka TA. The independent and interactive associations of physical activity intensity and vitamin D status with bone mineral density in prepubertal children: the PANIC Study. Osteoporos Int 2021; 32:1609-1620. [PMID: 33547487 DOI: 10.1007/s00198-021-05872-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 02/01/2021] [Indexed: 01/12/2023]
Abstract
UNLABELLED It is unclear how physical activity intensity and vitamin D status are related to bone health in prepubertal children. We found positive associations between vitamin D status and moderate-to-vigorous physical activity with bone in boys and girls. This highlights the importance of lifestyle factors for skeletal health prepuberty. INTRODUCTION The sex-specific independent and interactive associations of physical activity (PA) intensity and serum 25-hydroxyvitamin D (25(OH)D) levels with areal bone mineral density (aBMD) were investigated in prepubertal children. METHODS The participants were 366 prepubertal Finnish children (190 boys, 176 girls) aged 6-8 years. Linear regression analysed the associations of sedentary time (ST), light PA (LPA), moderate PA (MPA), moderate-to-vigorous PA (MVPA) and vigorous PA (VPA) measured by accelerometery, and serum 25(OH)D with total body less head (TBLH) and lower-limb aBMD, measured by dual-energy X-ray absorptiometry. RESULTS There was no interaction between PA intensity or serum 25(OH)D and sex with aBMD. MPA and MVPA were positively associated with TBLH and lower-limb aBMD (β = 0.11, 95% CI 0.02-0.20, p = 0.01). Serum 25(OH)D was positively associated with TBLH and lower-limb aBMD (β = 0.09, 95% CI 0.01-0.18, p = 0.03). There were no interactions between PA intensity and serum 25(OH)D with aBMD. CONCLUSION Vitamin D status, MPA and MVPA levels in active prepubertal children were positively associated with aBMD. The influence of MVPA is due to the MPA component, though our findings regarding the role of VPA should be interpreted with caution, as shorter accelerometer epochs are needed to more accurately assess VPA. This study adds evidence to the promotion of MPA and behaviours to encourage optimal vitamin D status in supporting skeletal health in childhood, though these need not be used in conjunction to be beneficial, and a sex-specific approach is not necessary in prepubertal children. TRIAL REGISTRATION NUMBER NCT01803776 . Date of registration: 4/03/2013.
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Affiliation(s)
- A M Constable
- Children's Health and Exercise Research Centre, University of Exeter, Exeter, UK
- Institute of Biomedicine, University of Eastern Finland, Kuopio, Finland
| | - D Vlachopoulos
- Children's Health and Exercise Research Centre, University of Exeter, Exeter, UK.
| | - A R Barker
- Children's Health and Exercise Research Centre, University of Exeter, Exeter, UK
| | - S A Moore
- School of Health and Human Performance, Dalhousie University, Halifax, Canada
| | - S Soininen
- Institute of Biomedicine, University of Eastern Finland, Kuopio, Finland
- Social and Health Center, Varkaus, Finland
| | - E A Haapala
- Institute of Biomedicine, University of Eastern Finland, Kuopio, Finland
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - J Väistö
- Institute of Biomedicine, University of Eastern Finland, Kuopio, Finland
| | - K Westgate
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - S Brage
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - A Mahonen
- Institute of Biomedicine, University of Eastern Finland, Kuopio, Finland
| | - T A Lakka
- Institute of Biomedicine, University of Eastern Finland, Kuopio, Finland
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Daly A, Högler W, Crabtree N, Shaw N, Evans S, Pinto A, Jackson R, Ashmore C, Rocha JC, Strauss BJ, Wilcox G, Fraser WD, Tang JCY, MacDonald A. A Three-Year Longitudinal Study Comparing Bone Mass, Density, and Geometry Measured by DXA, pQCT, and Bone Turnover Markers in Children with PKU Taking L-Amino Acid or Glycomacropeptide Protein Substitutes. Nutrients 2021; 13:nu13062075. [PMID: 34204378 PMCID: PMC8233747 DOI: 10.3390/nu13062075] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 06/09/2021] [Indexed: 12/20/2022] Open
Abstract
In patients with phenylketonuria (PKU), treated by diet therapy only, evidence suggests that areal bone mineral density (BMDa) is within the normal clinical reference range but is below the population norm. Aims: To study longitudinal bone density, mass, and geometry over 36 months in children with PKU taking either amino acid (L-AA) or casein glycomacropeptide substitutes (CGMP-AA) as their main protein source. Methodology: A total of 48 subjects completed the study, 19 subjects in the L-AA group (median age 11.1, range 5–16 years) and 29 subjects in the CGMP-AA group (median age 8.3, range 5–16 years). The CGMP-AA was further divided into two groups, CGMP100 (median age 9.2, range 5–16 years) (n = 13), children taking CGMP-AA only and CGMP50 (median age 7.3, range 5–15 years) (n = 16), children taking a combination of CGMP-AA and L-AA. Dual X-ray absorptiometry (DXA) was measured at enrolment and 36 months, peripheral quantitative computer tomography (pQCT) at 36 months only, and serum blood and urine bone turnover markers (BTM) and blood bone biochemistry at enrolment, 6, 12, and 36 months. Results: No statistically significant differences were found between the three groups for DXA outcome parameters, i.e., BMDa (L2–L4 BMDa g/cm2), bone mineral apparent density (L2–L4 BMAD g/cm3) and total body less head BMDa (TBLH g/cm2). All blood biochemistry markers were within the reference ranges, and BTM showed active bone turnover with a trend for BTM to decrease with increasing age. Conclusions: Bone density was clinically normal, although the median z scores were below the population mean. BTM showed active bone turnover and blood biochemistry was within the reference ranges. There appeared to be no advantage to bone density, mass, or geometry from taking a macropeptide-based protein substitute as compared with L-AAs.
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Affiliation(s)
- Anne Daly
- Birmingham Women’s and Children’s Hospital, NHS Foundation Trust, Birmingham B4 6NH, UK; (N.C.); (N.S.); (S.E.); (A.P.); (C.A.); (A.M.)
- Correspondence:
| | - Wolfgang Högler
- Department of Paediatrics and Adolescent Medicine, Johannes Kepler University, Kepler University Hospital, Krankenhausstraße 26-30, 4020 Linz, Austria;
| | - Nicola Crabtree
- Birmingham Women’s and Children’s Hospital, NHS Foundation Trust, Birmingham B4 6NH, UK; (N.C.); (N.S.); (S.E.); (A.P.); (C.A.); (A.M.)
| | - Nick Shaw
- Birmingham Women’s and Children’s Hospital, NHS Foundation Trust, Birmingham B4 6NH, UK; (N.C.); (N.S.); (S.E.); (A.P.); (C.A.); (A.M.)
| | - Sharon Evans
- Birmingham Women’s and Children’s Hospital, NHS Foundation Trust, Birmingham B4 6NH, UK; (N.C.); (N.S.); (S.E.); (A.P.); (C.A.); (A.M.)
| | - Alex Pinto
- Birmingham Women’s and Children’s Hospital, NHS Foundation Trust, Birmingham B4 6NH, UK; (N.C.); (N.S.); (S.E.); (A.P.); (C.A.); (A.M.)
| | - Richard Jackson
- Liverpool Clinical Trials Centre, University of Liverpool, Brownlow Hill, Liverpool L69 3GL, UK;
| | - Catherine Ashmore
- Birmingham Women’s and Children’s Hospital, NHS Foundation Trust, Birmingham B4 6NH, UK; (N.C.); (N.S.); (S.E.); (A.P.); (C.A.); (A.M.)
| | - Júlio C. Rocha
- Nutrition and Metabolism, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, 1169-056 Lisboa, Portugal;
- Centre for Health and Technology and Services Research (CINTESIS), 4200-450 Porto, Portugal
| | - Boyd J. Strauss
- School of Medical Sciences, Faculty of Biology, Medicine and Health Sciences, University of Manchester, Manchester M13 9PL, UK; (B.J.S.); (G.W.)
- School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne 3800, Australia
| | - Gisela Wilcox
- School of Medical Sciences, Faculty of Biology, Medicine and Health Sciences, University of Manchester, Manchester M13 9PL, UK; (B.J.S.); (G.W.)
- The Mark Holland Metabolic Unit, Salford Royal Foundation NHS Trust, Ladywell NW2, Salford, Manchester M6 8HD, UK
| | - William D. Fraser
- BioAnalytical Facility, BCRE Builiding University or East Anglia, Norwich NR4 7TJ, UK; (W.D.F.); (J.C.Y.T.)
| | - Jonathan C. Y. Tang
- BioAnalytical Facility, BCRE Builiding University or East Anglia, Norwich NR4 7TJ, UK; (W.D.F.); (J.C.Y.T.)
- Departments of Clinical Biochemistry and Endocrinology, Norfolk and Norwich University Hospitals Trust, Norwich NR4 7UY, UK
| | - Anita MacDonald
- Birmingham Women’s and Children’s Hospital, NHS Foundation Trust, Birmingham B4 6NH, UK; (N.C.); (N.S.); (S.E.); (A.P.); (C.A.); (A.M.)
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Percival MA, Pasco JA, Hosking SM, Williams LJ, Holloway-Kew KL, Hyde NK. Gestational Folate and Offspring Bone Health; The Vitamin D in Pregnancy Study. Calcif Tissue Int 2021; 108:605-609. [PMID: 33386479 DOI: 10.1007/s00223-020-00795-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 12/10/2020] [Indexed: 11/26/2022]
Abstract
Maternal nutritional intake, such as folate and folic acid supplementation, during pregnancy may affect offspring bone health during childhood. We aimed to determine the associations between maternal dietary and supplementary folate intake and offspring bone health measures, including fracture risk. Data were obtained from 160 of 475 mother-child pairs who had returned for the 11-year follow up of the Vitamin D in Pregnancy Study, an observational cohort study. Incident fractures were ascertained from radiological records and dual X-ray absorptiometry was used to measure bone mineral density and content at 11 years of age. Maternal dietary folate intake during pregnancy was determined by Food Frequency Questionnaire and folate supplementation was determined through self-report. Both measures were undertaken at recruitment (before 16 weeks gestation) and at 28-32 weeks' gestation. Multivariable linear regression models and Cox regression models were used to examine associations. Results are presented as per 1000 µg folate for dietary measures. There were significant associations between maternal folate supplementation in early pregnancy (< 16 weeks gestation) and offspring spine bone mineral content (BMC) (β = 1.53, 95% CI 0.21, 2.86), spine area (β = 1.10, 95% CI 0.37, 1.82) and total body less head area (β = 329.30, 95% CI 3.50, 55.20) at the 11-year follow-up. The association between spine BMC was attenuated after adjustment for bone size (β = 0.13 95% CI - 0.85, 1.10). There was no association between maternal folate supplementation at 28-32 weeks' or maternal dietary intake at either time point with any offspring bone outcome. These data suggest that folate supplementation in early pregnancy may be associated with offspring bone size, but not other bone measures.
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Affiliation(s)
- Mia A Percival
- IMPACT, The Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, Australia
| | - Julie A Pasco
- IMPACT, The Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, Australia
- Barwon Health, Geelong, Australia
- Department of Medicine -Western Health, The University of Melbourne, St Albans, Australia
- Department of Epidemiology and Preventative Medicine, Monash University, Prahran, Australia
| | - Sarah M Hosking
- IMPACT, The Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, Australia
| | - Lana J Williams
- IMPACT, The Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, Australia
| | - Kara L Holloway-Kew
- IMPACT, The Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, Australia
| | - Natalie K Hyde
- IMPACT, The Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, Australia.
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30
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Lee JH, Ha AW, Kim WK, Kim SH. The Combined Effects of Milk Intake and Physical Activity on Bone Mineral Density in Korean Adolescents. Nutrients 2021; 13:nu13030731. [PMID: 33668955 PMCID: PMC7996533 DOI: 10.3390/nu13030731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 02/17/2021] [Accepted: 02/19/2021] [Indexed: 01/02/2023] Open
Abstract
The purpose of this study was to examine the combined effects of milk intake and physical activity on bone mineral density in adolescents. This study was conducted using data from the 2009–2011 Korea National Health and Nutrition Examination Survey (KNHANES), which provided measurements of bone mineral density (BMD) in addition to basic health-related data. This study included 1061 adolescents aged 13 to 18 years (557 males and 504 females) whose data on milk intake and participation time in moderate to vigorous physical activity were available. BMD was measured by dual-energy X-ray absorptiometry (DXA). Milk intake was assessed using the 24-h recall method, and the levels of physical activity were examined using a questionnaire. The physical activity questions of 2009–2011 KNHANES were based on the Korean version of the International Physical Activity Questionnaire (IPAQ) short form. The subjects were classified into four groups according to milk intake and physical activity level: no milk intake + low-level physical activity group (MnoPlow), no milk intake + high-level physical activity group (MnoPhigh), milk intake + low-level physical activity group (MyesPlow), and milk intake + high-level physical activity group (MyesPhigh). The results of partial correlation controlling for age, body mass index (BMI), and energy intake showed that the BMD variables were associated significantly with physical activity in both males and females. Among males, the MnoPlow group had the lowest BMD in all BMD variables, showing a significant difference from the high-level physical activity groups (MnoPhigh, MyesPhigh) by multiple logistic regression analysis. Among females, the MyesPhigh group showed a significantly higher lumbar BMD value than the other groups. The MnoPlow group had approximately 0.3 to 0.5 times lower odds ratio for median or higher BMD values, compared to MyesPhigh group. These results show that milk intake and physical activity have a combined effect on BMD, and suggest that to achieve healthy bone growth, it is important to encourage both moderate to vigorous physical activity and milk intake during adolescence.
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Affiliation(s)
- Jae Hyun Lee
- Department of Sport Science, College of Natural Sciences, Chungnam National University, Daejeon City 34134, Korea;
| | - Ae Wha Ha
- Department of Food Science and Nutrition, College of Natural Science, Dankook University, Chungcheongnam-do, Cheonan City 31116, Korea; (A.W.H.); (W.K.K.)
| | - Woo Kyoung Kim
- Department of Food Science and Nutrition, College of Natural Science, Dankook University, Chungcheongnam-do, Cheonan City 31116, Korea; (A.W.H.); (W.K.K.)
| | - Sun Hyo Kim
- Department of Technology and Home Economics Education, Kongju National University, Chungcheongnam-do, Gongju City 32588, Korea
- Correspondence:
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Abstract
Bone mass is a key determinant of osteoporosis and fragility fractures. Epidemiologic studies have shown that a 10% increase in peak bone mass (PBM) at the population level reduces the risk of fracture later in life by 50%. Low PBM is possibly due to the bone loss caused by various conditions or processes that occur during adolescence and young adulthood. Race, gender, and family history (genetics) are responsible for the majority of PBM, but other factors, such as physical activity, calcium and vitamin D intake, weight, smoking and alcohol consumption, socioeconomic status, age at menarche, and other secondary causes (diseases and medications), play important roles in PBM gain during childhood and adolescence. Hence, the optimization of lifestyle factors that affect PBM and bone strength is an important strategy to maximize PBM among adolescents and young people, and thus to reduce the low bone mass or osteoporosis risk in later life. This review aims to summarize the available evidence for the common but important factors that influence bone mass gain during growth and development and discuss the advances of developing high PBM.
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Affiliation(s)
- Xiaowei Zhu
- Disease & Population (DaP) Geninfo Lab, School of Life Sciences, Westlake University, Hangzhou, 310024, China
- Institute of Basic Medical Sciences, Westlake Institute for Advanced Study, Westlake University, Hangzhou, 310024, China
- School of Life Sciences, Fudan University, Shanghai, 200433, China
| | - Houfeng Zheng
- Disease & Population (DaP) Geninfo Lab, School of Life Sciences, Westlake University, Hangzhou, 310024, China.
- Institute of Basic Medical Sciences, Westlake Institute for Advanced Study, Westlake University, Hangzhou, 310024, China.
- School of Life Sciences, Fudan University, Shanghai, 200433, China.
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Clinical Criteria Can Identify Children With Osteopenia in Newly Diagnosed Crohn Disease. J Pediatr Gastroenterol Nutr 2021; 72:270-275. [PMID: 32810035 DOI: 10.1097/mpg.0000000000002911] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Chronic inflammation of Crohn disease (CD) is associated with reduced bone mineral density (BMD). As bone mass is almost exclusively accrued during childhood, early recognition of osteopenia is especially important in pediatric CD. We aimed to identify variables associated with osteopenia to guide dual-energy X-ray absorptiometry (DXA) scan screening to those who most need it. METHODS This was a retrospective inception cohort study of children newly diagnosed with CD, and routinely referred to DXA scans. Demographic and explicit clinical data were recorded along with whole-body less head BMD, adjusted for age, sex, and height by z-scores. RESULTS Of the 116 included children (mean age 13 ± 3.1 years, 67 [58%] boys, mean body mass index [BMI] 16.7 ± 2.6), 63 (54%) had normal BMD (z-score > -1) or borderline osteopenia (-1 ≥ z-score > -2) and 53 (46%) had osteopenia (z-score ≤ -2). Osteopenia was associated with lower BMI z-score (-0.8 ± 1.2 vs -1.8 ± 1.1, P < 0.001) and higher PCDAI (33.7 ± 15.2 vs 25.7 ± 16.5; P = 0.009) than those with BMD z-score >-2. In total, 59% of children with BMI z-score <-0.5 had moderate-severe osteopenia and only 18% of those with higher z-scores. Multivariate logistic regression identified BMI z-score as the sole risk factor (OR 1.28 [95% CI 1.08-1.52], P = 0.005). BMI z-score ≥-0.5 excludes osteopenia with a sensitivity 87%, specificity 49%, NPV 82%, and PPV 59%. CONCLUSIONS Osteopenia was found in nearly half of children with newly onset CD. BMI z-score <-0.5 should prompt referral to DXA screening.
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Shah N, Khadilkar A, Ekbote V, Mughal Z, Gondhalekar K, Khadilkar S, Ramanan V, Khadilkar V, Padidela R. DXA and pQCT derived parameters in Indian children with beta thalassemia major - A case controlled study. Bone 2021; 143:115730. [PMID: 33137537 DOI: 10.1016/j.bone.2020.115730] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 09/26/2020] [Accepted: 10/20/2020] [Indexed: 01/19/2023]
Abstract
Children with beta thalassemia major (BTM) are known to have reduced bone mass which increases incidence of non-traumatic fractures. Few studies have assessed prevalence of fractures and bone health in underprivileged children with BTM. Our objectives were to 1) determine prevalence of fractures in underprivileged Indian children with BTM, 2) assess size corrected bone density and bone geometry using Dual x-ray absorptiometry (DXA) and peripheral quantitative computerized tomography (pQCT) in these children and healthy controls 3) determine predictors of fractures in children with BTM 4) compare differences in bone density between children with BMT with and without fractures. Bone mineral content and areal bone mineral density (aBMD) of lumbar spine and whole body and vertebral fracture assessment (VFA) was performed by DXA in 334 children (3-18 years, 167 BTM + 167 controls). Volumetric BMD (vBMD) and bone geometry were assessed by pQCT (subset, 70 BTM, 70 healthy) at distal radius. Children with BTM had higher prevalence of vertebral and long bone fractures (p < 0.05). DXA aBMD was lower in children with BTM (p < 0.05), whereas, lumbar spine bone mineral apparent density (LSBMAD) was higher (p > 0.05). Children with BTM had lower total distal radial vBMD, cortical vBMD and strength strain index (SSI) at 66% site whereas, distal radial trabecular vBMD at 4% was higher (p < 0.05). On height adjustment, children with BTM had lower muscle area and cortical thickness and higher marrow area (p < 0.05) at 66% site. Age, body size, total body less head (TBLH) aBMD and strength strain index (SSI) were important predictors of fractures in children with BTM. Thus, children with BTM had higher prevalence of non-traumatic fractures. Despite lower areal and volumetric densities, they had higher LSBMAD and trabecular densities which may be attributed to erythroid hyperplasia and iron deposition due to inadequate transfusion and chelation. As LSBMAD is raised in these children, it is unlikely to identify BTM subjects at risk of fracture; VFA thus maybe useful in identifying asymptomatic vertebral fractures.
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Affiliation(s)
- Nikhil Shah
- Department of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India
| | - Anuradha Khadilkar
- Department of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India.
| | - Veena Ekbote
- Department of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India
| | - Zulf Mughal
- Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Manchester University, NHS Foundation Trust, Manchester, UK
| | - Ketan Gondhalekar
- Department of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India
| | - Shachi Khadilkar
- Department of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India
| | - Vijay Ramanan
- Clinical Hematology and Transplant, Yashoda Hematology Clinic, Pune, Maharashtra, India
| | - Vaman Khadilkar
- Department of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India
| | - Raja Padidela
- Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Manchester University, NHS Foundation Trust, Manchester, UK
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Zheng WB, Dai Y, Hu J, Zhao DC, Wang O, Jiang Y, Xia WB, Xing XP, Li M. Effects of Bisphosphonates on Osteoporosis Induced by Duchenne Muscular Dystrophy: A Prospective Study. Endocr Pract 2021; 26:1477-1485. [PMID: 33471740 DOI: 10.4158/ep-2020-0073] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 07/24/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Duchenne muscular dystrophy (DMD) is a severe X-linked progressive neuromuscular disease that brings a significantly increased risk of osteoporosis and bone fractures. We prospectively evaluated the effects of oral and intravenous bisphosphonates on the bones of children with DMD. METHODS This study included a total of 52 children with DMD. They were divided into zoledronic acid (ZOL), alendronate (ALN), and control groups according to bone mineral density (BMD) and history of fragility fractures. For 2 years, all patients took calcium, vitamin D, and calcitriol. Meanwhile, 17 patients received infusions of ZOL, and 18 patients received ALN. BMD, serum levels of alkaline phosphatase (ALP) and the cross-linked C-telopeptide of type I collagen (β-CTX) were evaluated. RESULTS After 24 months of treatment, the percentage changes in lumbar spine BMD were 23.2 ± 9.7% and 23.6 ± 8.8% in the ZOL and ALN groups (all P<.01 vs. baseline). The increases did not differ between the ZOL and ALN groups, but were significantly larger than those of the control group (P<.01). Serum β-CTX and ALP levels, respectively, were decreased by 44.4 ± 18.0% and 31.9 ± 26.7% in the ZOL group and by 36.0 ± 20.3% and 25.8 ± 14.4% in the ALN group (all P<.01 vs. baseline). CONCLUSION Zoledronic acid and alendronate had similar protective effects to increase bone mineral density and reduce bone resorption in children with DMD, which were superior to treatment of calcium, vitamin D, and calcitriol. ABBREVIATIONS 25OHD = 25 hydroxyvitamin D; ALN = alendro-nate; ALP = alkaline phosphatase; ALT = alanine aminotransferase; BMD = bone mineral density; BP = bisphosphonate; Ca = calcium; β-CTX = cross-linked C-telopeptide of type I collagen; DMD = Duchenne muscular dystrophy; FN = femoral neck; GC = glucocorticoid; LS = lumbar spine; ZOL = zoledronic acid.
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Affiliation(s)
- Wen-Bin Zheng
- From the (1)Department of Endocrinology, National Health Commission Key Laboratory of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China, and the
| | - Yi Dai
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Jing Hu
- From the (1)Department of Endocrinology, National Health Commission Key Laboratory of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China, and the
| | - Di-Chen Zhao
- From the (1)Department of Endocrinology, National Health Commission Key Laboratory of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China, and the
| | - Ou Wang
- From the (1)Department of Endocrinology, National Health Commission Key Laboratory of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China, and the
| | - Yan Jiang
- From the (1)Department of Endocrinology, National Health Commission Key Laboratory of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China, and the
| | - Wei-Bo Xia
- From the (1)Department of Endocrinology, National Health Commission Key Laboratory of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China, and the
| | - Xiao-Ping Xing
- From the (1)Department of Endocrinology, National Health Commission Key Laboratory of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China, and the
| | - Mei Li
- From the (1)Department of Endocrinology, National Health Commission Key Laboratory of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China, and the.
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Khalatbari H, Binkovitz LA, Parisi MT. Dual-energy X-ray absorptiometry bone densitometry in pediatrics: a practical review and update. Pediatr Radiol 2021; 51:25-39. [PMID: 32857206 DOI: 10.1007/s00247-020-04756-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 05/13/2020] [Accepted: 06/15/2020] [Indexed: 12/18/2022]
Abstract
The assessment of pediatric bone mineral content and density is an evolving field. In this manuscript we provide a practical review and update on the interpretation of dual-energy X-ray absorptiometry (DXA) in pediatrics including historical perspectives as well as a discussion of the recently published 2019 Official Position Statements of the International Society of Clinical Densitometry (ISCD) that apply to children.
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Affiliation(s)
- Hedieh Khalatbari
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, 4800 Sand Point Way NE, Seattle, WA, 98105, USA.
| | - Larry A Binkovitz
- Department of Radiology, Divisions of Pediatric Radiology and Nuclear Medicine, Mayo Clinic Graduate School of Medicine, Rochester, MN, USA
| | - Marguerite T Parisi
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, 4800 Sand Point Way NE, Seattle, WA, 98105, USA.,Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
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Dumuid D, Simm P, Wake M, Burgner D, Juonala M, Wu F, Magnussen CG, Olds T. The "Goldilocks Day" for Children's Skeletal Health: Compositional Data Analysis of 24-Hour Activity Behaviors. J Bone Miner Res 2020; 35:2393-2403. [PMID: 32730680 DOI: 10.1002/jbmr.4143] [Citation(s) in RCA: 6] [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: 04/20/2020] [Revised: 07/16/2020] [Accepted: 07/23/2020] [Indexed: 12/13/2022]
Abstract
Optimization of children's activity behaviors for skeletal health is a key public health priority, yet it is unknown how many hours of moderate to vigorous physical activity (MVPA), light physical activity (LPA), sedentary behavior, or sleep constitute the best day-the "Goldilocks Day"-for children's bone structure and function. To describe the best day for children's skeletal health, we used data from the cross-sectional Child Health CheckPoint. Included participants (n = 804, aged 10.7 to 12.9 years, 50% male) underwent tibial peripheral quantitative CT to assesses cross-sectional area, trabecular and cortical density, periosteal and endosteal circumference, polar moment of inertia, and polar stress-strain index. Average daily time-use composition (MVPA, LPA, sedentary time, and sleep) was assessed through 8-day, 24-hour accelerometry. Skeletal outcomes were regressed against time-use compositions expressed as isometric log-ratios (with quadratic terms where indicated), adjusted for sex, age, pubertal status, and socioeconomic position. The models were used to estimate optimal time-use compositions (associated with best 5% of each skeletal outcome), which were plotted in three-dimensional quaternary figures. The center of the overlapping area was considered the Goldilocks Day for skeletal health. Children's time-use composition was associated with all skeletal measures (all p ≤ 0.001) except cross-sectional area (p = 0.72). Days with more sleep and MVPA, less sedentary time, and moderate LPA were beneficially associated with skeletal measures, except cortical density, which was adversely associated. The Goldilocks daily time-use composition for overall skeletal health was center (range): 10.9 (10.5 to 11.5) hours sleep; 8.2 (7.8 to 8.8) hours sedentary time; 3.4 (2.8 to 4.2) hours LPA, and 1.5 (1.3 to 1.5) hours MVPA. Estimated optimal sleep duration is consistent with current international guidelines (9 to 11 hours), while estimated optimal MVPA exceeds recommendations of at least 60 min/d. This first study to describe optimal durations of daily activities for children's skeletal health provides evidence to underpin guidelines. © 2020 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Dorothea Dumuid
- Allied Health & Human Performance, Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, Australia
| | - Peter Simm
- Murdoch Children's Research Institute, Parkville, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Australia
- Department of Endocrinology and Diabetes, Royal Children's Hospital, Parkville, Australia
| | - Melissa Wake
- Murdoch Children's Research Institute, Parkville, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Australia
- Liggins Institute, University of Auckland, Grafton, New Zealand
| | - David Burgner
- Murdoch Children's Research Institute, Parkville, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Australia
| | - Markus Juonala
- Department of Medicine, University of Turku, Turku, Finland
- Division of Medicine, Turku University Hospital, Turku, Finland
| | - Feitong Wu
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Costan G Magnussen
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - Timothy Olds
- Allied Health & Human Performance, Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, Australia
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Gil-Cosano JJ, Ubago-Guisado E, Sánchez MJ, Ortega-Acosta MJ, Mateos ME, Benito-Bernal AI, Llorente-Cantarero FJ, Ortega FB, Ruiz JR, Labayen I, Martinez-Vizcaino V, Vlachopoulos D, Arroyo-Morales M, Muñoz-Torres M, Pascual-Gázquez JF, Vicho-González MC, Gracia-Marco L. The effect of an online exercise programme on bone health in paediatric cancer survivors (iBoneFIT): study protocol of a multi-centre randomized controlled trial. BMC Public Health 2020; 20:1520. [PMID: 33032564 PMCID: PMC7545891 DOI: 10.1186/s12889-020-09607-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 09/14/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND New approaches on paediatric cancer treatment aim to maintain long-term health. As a result of radiotherapy, chemotherapy or surgery, paediatric cancer survivors tend to suffer from any chronic health condition. Endocrine dysfunction represents one of the most common issues and affects bone health. Exercise is key for bone mass accrual during growth, specifically plyometric jump training. The iBoneFIT study will investigate the effect of a 9-month online exercise programme on bone health in paediatric cancer survivors. This study will also examine the effect of the intervention on body composition, physical fitness, physical activity, calcium intake, vitamin D, blood samples quality of life and mental health. METHODS A minimum of 116 participants aged 6 to 18 years will be randomized into an intervention (n = 58) or control group (n = 58). The intervention group will receive an online exercise programme and diet counselling on calcium and vitamin D. In addition, five behaviour change techniques and a gamification design will be implemented in order to increase the interest of this non-game programme. The control group will only receive diet counselling. Participants will be assessed on 3 occasions: 1) at baseline; 2) after the 9 months of the intervention; 3) 4 months following the intervention. The primary outcome will be determined by dual energy X-ray absorptiometry (DXA) and the hip structural analysis, trabecular bone score and 3D-DXA softwares. Secondary outcomes will include anthropometry, body composition, physical fitness, physical activity, calcium and vitamin D intake, blood samples, quality of life and mental health. DISCUSSION Whether a simple, feasible and short in duration exercise programme can improve bone health has not been examined in paediatric cancer survivors. This article describes the design, rationale and methods of a study intended to test the effect of a rigorous online exercise programme on bone health in paediatric cancer survivors. If successful, the iBoneFIT study will contribute to decrease chronic health conditions in this population and will have a positive impact in the society. TRIAL REGISTRATION Prospectively registered in isrctn.com: isrctn61195625 . Registered 2 April 2020.
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Affiliation(s)
- Jose J Gil-Cosano
- PROFITH "PROmoting FITness and Health through Physical Activity" Research Group, Sport and Health University Research Institute (iMUDS), Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, 18071, Granada, Spain
| | - Esther Ubago-Guisado
- PROFITH "PROmoting FITness and Health through Physical Activity" Research Group, Sport and Health University Research Institute (iMUDS), Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, 18071, Granada, Spain
| | - Maria J Sánchez
- Andalusian School of Health (EASP), Granada, Spain
- Instituto de Investigación Biosanitaria Ibs.GRANADA, Granada, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
| | - Maria J Ortega-Acosta
- Servicio de Pediatría y Oncohematología Pediátricas, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Maria E Mateos
- Pediatric Oncology Unit, Department of Pediatrics, Reina Sofia University Hospital, Córdoba, Spain
- Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), Córdoba, Spain
| | | | - Francisco J Llorente-Cantarero
- Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), Córdoba, Spain
- CIBEROBN, (Physiopathology of Obesity and Nutrition) Institute of Health Carlos III (ISCIII), 28029, Madrid, Spain
- Department of Specific Didactics, Faculty of Education, University of Córdoba, 14071, Córdoba, Spain
| | - Francisco B Ortega
- PROFITH "PROmoting FITness and Health through Physical Activity" Research Group, Sport and Health University Research Institute (iMUDS), Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, 18071, Granada, Spain
| | - Jonatan R Ruiz
- PROFITH "PROmoting FITness and Health through Physical Activity" Research Group, Sport and Health University Research Institute (iMUDS), Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, 18071, Granada, Spain
| | - Idoia Labayen
- Institute for Innovation and Sustainable Development in Food Chain (IS-FOOD), Navarra's Health Research Institute (IdiSNA), Department of Health Sciences, Public University of Navarra, Calle Tajonar 22, 31006, Pamplona, Navarra, Spain
| | - Vicente Martinez-Vizcaino
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain
- Faculty of Health Sciences, Universidad Autónoma de Chile, Talca, Chile
| | - Dimitris Vlachopoulos
- Children's Health and Exercise Research Centre, Sport and Health Sciences, University of Exeter, Exeter, UK
| | - Manuel Arroyo-Morales
- Biohealth Research Institute in Granada (ibs.GRANADA), E-18012, Granada, Spain
- Department of Physiotherapy, University of Granada, E-18016, Granada, Spain
- "Cuídate" Support Unit for Oncology Patients (UAPO), Sport and Health University Research Institute (iMUDS), E-18016, Granada, Spain
| | - Manuel Muñoz-Torres
- Bone Metabolic Unit, Endocrinology and Nutrition Division, Hospital Universitario San Cecilio, Instituto de Investigación Biosanitaria de Granada (Ibs.GRANADA), Granada, Spain
- CIBERFES, Instituto de Salud Carlos III, Madrid, Spain
- Department of Medicine, Universidad de Granada, Granada, Spain
| | - Juan F Pascual-Gázquez
- Servicio de Pediatría y Oncohematología Pediátricas, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Maria C Vicho-González
- Pediatric Oncology Unit, Department of Pediatrics, Reina Sofia University Hospital, Córdoba, Spain
| | - Luis Gracia-Marco
- PROFITH "PROmoting FITness and Health through Physical Activity" Research Group, Sport and Health University Research Institute (iMUDS), Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, 18071, Granada, Spain.
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Vitamin D Status in Children With Forearm Fractures: Incidence and Risk Factors. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2020; 4:e20.00150-5. [PMID: 32852920 PMCID: PMC7447362 DOI: 10.5435/jaaosglobal-d-20-00150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Introduction: The association between vitamin D status and fracture characteristics in children remains ambiguous. We hypothesized that vitamin D deficient or insufficient children would have an increased risk of forearm fractures severe enough to require surgical management. Methods: One hundred children with low-energy forearm fractures were prospectively enrolled from a single hospital. Each participant answered a questionnaire focusing on the risk factors for vitamin D deficiency. Fractures were categorized as requiring nonsurgical or surgical management. Vitamin D status was based on the measurement of 25-hydroxyvitamin D (25(OH)D) concentration obtained during the clinic visit and compared between the two fracture groups. Results: The cohort exhibited a mean age of 9.8 ± 3.2 years (range: 3-15 years), comprising 65 (65%) men and 35 (35%) women. Overall, mean 25(OH)D was 27.5 ± 8.3 ng/mL. Using the Endocrine Society guidelines, 21% of patients were categorized as “vitamin D deficient” (25(OH)D ≤ 20 ng/mL) and 49% as “vitamin D insufficient” (25(OH)D: 21 to 29 ng/mL). Stratification by intervention revealed a mean 25(OH)D of 23.3 ± 8.8 ng/mL in the surgical group (n = 12) and 28.1 ± 8.1 in the nonsurgical group (n = 88) (P = 0.057). Fifty percent of the surgical group were “vitamin D deficient” compared with 17% of the nonsurgical group (P = 0.017). The relative risk of requiring surgical treatment in children with forearm fracture and vitamin D deficiency (25(OH)D < 20 ng/mL) was 3.8. 25(OH)D level, negatively correlated with body mass index (r = −0.21, P = 0.044); 9 surgical patients were overweight or obese (as defined by the criteria of the Centers for Disease Control and Prevention). 25(OH)D level was significantly lower in non-Caucasians compared with Caucasians (26.0 ± 7.2 versus 32.5 ± 9.9 ng/mL; P = 0.0008). Discussion: Vitamin D deficiency is common in children with forearm fractures and may be a contributing risk factor for forearm fractures requiring surgical management in children. Conclusion: Vitamin D deficiency and inefficiency are common in children with low energy forearm fractures, especially in obese children and in fractures requiring surgical treatment.
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Proton pump inhibitor use and risk of hip fracture in patients with type 2 diabetes. Sci Rep 2020; 10:14081. [PMID: 32826941 PMCID: PMC7443131 DOI: 10.1038/s41598-020-70712-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 08/03/2020] [Indexed: 01/10/2023] Open
Abstract
Type 2 diabetes mellitus (T2DM) is associated with a high rate of comorbidity, including osteoporosis and peptic ulcers. Proton pump inhibitors (PPIs) are a group of acid-suppressing drugs commonly used for treating peptic ulcers. However, observational studies have reported an association between PPI therapy and osteoporotic fractures. This study investigated the association between PPI use and hip fracture (HFx) among patients with T2DM. We conducted this population-based propensity-matched retrospective cohort study using the National Health Insurance Research Database in Taiwan. Patients newly diagnosed with T2DM between 2000 and 2008 were identified. After excluding those who previously used PPIs or suffered HFx, 398,885 patients were recruited (44,341 PPI users; 354,544 non-users). HFx risk data from 2000 to 2013 were collected to calculate the cumulative rate of HFx in these two groups. Sensitivity analyses were conducted to evaluate the effects of PPI dose. After propensity score matching of 1:4, 44,431 and 177,364 patients were assigned to the PPI user and non-user groups, respectively. PPI user group showed an increased risk of HFx with an adjusted hazard ratio of 1.41 (95% CI 1.29–1.54) without dose–response relationship. Thus, there is an increased risk of HFx in patients with T2DM receiving long-term PPI treatment.
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Baradaran Mahdavi S, Daniali SS, Farajzadegan Z, Bahreynian M, Riahi R, Kelishadi R. Association between maternal smoking and child bone mineral density: a systematic review and meta-analysis. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2020; 27:23538-23549. [PMID: 32314283 DOI: 10.1007/s11356-020-08740-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 04/02/2020] [Indexed: 06/11/2023]
Abstract
Maternal smoking during pregnancy has detrimental effects on fetal development. The current review examined the differences in offspring's bone mineral density (BMD) between mothers smoked during pregnancy and those who did not. A systematic review and meta-analysis on the studies investigating the influence of maternal smoking during pregnancy on children or neonates' bone measures published up to October 30, 2018, was performed. BMD results measured at different body sites were pooled and then fixed or random effect models were used based on the presence of heterogeneity. The desired pooled effect size was the offspring's BMD mean difference with 95% confidence interval between smoker and non-smoker mothers. Sensitivity analysis was performed for birth weight and current weight, two important mediator/confounders causing heterogeneity. Overall, eight studies consisting of 17,931 participants aged from infancy to 18 years were included. According to the fixed effect model, the mean of BMD in offspring whose mothers smoked during pregnancy was 0.01 g/cm2 lower than those with non-smoker mothers (95% CI = - 0.02 to - 0.002). However, subgroup meta-analysis adjusted for birth weight and current weight demonstrated no significant mean difference between BMD of children with smoker and non-smoker mothers (d = 0.06, 95% CI = -0.04 to 0.16, p value = 0.25 and d = - 0.005, 95% CI = - 0.01 to 0.004, p value = 0.28, respectively). According to available studies, it is suggested that maternal smoking during pregnancy does not have direct effect on the offspring's BMD. Instead, this association might be confounded by other factors such as placental weight, birth weight, and current body size of children.
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Affiliation(s)
- Sadegh Baradaran Mahdavi
- Department of Physical Medicine and Rehabilitation, School of Medicine, Student Research Committee, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Seyede Shahrbanoo Daniali
- Pediatric Department, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ziba Farajzadegan
- Department of Community Medicine, Faculty of Medicine, Child Growth and Development Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Bahreynian
- Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Science, Isfahan, Iran
| | - Roya Riahi
- Biostatistics Department, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical science, Isfahan, Iran.
- Department of Epidemiology and Biostatistics, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Roya Kelishadi
- Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Science, Isfahan, Iran.
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Tian C, Wong BL, Hornung L, Khoury JC, Rybalsky I, Shellenbarger KC, Rutter MM. Oral bisphosphonate treatment in patients with Duchenne muscular dystrophy on long term glucocorticoid therapy. Neuromuscul Disord 2020; 30:599-610. [DOI: 10.1016/j.nmd.2020.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/24/2020] [Accepted: 06/10/2020] [Indexed: 12/24/2022]
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Golden NH. Bones and Birth Control in Adolescent Girls. J Pediatr Adolesc Gynecol 2020; 33:249-254. [PMID: 31972296 DOI: 10.1016/j.jpag.2020.01.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 01/07/2020] [Accepted: 01/11/2020] [Indexed: 12/24/2022]
Abstract
Peak bone mass acquisition during adolescence is an important determinant of adult bone health. Knowledge about the effects of different contraceptives on peak bone mass acquisition could influence choice of method recommended. This review summarizes normal bone acquisition during adolescence, discusses methods of assessing bone health in this age group, and reviews the effects of different contraceptive options on bone health, both in adults and in adolescents. Based on the evidence, long-acting reversible contraceptives do not appear to affect peak bone mass acquisition or future fracture risk and remain the first-line contraceptive choice for adolescents. Oral contraceptives with doses of ethinyl estradiol greater than 30 μg should be used in preference to lower-dose preparations, and the adverse effects of depo medroxyprogesterone acetate (DMPA) on bone health are reversible on discontinuation of the medication. Concerns about bone health should not prevent use of DMPA in an adolescent who prefers this method.
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Affiliation(s)
- Neville H Golden
- Lucile Packard Children's Hospital, Stanford, Stanford University School of Medicine, Palo Alto, California.
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Abstract
PURPOSE OF REVIEW The main goal of this narrative review is to assess whether physical activity (PA) influences peak bone mass and fracture risk. RECENT FINDINGS Several randomized controlled trials (RCT) show that short-term PA intervention programs in childhood improve the accrual of bone mineral. There are now also long-term controlled PA intervention studies demonstrating that both boys and girls with daily school PA through puberty gain higher bone mineral content (BMC) and bone mineral density (BMD) and greater bone size than boys and girls with school PA 1-2 times/week. These benefits seem to be followed by a gradual reduction in expected fracture rates, so that in children with daily school PA, the incidence rate ratio (IRR) after 8 years is less than half that expected by age. Daily school PA from before to after puberty is associated with beneficial gains in bone traits and gradually lower relative fracture risk.
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Affiliation(s)
- Magnus K Karlsson
- Clinical and Molecular Osteoporosis Research Unit, Department of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital, SE - 205 02, Malmö, Sweden.
| | - Björn E Rosengren
- Clinical and Molecular Osteoporosis Research Unit, Department of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital, SE - 205 02, Malmö, Sweden
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Delshad M, Beck KL, Conlon CA, Mugridge O, Kruger MC, von Hurst PR. Fracture risk factors among children living in New Zealand. J Steroid Biochem Mol Biol 2020; 200:105655. [PMID: 32171787 DOI: 10.1016/j.jsbmb.2020.105655] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 03/10/2020] [Accepted: 03/10/2020] [Indexed: 12/11/2022]
Abstract
Factures are common during childhood. There are limited data available regarding relationships between bone fracture history and calcium intake, sugar sweetened beverages (SSBs) intake, vitamin D status, physical activity (PA), ethnicity, and body composition in New Zealand (NZ) children. Identifying groups of NZ children at risk of fracture and associated predictors may help to improve bone quality during childhood and decrease the risk of fractures throughout life. The aim of this study was to investigate fracture history and associated risk factors in New Zealand children. Children aged 8-12 years were recruited. Capillary blood spots collected from a finger prick were as analyzed for 25(OH)D concentrations. Bioelectrical impedance analysis (InBody720, Seoul, Korea) was used to measure body fat percentage (%BF). Information about fracture history, siblings' history of fractures, family osteoporosis history, PA, ethnicity, and intake of calcium containing foods, and SSBs was collected using questionnaires. Children (n = 647, 354 girls), mean ± SD age 9.8 ± 0.7 years were recruited from six Auckland primary schools. NZ European (n = 252) (NZE) and South Asian (n = 68) children reported the lowest (20.2 %) and highest (44.1 %) fracture incidence, respectively. NZE compared to South Asian children, had higher 25(OH)D concentrations (74.6 ± 19.8 vs. 48.4 ± 19.3 nmol/L, P < 0.001), higher total calcium intake (764.0 ± 394.4 vs. 592.7 ± 266.3 mg/d, P < 0.018), and lower %BF (19.5 ± 6.6 vs. 23.4 ± 8.4, P < 0.003). Māori children had the next highest fracture rate (32.5 %). This group had adequate 25(OH)D (64.2 ± 18.9 nmol/L), but high %BF (23.9 %) and most participated in vigorous PA. After stratifying by sex, binary logistic regression analysis revealed the main determinants of fracture history for boys were high %BF, low 25(OH)D, low calcium intake, high SSBs consumption, siblings' fracture history, family osteoporosis history, and being South Asian; and in girls, high SSBs consumption, siblings' fracture history, and family osteoporosis history. We found South Asian ethnicity was a significant risk factor for boys. Some children were at high risk of vitamin D deficiency and for whom supplementation may be necessary in winter. Good nutrition (especially good sources of calcium and reducing SSBs intakes) should be recommended to children during growth and development to reduce their risk of fractures.
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Affiliation(s)
- Maryam Delshad
- College of Health, Massey University, Auckland, New Zealand
| | - Kathryn L Beck
- College of Health, Massey University, Auckland, New Zealand
| | | | - Owen Mugridge
- College of Health, Massey University, Auckland, New Zealand
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Cronholm F, Lindgren E, Rosengren BE, Dencker M, Karlsson C, Karlsson MK. Daily School Physical Activity from Before to After Puberty Improves Bone Mass and a Musculoskeletal Composite Risk Score for Fracture. Sports (Basel) 2020; 8:E40. [PMID: 32231105 PMCID: PMC7240745 DOI: 10.3390/sports8040040] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 03/25/2020] [Accepted: 03/26/2020] [Indexed: 01/29/2023] Open
Abstract
This 7.5-year prospective controlled exercise intervention study assessed if daily school physical activity (PA), from before to after puberty, improved musculoskeletal traits. There were 63 boys and 34 girls in the intervention group (40 min PA/day), and 26 boys and 17 girls in the control group (60 min PA/week). We measured musculoskeletal traits at the start and end of the study. The overall musculoskeletal effect of PA was also estimated by a composite score (mean Z-score of the lumbar spine bone mineral content (BMC), bone area (BA), total body lean mass (TBLM), calcaneal ultrasound (speed of sound (SOS)), and muscle strength (knee flexion peak torque)). We used analyses of covariance (ANCOVA) for group comparisons. Compared to the gender-matched control group, intervention boys reached higher gains in BMC, BA, muscle strength, as well as in the composite score, and intervention girls higher gains in BMC, BA, SOS, as well as in the composite score (all p < 0.05, respectively). Our small sample study indicates that a daily school-based PA intervention program from Tanner stage 1 to 5 in both sexes is associated with greater bone mineral accrual, greater gain in bone size, and a greater gain in a musculoskeletal composite score for fractures.
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Affiliation(s)
- Felix Cronholm
- Clinical and Molecular Osteoporosis Research Unit, Department of Orthopedics and Clinical Sciences, Skane University Hospital, Lund University, SE-205 02 Malmo, Sweden; (F.C.); (E.L.); (B.E.R.); (C.K.)
| | - Erik Lindgren
- Clinical and Molecular Osteoporosis Research Unit, Department of Orthopedics and Clinical Sciences, Skane University Hospital, Lund University, SE-205 02 Malmo, Sweden; (F.C.); (E.L.); (B.E.R.); (C.K.)
| | - Björn E. Rosengren
- Clinical and Molecular Osteoporosis Research Unit, Department of Orthopedics and Clinical Sciences, Skane University Hospital, Lund University, SE-205 02 Malmo, Sweden; (F.C.); (E.L.); (B.E.R.); (C.K.)
| | - Magnus Dencker
- Department of Physiology and Clinical Sciences, Skane University Hospital, Lund University, SE-205 02 Malmo, Sweden;
| | - Caroline Karlsson
- Clinical and Molecular Osteoporosis Research Unit, Department of Orthopedics and Clinical Sciences, Skane University Hospital, Lund University, SE-205 02 Malmo, Sweden; (F.C.); (E.L.); (B.E.R.); (C.K.)
| | - Magnus K. Karlsson
- Clinical and Molecular Osteoporosis Research Unit, Department of Orthopedics and Clinical Sciences, Skane University Hospital, Lund University, SE-205 02 Malmo, Sweden; (F.C.); (E.L.); (B.E.R.); (C.K.)
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Serum 25-hydroxyvitamin D concentrations in 16-year-old Icelandic adolescent and its association with bone mineral density. Public Health Nutr 2020; 23:1329-1333. [PMID: 32188523 PMCID: PMC7196732 DOI: 10.1017/s1368980019004142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The aim of the study was to assess the potential association between serum 25-hydroxyvitamin D (25(OH)D) and whole-body bone mineral density (BMD) among 16-year-old adolescents and to study the prevalence of 25(OH)D insufficiency, defined as concentration under 50 nmol/l. DESIGN A cross-sectional study. SETTING Reykjavik, Iceland, latitude 64°08'N. Measurements took place in the Icelandic Heart Association's research lab during April-June 2015. PARTICIPANTS In total, 411 students in Reykjavik, Iceland, were invited to participate, 315 accepted the invitation (76·6 %) and 289 had valid data (mainly Caucasian). RESULTS 25(OH)D < 50 nmol/l was observed in 70 % of girls and 66·7 % of boys. 25(OH)D ≥ 50 nmol/l was significantly associated with higher whole-body BMD after adjusting for the influence of sex, height, fat mass and lean mass. A linear relationship between 25(OH)D and whole-body BMD was significant for 25(OH)D < 50 nmol/l (n 199, P < 0·05) but NS for 25(OH)D ≥ 50 nmol/l (n 86, P = 0·48). CONCLUSIONS Our results are in line with some but not all previous studies on the relationship between BMD and 25(OH)D in adolescents. The observed difference in BMD between those with above v. below a 25(OH)D concentration of 50 nmol/l was of about a fifth of one SD, which may have a clinical relevance as one SD decrease in volumetric BMD has been associated with a 89 % increase in 2 years risk of fracture. Icelandic adolescents should be encouraged to increase their vitamin D intake as it is possible that their current intake is insufficient to achieve optimal peak bone mass.
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Associations of Weight-Adjusted Body Fat and Fat Distribution with Bone Mineral Density in Chinese Children Aged 6-10 Years. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17051763. [PMID: 32182741 PMCID: PMC7084411 DOI: 10.3390/ijerph17051763] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 02/25/2020] [Accepted: 03/06/2020] [Indexed: 02/07/2023]
Abstract
Although obesity is considered osteoprotective, the effects of body fat and fat distribution on bone tissue after adjusting for the effects of body weight remain uncertain. This study evaluated the relationships between fat mass, fat distribution, and bone mineral status beyond its weight-bearing effect. We recruited 466 children aged 6–10 years in China. Dual-energy X-ray absorptiometry was used to determine the bone mineral density (BMD) and bone mineral content (BMC) in the total body and total body less head (TBLH), as well as the fat mass (FM) and percentage fat mass (%FM) of the total and segmental body. Weight-adjusted measures of FM and %FM were derived using the residual method. After adjusting for the effects of covariates, we observed statistically significant, dose-dependent negative relationships between the TBLH·BMD/BMC and various weight-adjusted measures of body fat (p for trend: <0.001–0.038). For each standard deviation increment in the weight-adjusted total body, TBLH, trunk and limbs, the size-adjusted BMC decreased approximately 9.44, 9.28, 8.13, and 6.65 g in boys, respectively, and by approximately 13.74, 13.71, 7.84, and 12.95 g in girls, respectively. Significant inverse associations between FM accumulation in the total body and most body parts with the BMD/BMC were observed in both boys and girls after adjusting for weight and potential confounders.
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Gopal-Kothandapani JS, Rigby AS, Harrison R, Eastell R, Moon RJ, Curtis EM, Cooper C, Harvey NC, Bishop N. Maternal pregnancy vitamin D supplementation increases offspring bone formation in response to mechanical loading: Findings from a MAVIDOS Trial sub-study. JOURNAL OF MUSCULOSKELETAL & NEURONAL INTERACTIONS 2020; 20:4-11. [PMID: 32131365 PMCID: PMC7104581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/16/2020] [Indexed: 10/25/2022]
Abstract
The Maternal Vitamin D Osteoporosis (MAVIDOS) trial reported higher total body bone mineral content in winter-born infants of mothers receiving vitamin D supplementation [1000 IU/day cholecalciferol] compared with placebo from 14 weeks gestation until delivery. This sub-study aimed to determine whether antenatal vitamin D supplementation altered postnatal bone formation in response to mechanical stimulation. Thirty-one children born to MAVIDOS participants randomised to either placebo (n=19) or cholecalciferol (n=12) were recruited at age 4-5 years. Children received whole body vibration (WBV) for 10 minutes on 5 consecutive days. Fasting blood samples for bone homeostasis, 25 hydroxyvitamin D (25OHD), parathyroid hormone (PTH), and bone turnover markers (Pro-collagen Type 1 N-terminal propeptide, P1NP; Cross-linked C-telopeptide of Type I Collagen, CTX) were collected pre-WBV and on day 8 (D8). Mean changes (D) in P1NP (ng/ml) between baseline and D8 in the vitamin-D intervention and placebo groups were 40.6 and -92.6 respectively and mean changes (Δ) in CTX (ng/ml) were 0.034 (intervention) and -0.084 (placebo) respectively. Between-group DP1NP difference was 133.2ng/ml [95% CI 0.4, 266.0; p=0.049] and ΔCTX 0.05ng/ml (95% CI -0.159, 0.26ng/mL; p=0.62). Antenatal vitamin-D supplementation resulted in increased P1NP in response to WBV, suggesting early life vitamin D supplementation increases the anabolic response of bone to mechanical loading in children.
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Affiliation(s)
| | - Alan S Rigby
- Hull York Medical School, Faculty of Health, University of Hull, Hull, UK
| | - Rachel Harrison
- Sheffield Children’s NHS Foundation Trust, University of Sheffield, Sheffield, UK
| | - Richard Eastell
- Academic Unit of Bone Metabolism, Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Rebecca J. Moon
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton, UK, UK
- University Hospital Southampton NHS Foundation Trust, Southampton, UK, UK
| | - Elizabeth M. Curtis
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton, UK, UK
- University Hospital Southampton NHS Foundation Trust, Southampton, UK, UK
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton, UK, UK
- University Hospital Southampton NHS Foundation Trust, Southampton, UK, UK
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Nicholas C. Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton, UK, UK
- University Hospital Southampton NHS Foundation Trust, Southampton, UK, UK
| | - Nick Bishop
- Academic Unit of Child Health, Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
- Sheffield Children’s NHS Foundation Trust, University of Sheffield, Sheffield, UK
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Allison RM, Birken CS, Lebovic G, Howard AW, L’Abbe MR, Morency ME, Maguire JL. Consumption of Cow's Milk in Early Childhood and Fracture Risk: A Prospective Cohort Study. Am J Epidemiol 2020; 189:146-155. [PMID: 31712819 DOI: 10.1093/aje/kwz216] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 09/12/2019] [Indexed: 11/13/2022] Open
Abstract
Cow's milk is consumed by most North American children, yet the relationships between the volume and fat content of cow's milk consumed and childhood fracture risk are unclear. Our primary objectives in this study were to evaluate whether the volume or fat content of cow's milk consumed at 1-3 years of age was associated with the risk of fracture between 3 and 10 years of age. This was a prospective cohort study of 2,466 children enrolled in Toronto, Ontario, Canada, between 2008 and 2016. The primary exposure was volume of cow's milk consumed between the ages of 1 and 3 years, and the secondary exposure was average percentage of milk fat consumed by each child during the same period. The primary outcome was a parental report of child fracture at ages 3-10 years. In the primary and secondary adjusted analyses, no association between milk volume and fracture risk (adjusted relative risk = 1.04, 95% confidence interval: 0.87, 1.26) or between milk-fat content and fracture risk (adjusted relative risk = 1.05, 95% confidence interval: 0.84, 1.31) was observed. In this study, we did not identify a protective association of early childhood cow's milk volume or fat consumption with fracture risk in later childhood. Future prospective research is needed to understand whether cow's milk is beneficial for fracture prevention through the life course.
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Affiliation(s)
- Riley M Allison
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, St. Michael’s Hospital, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilan Centre for Research and Learning, Toronto, Ontario, Canada
| | - Catherine S Birken
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Pediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilan Centre for Research and Learning, Toronto, Ontario, Canada
- Institute of Health Policy and Management and Evaluation, School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Gerald Lebovic
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Institute of Health Policy and Management and Evaluation, School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Andrew W Howard
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Pediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilan Centre for Research and Learning, Toronto, Ontario, Canada
| | - Mary R L’Abbe
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Pediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilan Centre for Research and Learning, Toronto, Ontario, Canada
| | - Marie-Elssa Morency
- Department of Pediatrics, St. Michael’s Hospital, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Jonathon L Maguire
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, St. Michael’s Hospital, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Pediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
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Galindo-Zavala R, Bou-Torrent R, Magallares-López B, Mir-Perelló C, Palmou-Fontana N, Sevilla-Pérez B, Medrano-San Ildefonso M, González-Fernández MI, Román-Pascual A, Alcañiz-Rodríguez P, Nieto-Gonzalez JC, López-Corbeto M, Graña-Gil J. Expert panel consensus recommendations for diagnosis and treatment of secondary osteoporosis in children. Pediatr Rheumatol Online J 2020; 18:20. [PMID: 32093703 PMCID: PMC7041118 DOI: 10.1186/s12969-020-0411-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 02/03/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Osteoporosis incidence in children is increasing due to the increased survival rate of patients suffering from chronic diseases and the increased use of drugs that can damage bones. Recent changes made to the definition of childhood osteoporosis, along with the lack of guidelines or national consensuses regarding its diagnosis and treatment, have resulted in a wide variability in the approaches used to treat this disease. For these reasons, the Osteogenesis Imperfecta and Childhood Osteoporosis Working Group of the Spanish Society of Pediatric Rheumatology has sounded the need for developing guidelines to standardize clinical practice with regard to this pathology. METHODS An expert panel comprised of 6 pediatricians and 5 rheumatologists carried out a qualitative literature review and provided recommendations based on evidence, when that was available, or on their own experience. The level of evidence was determined for each section using the Oxford Centre for Evidence-based Medicine (CEBM) system. A Delphi survey was conducted for those recommendations with an evidence level of IV or V. This survey was sent to all members of the SERPE. All recommendations that had a level of agreement higher or equal to 70% were included. RESULTS Fifty-one recommendations, categorized into eight sections, were obtained. Twenty-four of them presented an evidence level 4 or 5, and therefore a Delphi survey was conducted. This was submitted electronically and received a response rate of 40%. All recommendations submitted to the Delphi round obtained a level of agreement of 70% or higher and were therefore accepted. CONCLUSION In summary, we present herein guidelines for the prevention, diagnosis and treatment of secondary childhood osteoporosis based on the available evidence and expert clinical experience. We believe it can serve as a useful tool that will contribute to the standardization of clinical practice for this pathology. Prophylactic measures, early diagnosis and a proper therapeutic approach are essential to improving bone health, not only in children and adolescents, but also in the adults they will become in the future.
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Affiliation(s)
- Rocío Galindo-Zavala
- UGC Pediatría. Sección Reumatología Pediátrica, Hospital Regional Universitario de Málaga, Málaga, Spain.
| | - Rosa Bou-Torrent
- 0000 0001 0663 8628grid.411160.3Unidad de Reumatología Pediátrica, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Berta Magallares-López
- 0000 0004 1768 8905grid.413396.aServicio de Reumatología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Concepción Mir-Perelló
- 0000 0004 1796 5984grid.411164.7Unidad de Pediatría, Sección Reumatología Pediátrica, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Natalia Palmou-Fontana
- 0000 0001 0627 4262grid.411325.0Unidad de Reumatología, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Belén Sevilla-Pérez
- UGC Pediatría, Sección Reumatología Pediátrica, Hospital Campus de la Salud, Granada, Spain
| | | | - Mª. Isabel González-Fernández
- 0000 0001 0360 9602grid.84393.35Unidad de Pediatría, Sección de Reumatología Pediátrica, Hospital La Fe, Valencia, Spain
| | | | - Paula Alcañiz-Rodríguez
- Unidad de Pediatría, Sección de Reumatología Pediátrica, Hospital Virgen de la Arriaxaca, Murcia, Spain
| | - Juan Carlos Nieto-Gonzalez
- 0000 0001 0277 7938grid.410526.4Servicio de Reumatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Mireia López-Corbeto
- 0000 0001 0675 8654grid.411083.fServicio de Reumatología Hospital Vall d’Hebron, Barcelona, Spain
| | - Jenaro Graña-Gil
- 0000 0004 1771 0279grid.411066.4Servicio de Reumatología, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain ,Osteogenesis Imperfecta and Secondary Osteoporosis Working Group from the Spanish Pediatric Rheumatology Society, Madrid, Spain
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