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Kääntä E, Parviainen R, Tikanmäki M, Alenius S, Sinikumpu JJ, Kajantie E. Maternal Smoking During Pregnancy and Offspring's Risk for Bone Fracture in Childhood and Adolescence. J Bone Miner Res 2023; 38:1791-1799. [PMID: 37823763 DOI: 10.1002/jbmr.4923] [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: 05/19/2023] [Revised: 09/06/2023] [Accepted: 10/07/2023] [Indexed: 10/13/2023]
Abstract
Conditions during gestation, such as maternal smoking, may affect offspring's bone structure. This could increase the offspring's risk of bone fractures during childhood. In this study, we aimed to assess the association between prenatal exposure to maternal smoking and childhood bone fracture risk. We used a register-based birth cohort that included all children born in Finland between January 1987 and September 1990. After exclusions, the final study population consisted of 220,699 persons. Using a unique national identification number, we linked the cohort data to the fracture diagnosis in specialty care and covariate data using the Medical Birth Register (MBR), Statistics Finland and Care Register for Health Care (CRHC). The fractures were analyzed in three groups: all fractures, non-high-energy fractures, and high-energy fractures. The analyses were adjusted for sex, parity, child's year of birth, mother's age at childbirth, mother's and father's educational level, and mother's fracture status. We tested the association in three age groups: <1 year, 1-<5 years, and 5-<15 years using Cox and (recurrent fractures) Poisson regression. A total of 18,857 (8.5%) persons had at least one bone fracture diagnosis before the age of 15 years. In the age group 5-<15 years, maternal smoking during pregnancy was associated with higher fracture risk in all of the studied fracture groups: hazard ratio (HR) = 1.12 (95% confidence interval [CI] 1.06-1.17) in all fractures, 1.13 (95% CI 1.07-1.19) in non-high-energy, and 1.15 (95% CI 1.00-1.32) in high-energy fractures. There were no significant associations in other age groups in any of the fracture groups. No statistically significant association between maternal smoking during pregnancy and offspring's risk of recurrent fractures was found. In conclusion, 5- to 15-year-olds whose mothers have smoked during pregnancy have an increased risk of bone fractures treated in specialty care. © 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)
- Emil Kääntä
- Research Unit of Clinical Medicine, Medical Research Center, University of Oulu, Oulu, Finland
- Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland
- Finnish Institute of Health and Welfare, Helsinki, Finland
| | - Roope Parviainen
- Research Unit of Clinical Medicine, Medical Research Center, University of Oulu, Oulu, Finland
- Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland
- Finnish Institute of Health and Welfare, Helsinki, Finland
| | - Marjaana Tikanmäki
- Research Unit of Clinical Medicine, Medical Research Center, University of Oulu, Oulu, Finland
- Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland
- Finnish Institute of Health and Welfare, Helsinki, Finland
| | - Suvi Alenius
- Finnish Institute of Health and Welfare, Helsinki, Finland
- Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Juha-Jaakko Sinikumpu
- Research Unit of Clinical Medicine, Medical Research Center, University of Oulu, Oulu, Finland
- Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland
| | - Eero Kajantie
- Research Unit of Clinical Medicine, Medical Research Center, University of Oulu, Oulu, Finland
- Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland
- Finnish Institute of Health and Welfare, Helsinki, Finland
- Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
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Akhiiarova K, Khusainova R, Minniakhmetov I, Mokrysheva N, Tyurin A. Peak Bone Mass Formation: Modern View of the Problem. Biomedicines 2023; 11:2982. [PMID: 38001982 PMCID: PMC10669090 DOI: 10.3390/biomedicines11112982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/26/2023] [Accepted: 11/02/2023] [Indexed: 11/26/2023] Open
Abstract
Peak bone mass is the amount of bone tissue that is formed when a stable skeletal state is achieved at a young age. To date, there are no established peak bone mass standards nor clear data on the age at which peak bone mass occurs. At the same time, the level of peak bone mass at a young age is an important predictor of the onset of primary osteoporosis. The purpose of this review is to analyze the results of studies of levels of peak bone mass in general, the age of its onset, as well as factors influencing its formation. Factors such as hormonal levels, body composition, physical activity, nutrition, heredity, smoking, lifestyle, prenatal predictors, intestinal microbiota, and vitamin and micronutrient status were considered, and a comprehensive scheme of the influence of these factors on the level of peak bone mass was created. Determining the standards and timing of the formation of peak bone mass, and the factors affecting it, will help in the development of measures to prevent its shortage and the consequent prevention of osteoporosis and concomitant diseases.
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Affiliation(s)
- Karina Akhiiarova
- Internal Medicine Department, Bashkir State Medical University, 450008 Ufa, Russia;
| | - Rita Khusainova
- Medical Genetics Department, Bashkir State Medical University, 450008 Ufa, Russia;
- Endocrinology Research Centre, Dmitriya Ulianova Street, 11, 117036 Moscow, Russia; (I.M.); (N.M.)
| | - Ildar Minniakhmetov
- Endocrinology Research Centre, Dmitriya Ulianova Street, 11, 117036 Moscow, Russia; (I.M.); (N.M.)
| | - Natalia Mokrysheva
- Endocrinology Research Centre, Dmitriya Ulianova Street, 11, 117036 Moscow, Russia; (I.M.); (N.M.)
| | - Anton Tyurin
- Internal Medicine Department, Bashkir State Medical University, 450008 Ufa, Russia;
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Hart DA. Sex Differences in Biological Systems and the Conundrum of Menopause: Potential Commonalities in Post-Menopausal Disease Mechanisms. Int J Mol Sci 2022; 23:4119. [PMID: 35456937 PMCID: PMC9026302 DOI: 10.3390/ijms23084119] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/30/2022] [Accepted: 04/05/2022] [Indexed: 02/04/2023] Open
Abstract
Sex-specific differences in biology and physiology likely start at the time of conception and progress and mature during the pre-puberty time frame and then during the transitions accompanying puberty. These sex differences are impacted by both genetics and epigenetic alterations during the maturation process, likely for the purpose of preparing for successful reproduction. For females, later in life (~45-50) they undergo another transition leading to a loss of ovarian hormone production at menopause. The reasons for menopause are not clear, but for a subset of females, menopause is accompanied by an increased risk of a number of diseases or conditions that impact a variety of tissues. Most research has mainly focused on the target cells in each of the affected tissues rather than pursue the alternative option that there may be commonalities in the development of these post-menopausal conditions in addition to influences on specific target cells. This review will address some of the potential commonalities presented by an integration of the literature regarding tissue-specific aspects of these post-menopausal conditions and data presented by space flight/microgravity (a condition not anticipated by evolution) that could implicate a loss of a regulatory function of the microvasculature in the risk attached to the affected tissues. Thus, the loss of the integration of the paracrine relationships between endothelial cells of the microvasculature of the tissues affected in the post-menopausal environment could contribute to the risk for post-menopausal diseases/conditions. The validation of this concept could lead to new approaches for interventions to treat post-menopausal conditions, as well as provide new understanding regarding sex-specific biological regulation.
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Affiliation(s)
- David A. Hart
- Department of Surgery and Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 4N1, Canada; ; Tel.: +1-403-220-4571
- Bone & Joint Health Strategic Clinical Network, Alberta Health Services, Edmonton, AB T5J 3E4, Canada
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4
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Vlok J, Simm PJ, Lycett K, Clifford SA, Grobler AC, Lange K, Ismail N, Osborn W, Wake M. pQCT bone geometry and strength: population epidemiology and concordance in Australian children aged 11-12 years and their parents. BMJ Open 2019; 9:63-74. [PMID: 31273017 PMCID: PMC6624036 DOI: 10.1136/bmjopen-2018-022400] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 12/24/2018] [Accepted: 04/04/2019] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES To describe the epidemiology and concordance of bone health in a population-based sample of Australian parent-child dyads at child age 11-12 years. DESIGN Population-based cross-sectional study (the Child Health CheckPoint) nested between waves 6 and 7 of the Longitudinal Study of Australian Children (LSAC). SETTING Assessment centres in seven cities around Australia, February 2015-March 2016. PARTICIPANTS of all participating CheckPoint families (n=1874), bone data were available for 1222 dyads (1271 children, 50% girls; 1250 parents, 86% mothers). OUTCOME MEASURES Peripheral quantitative CT (pQCT) of the non-dominant leg scanned at the 4% (distal) and 66% (mid-calf) tibial sites. Stratec XCT 2000 software generated estimates of bone density, geometry and polar stress-strain index.Parent-child concordance were assessed using Pearson's correlation coefficients and multivariable linear regression models. Percentiles were determined using survey weights. Survey weights and methods accounted for LSAC's complex sampling, stratification and clustering within postcodes. RESULTS Concordances were greater for the geometric pQCT parameters (periosteal circumference 0.38, 95% CI 0.33 to 0.43; endosteal circumference 0.42, 95% CI 0.37 to 0.47; total cross-sectional area 0.37, 95% CI 0.32 to 0.42) than density (cortical density 0.25, 95% CI 0.19 to 0.30). Mother-child and father-child values were similar. Relationships attenuated only slightly on adjustment for age, sex and body mass index. Percentiles and concordance are presented for the whole sample and by sex. CONCLUSIONS There is strong parent-child concordance in bone geometry and, to a lesser extent, density even before the period of peak adolescent bone deposition. This geometrical concordance suggests that future intergenerational bone studies could consider using pQCT rather than the more commonly used dual X-ray absorptiometry (DXA).
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Affiliation(s)
- Jennifer Vlok
- Department of Surgery, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Murdoch Children’s Research Institute, Parkville, Victoria, Australia
| | - Peter J Simm
- Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
- Department of Endocrinology, The Royal Children’s Hospital, Melbourne, Victoria, Australia
| | - Kate Lycett
- Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
- School of Psychology, Deakin University, Burwood, Victoria, Australia
| | - Susan A Clifford
- Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Anneke C Grobler
- Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Katherine Lange
- Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Najmi Ismail
- Murdoch Children’s Research Institute, Parkville, Victoria, Australia
| | - William Osborn
- Murdoch Children’s Research Institute, Parkville, Victoria, Australia
| | - Melissa Wake
- Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
- Department of Paediatrics and The Liggins Institute, The University of Auckland, Auckland, New Zealand
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Yang Y, Pan F, Wu F, Squibb K, Thomson R, Winzenberg T, Jones G. Familial resemblance in trabecular and cortical volumetric bone mineral density and bone microarchitecture as measured by HRpQCT. Bone 2018; 110:76-83. [PMID: 29382612 DOI: 10.1016/j.bone.2018.01.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 01/16/2018] [Accepted: 01/26/2018] [Indexed: 11/29/2022]
Abstract
To estimate the heritability of bone geometry, volumetric bone mineral density (vBMD) and microarchitecture of trabecular (Tb) and cortical (Ct) bone measured by high resolution peripheral quantitative computerised tomography (HRpQCT) at the distal radius and tibia and to investigate the genetic correlations of these measures. Participants were 177 mother-offspring pairs from 162 families (mothers, mean age (SD) = 52.1 (4.7) years; offspring, 25.6 (0.73) years). Trabecular and cortical bone measures were obtained by HRpQCT. Multivariable linear regression was used to analyse the association of bone measures between mother and offspring. Sequential Oligogenic Linkage Analysis Routines (SOLAR) software was utilised to conduct quantitative genetic analyses. All maternal bone measures were independently associated with the corresponding bone measures in the offspring before and after adjustment for age, sex, weight and height. Heritability estimates ranged from 24% to 67% at the radius and from 42% to 74% at the tibia. The relationship for most bone geometry measures was significantly stronger in mother-son pairs (n = 107) compared with mother-daughter pairs (n = 70) (p < 0.05). In contrast, the heritability for most vBMD and microarchitecture measures were higher in mother-daughter pairs. Bivariate analyses found moderate to strong genetic correlations across all measures between radius and tibia (Rg = 0.49 to 0.93). Genetic factors have an important role in the development of bone geometry, vBMD and microarchitecture. These factors are strongly shared for the radius and tibia but vary by sex implying a role for imprinting.
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Affiliation(s)
- Yi Yang
- Menzies Institute for Medical Research, University of Tasmania, Hobart 7000, Australia.
| | - Feng Pan
- Menzies Institute for Medical Research, University of Tasmania, Hobart 7000, Australia.
| | - Feitong Wu
- Menzies Institute for Medical Research, University of Tasmania, Hobart 7000, Australia.
| | - Kathryn Squibb
- Menzies Institute for Medical Research, University of Tasmania, Hobart 7000, Australia.
| | - Russell Thomson
- Centre for Research in Mathematics, School of Engineering, Mathematics and Computing, Western Sydney University, Sydney 2751, Australia.
| | - Tania Winzenberg
- Menzies Institute for Medical Research, University of Tasmania, Hobart 7000, Australia; Faculty of Health, University of Tasmania, Hobart 7000, Australia.
| | - Graeme Jones
- Menzies Institute for Medical Research, University of Tasmania, Hobart 7000, Australia.
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Bao L, Chen M, Lei Y, Zhou Z, Shen H, Le F. Association between vitamin D receptor BsmI polymorphism and bone mineral density in pediatric patients: A meta-analysis and systematic review of observational studies. Medicine (Baltimore) 2017; 96:e6718. [PMID: 28445285 PMCID: PMC5413250 DOI: 10.1097/md.0000000000006718] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Vitamin D and the vitamin D receptor (VDR) are important in the metabolic processes that affect bone mineral density (BMD). However, the effect of VDR BsmI polymorphism on BMD in pediatric patients is still unclear. METHODS Eligible studies were identified from the following electronic databases: PubMed, Embase, the Cochrane Library, and the Chinese CNKI and Wanfang databases before October 1, 2016. Data were extracted from the eligible studies, and associations between VDR BsmI polymorphism and BMD in pediatric patients were estimated with weighted mean differences (WMDs) and 95% confidence intervals (CIs). Subgroup analysis of ethnicity and sensitivity analyses were used to identify sources of heterogeneity. RESULTS A significant difference was observed between VDR BsmI polymorphism and pediatric BMD levels of the lumbar spine (LS) in the corecessive model (bb vs BB + Bb: WMD = -0.23, 95% CI [-0.35, -0.11], P < 0.01). No significant relationship was found in the dominant, recessive, or codominant models for LS BMD (BB vs Bb: WMD = -0.56, 95% CI [-1.58, 0.46], P = 0.29; BB vs bb: WMD = -0.54, 95% CI [-1.49, 0.41], P = 0.27; and BB vs Bb + bb: WMD = -0.45, 95% CI [-1.71, 0.26], P = 0.22). In addition, we found no remarkable association between the BsmI polymorphism and BMD levels of the femoral neck (FN) in children (BB vs Bb: WMD = -1.08, 95% CI [-3.13, 0.96], P = 0.30; BB vs bb: WMD = 0.98, 95% CI [-0.89, 2.85], P = 0.31; BB vs Bb + bb: WMD = -0.061, 95% CI [-0.30, 0.17], P = 0.61; and bb vs BB + Bb: WMD = 0.82, 95% CI [-0.59, 2.32], P = 0.25). CONCLUSION Our meta-analysis found that the VDR BsmI genetic polymorphism was correlated with LS BMD level in pediatric patients: compared with those with the B allele, children with the bb genotype were less likely to have lower BMD levels. No significant difference was identified in the pediatric FN BMD levels.
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Affiliation(s)
| | | | | | | | | | - Feng Le
- Department of Protection, Affiliated Yixing People Hospital, Jiangsu University, Yixing, China
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7
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Kim KM, Kim YJ, Choi SH, Lim S, Moon JH, Kim JH, Kim SW, Jang HC, Shin CS. The effects of body mass index on the hereditary influences that determine peak bone mass in mother-daughter pairs (KNHANES V). Osteoporos Int 2016; 27:2057-64. [PMID: 26809191 DOI: 10.1007/s00198-016-3487-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 01/06/2016] [Indexed: 12/26/2022]
Abstract
UNLABELLED A daughter's bone mineral density (BMD) is significantly correlated with her mother's BMD, but the daughter's body mass index (BMI) could modulate this association. Maternal inheritance dominantly affects daughters with a lower BMI, but BMI could compensate for hereditary influences in daughters with a higher BMI in terms of daughter's BMD. INTRODUCTION Achieving optimal peak bone mass at a young age is the best way to protect against future osteoporosis and subsequent fractures. Although environmental components influence bone mass accrual, but peak bone mass is largely programmed by inheritance. The aims of this study were to investigate the influence of maternal inheritance on the daughter's bone mass and to assess whether these influences differ according to the daughter's body mass index (BMI). METHODS We used data obtained from the 2010 Korean National Health and Nutrition Examination Survey V and included 187 mother-daughter pairs. Bone mineral density (BMD) was measured at the lumbar spine (LS), femur neck (FN), and total hip (TH) by using dual-energy X-ray absorptiometry (DXA). The daughter group was stratified into two groups according to the mean BMI (21.4 kg/m(2)). RESULTS The daughters' BMD correlated significantly with both their BMI and their mothers' Z-score for each skeletal site. In the daughters with a lower BMI (≤21.4 kg/m(2)), the BMDs at the FN and TH were affected more by the mothers' Z-score than by the daughters' BMI. Meanwhile, the influence of the daughters' BMI on their BMD was higher than that of their mothers' Z-score in daughters with a higher BMI (>21.4 kg/m(2)). Moreover, the mothers' Z-scores were a significant predictor of their daughters having Z-scores < -1.0 only in daughters with a lower BMI. CONCLUSIONS This study suggests that maternal inheritance is an important determinant of the daughters' bone mass, but that this hereditary factor may vary according to the daughters' BMI.
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Affiliation(s)
- K M Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Y J Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - S H Choi
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - S Lim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - J H Moon
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - J H Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - S W Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Borame Hospital, Seoul, Korea
| | - H C Jang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - C S Shin
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
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Warrington NM, Kemp JP, Tilling K, Tobias JH, Evans DM. Genetic variants in adult bone mineral density and fracture risk genes are associated with the rate of bone mineral density acquisition in adolescence. Hum Mol Genet 2015; 24:4158-66. [PMID: 25941325 PMCID: PMC4476449 DOI: 10.1093/hmg/ddv143] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 04/09/2015] [Accepted: 04/19/2015] [Indexed: 01/27/2023] Open
Abstract
Previous studies have identified 63 single-nucleotide polymorphisms (SNPs) associated with bone mineral density (BMD) in adults. These SNPs are thought to reflect variants that influence bone maintenance and/or loss in adults. It is unclear whether they affect the rate of bone acquisition during adolescence. Bone measurements and genetic data were available on 6397 individuals from the Avon Longitudinal Study of Parents and Children at up to five follow-up clinics. Linear mixed effects models with smoothing splines were used for longitudinal modelling of BMD and its components bone mineral content (BMC) and bone area (BA), from 9 to 17 years. Genotype data from the 63 adult BMD associated SNPs were investigated individually and as a genetic risk score in the longitudinal model. Each additional BMD lowering allele of the genetic risk score was associated with lower BMD at age 13 [per allele effect size, 0.002 g/cm(2) (SE = 0.0001, P = 1.24 × 10(-38))] and decreased BMD acquisition from 9 to 17 years (P = 9.17 × 10(-7)). This association was driven by changes in BMC rather than BA. The genetic risk score explained ∼2% of the variation in BMD at 9 and 17 years, a third of that explained in adults (6%). Genetic variants that putatively affect bone maintenance and/or loss in adults appear to have a small influence on the rate of bone acquisition through adolescence.
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Affiliation(s)
- Nicole M Warrington
- The University of Queensland Diamantina Institute, The University of Queensland, Translational Research Institute, Brisbane, Australia,
| | - John P Kemp
- The University of Queensland Diamantina Institute, The University of Queensland, Translational Research Institute, Brisbane, Australia, MRC Integrative Epidemiology Unit, School of Social and Community Medicine and
| | - Kate Tilling
- MRC Integrative Epidemiology Unit, School of Social and Community Medicine and
| | | | - David M Evans
- The University of Queensland Diamantina Institute, The University of Queensland, Translational Research Institute, Brisbane, Australia, MRC Integrative Epidemiology Unit, School of Social and Community Medicine and
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Crabtree NJ, Arabi A, Bachrach LK, Fewtrell M, El-Hajj Fuleihan G, Kecskemethy HH, Jaworski M, Gordon CM. Dual-energy X-ray absorptiometry interpretation and reporting in children and adolescents: the revised 2013 ISCD Pediatric Official Positions. J Clin Densitom 2014; 17:225-42. [PMID: 24690232 DOI: 10.1016/j.jocd.2014.01.003] [Citation(s) in RCA: 378] [Impact Index Per Article: 37.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 01/08/2014] [Indexed: 01/17/2023]
Abstract
The International Society for Clinical Densitometry Official Revised Positions on reporting of densitometry results in children represent current expert recommendations to assist health care providers determine which skeletal sites should be measured, which, if any, adjustments should be made, reference databases to be used, and the elements to include in a dual-energy X-ray absorptiometry report. The recommended scanning sites remain the total body less head and the posterior-anterior spine. Other sites such as the proximal femur, lateral distal femur, lateral vertebral assessment, and forearm are discussed but are only recommended for specific pediatric populations. Different methods of interpreting bone density scans in children with short stature or growth delay are presented. The use of bone mineral apparent density and height-adjusted Z-scores are recommended as suitable size adjustment techniques. The validity of appropriate reference databases and technical considerations to consider when upgrading software and hardware remain unchanged. Updated reference data sets for all contemporary bone densitometers are listed. The inclusion of relevant demographic and health information, technical details of the scan, Z-scores, and the wording "low bone mass or bone density" for Z-scores less than or equal to -2.0 standard deviation are still recommended for clinical practice. The rationale and evidence for the development of the Official Positions are provided. Changes in the grading of quality of evidence, strength of recommendation, and worldwide applicability represent a change in current evidence and/or differences in opinion of the expert panelists used to validate the position statements for the 2013 Position Development Conference.
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Affiliation(s)
- Nicola J Crabtree
- Department of Endocrinology, Birmingham Children's Hospital, Birmingham, UK.
| | - Asma Arabi
- Calcium Metabolism and Osteoporosis Program, American University of Beirut, Lebanon
| | - Laura K Bachrach
- Endocrinology, Department of Medicine, Stanford University, Palo Alto, CA, USA
| | - Mary Fewtrell
- Department of Nutritional and Surgical Science, UCL Institute of Child Health, London, UK
| | | | - Heidi H Kecskemethy
- Department of Research, Nemours/A.I. duPont Hospital for Children, Wilmington, DE, USA
| | - Maciej Jaworski
- Department of Biochemistry and Experimental Medicine, The Children's Memorial Health Institute, Warsaw, Poland
| | - Catherine M Gordon
- Division of Adolescent Medicine, Hasbro Children's Hospital and Alpert Medical School of Brown University, Providence, RI, USA
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10
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Nabulsi M, Mahfoud Z, El-Rassi R, Al-Shaar L, Maalouf J, El-Hajj Fuleihan G. Gender differences in the heritability of musculoskeletal and body composition parameters in mother-daughter and mother-son pairs. J Clin Densitom 2013; 16:223-30. [PMID: 22704220 DOI: 10.1016/j.jocd.2012.04.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Revised: 04/22/2012] [Accepted: 04/23/2012] [Indexed: 11/22/2022]
Abstract
Bone mass and body composition traits are genetically programmed, but the timing and gender and site specificities of their heritability are unclear. Mother-child correlations of bone mineral density (BMD) and bone mineral content, lean mass, and fat mass were studied in 169 premenopausal mothers and their 239 children. Heritability estimates of lean mass, fat mass, BMD, and area were derived for each gender and pubertal stage. There were significant correlations for most densitometry-derived variables at the spine, hip, femoral neck (FN), and total body (r=0.192-0.388) in mother-postmenarcheal daughter pairs, for bone areas at all sites in early puberty (r=0.229-0.508) and for volumetric-derived density at FN and spine (r=0.238-0.368) in mother-son pairs. Fat mass correlations were significant in both genders after puberty (r=0.299-0.324) and lean mass in postmenarcheal girls only (r = 0.299). Heritability estimates varied between 21% and 37% for mother-daughter and 18% and 35% for mother-son pairs for density-derived variables and between 26% and 40% for body composition variables. Maternal inheritance of bone traits is expressed in early-pubertal boys for several skeletal site traits but consistently involves most site traits in girls and boys by late puberty. Body composition inheritance is more variable.
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Affiliation(s)
- Mona Nabulsi
- Department of Pediatrics and Adolescent Medicine, Faculty of Medicine, American University of Beirut, Beirut, Lebanon.
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11
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Sešelj M, Nahhas RW, Sherwood RJ, Chumlea WC, Towne B, Duren DL. The influence of age at menarche on cross-sectional geometry of bone in young adulthood. Bone 2012; 51:38-45. [PMID: 22513271 PMCID: PMC3584571 DOI: 10.1016/j.bone.2012.03.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Revised: 02/24/2012] [Accepted: 03/29/2012] [Indexed: 11/24/2022]
Abstract
Elucidating the somatic and maturational influences on the biomechanical properties of bone in children is crucial for a proper understanding of bone strength and quality in childhood and later life, and has significant potential for predicting adult fracture and osteoporosis risks. The ability of a long bone to resist bending and torsion is primarily a function of its cross-sectional geometric properties, and is negatively impacted by smaller external bone diameter. In pubescent girls, elevated levels of estrogen impede subperiosteal bone growth and increase endosteal bone deposition, resulting in bones averaging a smaller external and internal diameter relative to boys. In addition, given a well-documented secular trend for an earlier menarche, the age at which the rate of subperiosteal bone deposition decreases may also be younger in more recent cohorts of girls. In this study we examined the relationship between pubertal timing and subsequent bone strength in girls. Specifically, we investigated the effects of age at menarche on bone strength indicators (polar moment of inertia and section modulus) determined from cross-sectional geometry of the second metacarpal (MC2) using data derived from serial hand-wrist radiographs of female participants (N=223) in the Fels Longitudinal Study, with repeated measures of MC2 between the ages of 7 and 35 years. Using multivariate regression models, we evaluated the effects of age at menarche on associations between measures of bone strength in early adulthood and the same measures at a prepubertal age. Results indicate that later age at menarche is associated with stronger adult bone (in torsion and bending) when controlling for prepubertal bone strength (R(2) ranged between 0.54 and 0.70, p<0.001). Since cross-sectional properties of bone in childhood may have long lasting implications, they should be considered along with pubertal timing in assessing risk for future fracture and in clinical recommendations.
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Affiliation(s)
- Maja Sešelj
- Division of Morphological Sciences and Biostatistics, Lifespan Health Research Center, Department of Community Health, Wright State University Boonshoft School of Medicine, USA.
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12
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Zhao J, Bradfield JP, Li M, Zhang H, Mentch FD, Wang K, Sleiman PMA, Kim CE, Glessner JT, Frackelton EC, Chiavacci RM, Berkowitz RI, Zemel BS, Hakonarson H, Grant SFA. BMD-associated variation at the Osterix locus is correlated with childhood obesity in females. Obesity (Silver Spring) 2011; 19:1311-4. [PMID: 21212767 DOI: 10.1038/oby.2010.324] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Recent genome wide association studies (GWAS) have revealed a number of genetic variants robustly associated with bone mineral density (BMD) and/or osteoporosis. Evidence from epidemiological and clinical studies has shown an association between BMD and BMI, presumably as a consequence of bone loading. We investigated the 23 previously published BMD GWAS-derived loci in the context of childhood obesity by leveraging our existing genome-wide genotyped European American cohort of 1106 obese children (BMI ≥ 95th percentile) and 5997 controls (BMI < 95th percentile). Evidence of association was only observed at one locus, namely Osterix (SP7), with the G allele of rs2016266 being significantly over-represented among childhood obesity cases (P = 2.85 × 10(-3)). When restricting these analyses to each gender, we observed strong association between rs2016266 and childhood obesity in females (477 cases and 2867 controls; P = 3.56 × 10(-4)), which survived adjustment for all tests applied. However, no evidence of association was observed among males. Interestingly, Osterix is the only GWAS locus uncovered to date that has also been previously implicated in the determination of BMD in childhood. In conclusion, these findings indicate that a well established variant at the Osterix locus associated with increased BMD is also associated with childhood obesity primarily in females.
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Affiliation(s)
- Jianhua Zhao
- Division of Human Genetics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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13
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Vidulich L, Norris SA, Cameron N, Pettifor JM. Bone mass and bone size in pre- or early pubertal 10-year-old black and white South African children and their parents. Calcif Tissue Int 2011; 88:281-93. [PMID: 21274706 DOI: 10.1007/s00223-011-9460-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2010] [Accepted: 12/20/2010] [Indexed: 11/26/2022]
Abstract
Genetic factors are thought to maintain bone mass in socioeconomically disadvantaged black South Africans. We compared bone mass between environmentally disadvantaged black and advantaged white children and their parents, after determining the most appropriate method by which to correct bone mineral content (BMC) for size. We collected data from 419 healthy black and white children of mean age 10.6 years (range 10.0-10.9), 406 biological mothers, and 100 biological fathers. Whole-body, femoral neck, lumbar spine, and mid- and distal one-third of radius bone area (BA) and BMC were measured by dual-energy X-ray absorptiometry. Power coefficients (PCs) were calculated from the linear-regression analyses of ln(BMC) on ln(BA) and used to correct site-specific BMC for bone size differences. Heritability (½h(2), %) by maternal and paternal descent was estimated by regressing children's Z scores on parents' Z scores. Correcting BMC for height, weight, and BA(PC) accounted for the greatest variance of BMC at all skeletal sites. In so doing, BMC in blacks was up to 2.6 times greater at the femoral neck and lumbar spine. Maternal and paternal heritability was estimated to be ~30% in both black and white subjects. These results may in part explain the lower prevalence of fragility fractures at the hip in black South African children when compared to whites. Heritability was comparable between environmentally disadvantaged black and advantaged white South African children and similar to that reported for Caucasians in other parts of the world.
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Affiliation(s)
- L Vidulich
- MRC Mineral Metabolism Research Unit, Department of Paediatrics, Chris Hani Baragwanath Hospital, University of the Witwatersrand, Johannesburg, South Africa.
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14
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Cvijetic S, Colic Baric I, Satalic Z. Influence of heredity and environment on peak bone density: a parent-offspring study. J Clin Densitom 2010; 13:301-6. [PMID: 20542459 DOI: 10.1016/j.jocd.2010.03.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2009] [Revised: 03/08/2010] [Accepted: 03/08/2010] [Indexed: 11/19/2022]
Abstract
The aim of the study was to determine the relative influence of heredity and environment on peak bone density and also to estimate the risk of having low peak bone density if the bone density of parents is low. The study comprised 83 families (48 daughters and 35 sons and their parents). The children were at an age when bone density is at its peak at most skeletal sites (22.2+/-1.8 girls; 23.1+/-1.2 boys). Bone mineral density (BMD; g/cm(2)) was determined by dual-energy X-ray absorptiometry. Anthropometric measurements were made, and calcium intake and physical activity were assessed. Heredity accounted for 22-42% of the variation in BMD of the children, depending on the skeletal site. Heritability for cortical BMD of mid-radius was considerably lower than that for spinal trabecular BMD. Children whose parents had low BMDs (T-score< or =-1) were 1.1 times more likely to inherit low BMD. Child BMD depended significantly on parent BMD and also on physical activity. In our study, heredity accounted for the total BMD variation more than the environmental factors. This influence was lower in the cortical than in the trabecular parts of the skeleton. Optimal environmental factors, such as physical activity, may influence the risk of inheriting low BMD.
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Affiliation(s)
- Selma Cvijetic
- Institute for Medical Research and Occupational Health, Center for Osteoporosis, Zagreb, Croatia.
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15
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Duncan EL, Brown MA. Clinical review 2: Genetic determinants of bone density and fracture risk--state of the art and future directions. J Clin Endocrinol Metab 2010; 95:2576-87. [PMID: 20375209 DOI: 10.1210/jc.2009-2406] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
CONTEXT Osteoporosis is a common, highly heritable condition that causes substantial morbidity and mortality, the etiopathogenesis of which is poorly understood. Genetic studies are making increasingly rapid progress in identifying the genes involved. EVIDENCE ACQUISITION AND SYNTHESIS In this review, we will summarize the current understanding of the genetics of osteoporosis based on publications from PubMed from the year 1987 onward. CONCLUSIONS Most genes involved in osteoporosis identified to date encode components of known pathways involved in bone synthesis or resorption, but as the field progresses, new pathways are being identified. Only a small proportion of the total genetic variation involved in osteoporosis has been identified, and new approaches will be required to identify most of the remaining genes.
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Affiliation(s)
- Emma L Duncan
- University of Queensland Diamantina Institute for Cancer, Immunology and Metabolic Medicine, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Queensland 4102, Australia.
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16
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Crabtree NJ, Roper H, McMurchie H, Shaw NJ. Regional changes in bone area and bone mineral content in boys with duchenne muscular dystrophy receiving corticosteroid therapy. J Pediatr 2010; 156:450-5. [PMID: 19880140 DOI: 10.1016/j.jpeds.2009.09.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2009] [Revised: 08/04/2009] [Accepted: 09/03/2009] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine the functional and skeletal effects of 30 months of steroid treatment in boys with Duchenne muscular dystrophy. STUDY DESIGN Lumbar spine (L(2)L(4)) and subcranial dual energy X-ray absorptiometry scanning was performed on 25 boys (mean age 7.4 years) at baseline and after 30 months of steroid treatment. RESULTS At baseline, L(2)L(4) bone mineral content (BMC) was significantly low for projected bone area although appropriate for reduced lean body mass (LBM). Subcranial bone area for height and subcranial BMC for area and LBM were all significantly reduced. After 30 months of steroid therapy there was a significant increase in subcranial bone area for height but a significant reduction of subcranial BMC for area. At the lumbar spine there were no significant changes in bone area but small increases in L(2)L(4) BMC both for bone area and LBM. CONCLUSION At baseline reduced mechanical load from diminished muscle function results in narrow light bones more noticeable in the subcranial region than the lumbar spine. Increases observed in subcranial bone area at 30 months suggest a gradual adaptation to increased gravitational load whereas at the spine there were no apparent detrimental effects on bone after 30 months of steroid therapy.
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Affiliation(s)
- Nicola J Crabtree
- Department of Nuclear Medicine, Queen Elizabeth Hospital, Birmingham, United Kingdom.
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17
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High-density association study of 383 candidate genes for volumetric BMD at the femoral neck and lumbar spine among older men. J Bone Miner Res 2009; 24:2039-49. [PMID: 19453261 PMCID: PMC2791518 DOI: 10.1359/jbmr.090524] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Genetics is a well-established but poorly understood determinant of BMD. Whereas some genetic variants may influence BMD throughout the body, others may be skeletal site specific. We initially screened for associations between 4608 tagging and potentially functional single nucleotide polymorphisms (SNPs) in 383 candidate genes and femoral neck and lumbar spine volumetric BMD (vBMD) measured from QCT scans among 862 community-dwelling white men >or=65 yr of age in the Osteoporotic Fractures in Men Study (MrOS). The most promising SNP associations (p < 0.01) were validated by genotyping an additional 1156 white men from MrOS. This analysis identified 8 SNPs in 6 genes (APC, DMP1, FGFR2, FLT1, HOXA, and PTN) that were associated with femoral neck vBMD and 13 SNPs in 7 genes (APC, BMPR1B, FOXC2, HOXA, IGFBP2, NFATC1, and SOST) that were associated with lumbar spine vBMD in both genotyping samples (p < 0.05). Although most associations were specific to one skeletal site, SNPs in the APC and HOXA gene regions were associated with both femoral neck and lumbar spine BMD. This analysis identifies several novel and robust genetic associations for volumetric BMD, and these findings in combination with other data suggest the presence of genetic loci for volumetric BMD that are at least to some extent skeletal-site specific.
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18
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Greene DA, Wiebe PN, Naughton GA. Influence of drop-landing exercises on bone geometry and biomechanical properties in prepubertal girls: a randomized controlled study. Calcif Tissue Int 2009; 85:94-103. [PMID: 19458887 DOI: 10.1007/s00223-009-9253-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2008] [Accepted: 04/22/2009] [Indexed: 10/20/2022]
Abstract
We conducted a 28-week school-based exercise trial of single-leg drop-landing exercise with 42 girls (Tanner stage 1, 6-10 years old) randomly assigned to control (C), low-drop (LD), or high-drop (HD) exercise groups. The LD and HD groups performed single-leg drop-landings (three sessions/week and 50 landings/session) from 14 and 28 cm, respectively, using the nondominant leg. Single-leg peak ground-reaction impact forces in a subsample ranged between 2.5 and 4.4 times body weight. Dependent variables were bone geometry and biomechanical properties using magnetic resonance imaging. No differences (P > 0.05) were found among groups at baseline for age, stature, lean tissue mass (DXA--Lunar 3.6-DPX), leisure-time physical activity, average daily calcium intake, or measures of knee extensor or flexor torque. A series of ANOVA and ANCOVA tests showed no within- or between-group differences from baseline to posttraining. Group comparisons assessing magnitude of change in side-to-side differences in geometry (area cm(2)) and cross-sectional moment of inertia (cm(4)) at proximal, mid, and distal sites revealed negligible effect sizes. Our findings suggest that strictly controlled unimodal, unidirectional single-leg drop-landing exercises involving low to moderate peak ground-reaction impact forces do not influence geometrical or biomechanical measures in the developing prepubertal female skeleton.
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Affiliation(s)
- David A Greene
- Centre of Physical Activity Across the Lifespan, School of Exercise Science, Australian Catholic University (ACU National), Strathfield, NSW 2135, Australia.
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19
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Foley S, Quinn S, Jones G. Tracking of bone mass from childhood to adolescence and factors that predict deviation from tracking. Bone 2009; 44:752-7. [PMID: 19103314 DOI: 10.1016/j.bone.2008.11.009] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2008] [Revised: 10/16/2008] [Accepted: 11/06/2008] [Indexed: 11/15/2022]
Abstract
It has been hypothesized that bone density tracks but long term studies in children are lacking. As such, the aim of this study was to describe tracking of dual X-ray absorptiometry measures from age 8 to age 16 years, whether this was independent of change in body size and whether deviation from tracking could be predicted. 116 males and 67 females had anthropometric (height and weight), questionnaire (medication use, sports, breastfeeding), fitness (PWC(170)) and DXA measures (bone free lean mass [LM], fat mass [FM] and bone mass) at baseline and follow-up. BMC and aBMD were assessed at the spine and hip and total body and bone mineral apparent density (BMAD) at the spine and hip. We found all DXA measures tracked significantly after adjustment for change in height and change in weight (males: R(2): BMC 24-62%; aBMD 41-48%; BMAD 30-37%, females: R(2): BMC 45-72%; aBMD 36-56%; BMAD 30-48%). Factors that predicted subjects would deviate positively, that is improve in tertile or remain in the highest tertile of spine and hip aBMD included having been breastfed, increase in LM, PWC(170) at age 8 and sport participation in males. LM at age 8 was beneficial in males while in females; FM at age 8 predicted subjects would deviate positively. Boys who gained absolute and percent FM and girls who gained percent FM, were more likely to deviate negatively, that is, decrease in tertile or remain in the lowest tertile of spine and hip aBMD. ICS use at age 8 also predicted subjects, particularly males would not improve in bone mass relative to their peers. In conclusion, DXA measures track moderately to strongly from childhood to adolescence. This was independent of linear growth and sex indicating bone development and physical growth are under largely separate mechanistic control. Body composition was the main predictor of altered tracking but environmental factors also appear important.
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Affiliation(s)
- Stella Foley
- Menzies Research Institute, University of Tasmania Private Bag 23, Hobart, Tasmania, Australia.
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20
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Timpson NJ, Tobias JH, Richards JB, Soranzo N, Duncan EL, Sims AM, Whittaker P, Kumanduri V, Zhai G, Glaser B, Eisman J, Jones G, Nicholson G, Prince R, Seeman E, Spector TD, Brown MA, Peltonen L, Smith GD, Deloukas P, Evans DM. Common variants in the region around Osterix are associated with bone mineral density and growth in childhood. Hum Mol Genet 2009; 18:1510-7. [PMID: 19181680 PMCID: PMC2664147 DOI: 10.1093/hmg/ddp052] [Citation(s) in RCA: 109] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2008] [Revised: 01/26/2009] [Accepted: 01/26/2009] [Indexed: 11/15/2022] Open
Abstract
Peak bone mass achieved in adolescence is a determinant of bone mass in later life. In order to identify genetic variants affecting bone mineral density (BMD), we performed a genome-wide association study of BMD and related traits in 1518 children from the Avon Longitudinal Study of Parents and Children (ALSPAC). We compared results with a scan of 134 adults with high or low hip BMD. We identified associations with BMD in an area of chromosome 12 containing the Osterix (SP7) locus, a transcription factor responsible for regulating osteoblast differentiation (ALSPAC: P = 5.8 x 10(-4); Australia: P = 3.7 x 10(-4)). This region has previously shown evidence of association with adult hip and lumbar spine BMD in an Icelandic population, as well as nominal association in a UK population. A meta-analysis of these existing studies revealed strong association between SNPs in the Osterix region and adult lumbar spine BMD (P = 9.9 x 10(-11)). In light of these findings, we genotyped a further 3692 individuals from ALSPAC who had whole body BMD and confirmed the association in children as well (P = 5.4 x 10(-5)). Moreover, all SNPs were related to height in ALSPAC children, but not weight or body mass index, and when height was included as a covariate in the regression equation, the association with total body BMD was attenuated. We conclude that genetic variants in the region of Osterix are associated with BMD in children and adults probably through primary effects on growth.
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Affiliation(s)
- Nicholas J. Timpson
- MRC Centre for Causal Analyses in Translational Epidemiology, Department of Social Medicine, University of Bristol, Bristol BS8 2BN, UK
| | - Jon H. Tobias
- Department of Clinical Science at North Bristol, University of Bristol, Bristol BS10 5NB, UK
| | - J. Brent Richards
- Department of Medicine, Jewish General Hospital, McGill University, Montreal, CanadaH3T 1E2
- Department of Twin Research and Genetic Epidemiology, Kings College London, London SE1 7EH, UK
| | - Nicole Soranzo
- Department of Twin Research and Genetic Epidemiology, Kings College London, London SE1 7EH, UK
- Wellcome Trust Sanger Institute, Cambridge CB10 1SA, UK
| | - Emma L. Duncan
- University of Queensland Diamantina Institute for Cancer, Immunology and Metabolic Medicine, Brisbane 4102, Australia
| | - Anne-Marie Sims
- University of Queensland Diamantina Institute for Cancer, Immunology and Metabolic Medicine, Brisbane 4102, Australia
- Institute of Musculoskeletal Sciences, Botnar Research Centre, Nuffield Orthopaedic Centre, University of Oxford, Oxford OX3 7LD, UK
| | | | | | - Guangju Zhai
- Department of Twin Research and Genetic Epidemiology, Kings College London, London SE1 7EH, UK
| | - Beate Glaser
- MRC Centre for Causal Analyses in Translational Epidemiology, Department of Social Medicine, University of Bristol, Bristol BS8 2BN, UK
| | - John Eisman
- Garvan Institute of Medical Research, Sydney 2010, Australia
| | - Graeme Jones
- Menzies Research Institute, Hobart 7000, Australia
| | - Geoff Nicholson
- Department of Clinical and Biomedical Sciences, The University of Melbourne, Barwon Health, Geelong 3220, Australia
| | - Richard Prince
- School of Medicine and Pharmacology, University of Western Australia, Perth 6009, Australia
| | - Ego Seeman
- Departments of Medicine and Endocrinology, University of Melbourne, Melbourne 3084, Australia
| | - Tim D. Spector
- Department of Twin Research and Genetic Epidemiology, Kings College London, London SE1 7EH, UK
| | - Matthew A. Brown
- University of Queensland Diamantina Institute for Cancer, Immunology and Metabolic Medicine, Brisbane 4102, Australia
- Institute of Musculoskeletal Sciences, Botnar Research Centre, Nuffield Orthopaedic Centre, University of Oxford, Oxford OX3 7LD, UK
| | - Leena Peltonen
- Wellcome Trust Sanger Institute, Cambridge CB10 1SA, UK
- Biomedicum Helsinki, Research Program in Molecular Medicine, University of Helsinki, Finland
- Department of Molecular Medicine, National Public Health Institute, Helsinki, Finland
- The Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - George Davey Smith
- MRC Centre for Causal Analyses in Translational Epidemiology, Department of Social Medicine, University of Bristol, Bristol BS8 2BN, UK
| | | | - David M. Evans
- MRC Centre for Causal Analyses in Translational Epidemiology, Department of Social Medicine, University of Bristol, Bristol BS8 2BN, UK
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Abstract
Low bone mass in adults is a major risk factor for low-impact fractures and is considered of complex origin because of interaction of environmental and genetic factors, each with modest effect. The objective was to assess the relative impact of genetics and environment and quantify the risk in relatives of osteopenic individuals. We studied 440 Icelandic nuclear families with 869 first-degree relatives of both sexes. Index cases (male or female) had BMD in the lumbar spine or hip >1.5 SD less than sex-matched controls. Heritability of BMD was estimated by maximum likelihood method, and variance component analysis was used to partition the genetic and environmental effects. Relative risk of low BMD (< -1 SD) in first-degree relatives was estimated, and heritable decrement in BMD was calculated compared with controls. Heritability was estimated as 0.61-0.66. Relative risk among first-degree relatives was 2.28, and the yield of screening was as high as 36%. The genetic influence was consistent with one or a few genes with considerable effect in addition to multiple genes each with a small effect. The genetic deficit in BMD was already present before 35 yr of age and equaled bone loss during 8-30 yr after menopause. We confirmed that genetics are more important than environment to low bone mass in adults. Our results are consistent with a few underlying genes with considerable effect. The prevalence among first-degree relatives of both sexes is common, suggesting that screening them should be cost effective and informative to elucidate the underlying genetics.
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Dual energy X-ray absorptiometry interpretation and reporting in children and adolescents: the 2007 ISCD Pediatric Official Positions. J Clin Densitom 2008; 11:43-58. [PMID: 18442752 DOI: 10.1016/j.jocd.2007.12.005] [Citation(s) in RCA: 269] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2007] [Accepted: 12/05/2007] [Indexed: 02/07/2023]
Abstract
The International Society for Clinical Densitometry Official Positions on reporting of densitometry results in children represent an effort to consolidate opinions to assist healthcare providers determine which skeletal sites should be assessed, which adjustments should be made in these assessments, appropriate pediatric reference databases, and elements to include in a dual energy X-ray absorptiometry (DXA) report. Skeletal sites recommended for assessment are the lumbar spine and total body less head, the latter being valuable as it provides information on soft tissue, as well as bone. Interpretation of DXA findings in children with growth or maturational delay requires special consideration; adjustments are required to prevent erroneous interpretation. Normative databases used as a reference should be based on a large sample of healthy children that characterizes the variability in bone measures relative to gender, age, and race/ethnicity, and should be specific for each manufacturer and model of densitometer and software. Pediatric DXA reports should provide relevant demographic and health information, technical details of the scan, Z-scores, and should not include T-scores. The rationale and evidence for development of the Official Positions are provided. Given the sparse data currently available in many of these areas, it is likely that these positions will change over time as new data become available.
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23
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Livshits G, Kato BS, Wilson SG, Spector TD. Linkage of genes to total lean body mass in normal women. J Clin Endocrinol Metab 2007; 92:3171-6. [PMID: 17550956 DOI: 10.1210/jc.2007-0418] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
BACKGROUND Total lean body mass (LEAN-tot) is one of the three major components of body weight. Its deterioration is a risk factor for frailty. Despite this, there are few studies examining the contribution of genetic factors. OBJECTIVE Our objective was to examine the contribution of genetic factors for LEAN-tot variation, including a genome-wide search for the genes. RESEARCH METHODS Dual-energy x-ray absorptiometry measurements of LEAN-tot were obtained from each of the 3180 United Kingdom females (509 monozygotic and 1081 dizygotic twin pairs). Contribution of genetic factors was assessed using variance component analysis. A genome-wide linkage analysis was performed on the dizygotic twins using a modified version of the Haseman-Elston method. RESULTS Age, body height, total fat, and bone mass were correlated with LEAN-tot, and commonly explained 52% of the LEAN-tot variation. The crude heritability estimate was 74.0 +/- 4.0%, after adjustment for the aforementioned factors; 65.2 +/- 4.6% was attributable to independent genetic effects. Significant (P < 0.001) genetic correlations were found between LEAN-tot and bone mass, and LEAN-tot and total fat. Adjusted only for age, LEAN-tot showed no significant linkage. After adjustment for all covariates, significant linkage (LOD = 4.49 and 3.62) was observed at chromosome 12q24.3 and 14q22.3, respectively. Additional peaks of interest were on 7p15.3-15.1 (LOD = 2.86) and 8p22 (LOD = 2.83). CONCLUSIONS LEAN-tot measured by dual-energy x-ray absorptiometry is highly heritable, independent of other body measures. This first genomic search for genes associated with the lean component of body mass suggests significant linkage to quantitative trait loci on chromosomes 12 and 14.
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24
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Koay MA, Tobias JH, Leary SD, Steer CD, Vilariño-Güell C, Brown MA. The effect of LRP5 polymorphisms on bone mineral density is apparent in childhood. Calcif Tissue Int 2007; 81:1-9. [PMID: 17505772 PMCID: PMC2742716 DOI: 10.1007/s00223-007-9024-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2006] [Accepted: 02/26/2007] [Indexed: 12/01/2022]
Abstract
Bone mass acquired during childhood is the primary determinant of adult bone mineral density (BMD) and osteoporosis risk. Bone accrual is subject to genetic influences. Activating and inactivating LRP5 gene mutations elicit extreme bone phenotypes, while more common LRP5 polymorphisms are associated with normal variation of BMD. Our aim was to test the hypothesis that LRP5 gene polymorphisms influence bone mass acquisition during childhood. The association between LRP5 gene polymorphisms and bone size and mineralization was examined in 819 unrelated British Caucasian children (n = 429 boys) aged 9 years. Height, weight, pubertal status (where available), total-body and spinal bone area, bone mineral content (BMC), BMD, and area-adjusted BMC (aBMC) were assessed. Dual-energy X-ray absorptiometry (DXA)-gene associations were assessed by linear regression, with adjustment for age, gender, pubertal status, and body size parameters. There were 140, 79, 12, and 2 girls who achieved Tanner stages I-IV, respectively, and 179 and 32 boys who achieved Tanner stages I and II, respectively. The rs2,306,862 (N740N) coding polymorphism in exon 10 of the LRP5 gene was associated with spinal BMD and aBMC (each P = 0.01) and total-body BMD and aBMC (P = 0.04 and 0.03, respectively). Adjusting for pubertal stage strengthened associations between this polymorphism and spinal BMD and aBMC (P = 0.01 and 0.002, respectively). Individuals homozygous for the T allele had greater spinal BMD and aBMC scores than those homozygous for the C allele. A dose effect was apparent as the mean spinal BMD and aBMC of heterozygous TC individuals were intermediate between those of their TT and CC counterparts. The N740N polymorphism in exon 10 of LRP5 was associated with spinal BMD and aBMC in pre- and early pubertal children. These results indicate that LRP5 influences volumetric bone density in childhood, possibly through effects on trabecular bone formation.
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Affiliation(s)
- M. Audrey Koay
- Institute of Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Nuffield Orthopaedic Centre, Windmill Road, HeadingtonOxford, OX3 7LD, UK
| | | | - Sam D. Leary
- Community Based Medicine, University of Bristol, Bristol, UK
| | - Colin D. Steer
- Community Based Medicine, University of Bristol, Bristol, UK c.d.steer.@bristol.ac.uk
| | - Carles Vilariño-Güell
- Institute of Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Nuffield Orthopaedic Centre, Windmill Road, HeadingtonOxford, OX3 7LD, UK
| | - Matthew A. Brown
- Institute of Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Nuffield Orthopaedic Centre, Windmill Road, HeadingtonOxford, OX3 7LD, UK
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25
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Pelat C, Van Pottelbergh I, Cohen-Solal M, Ostertag A, Kaufman JM, Martinez M, de Vernejoul MC. Complex segregation analysis accounting for GxE of bone mineral density in European pedigrees selected through a male proband with low BMD. Ann Hum Genet 2007; 71:29-42. [PMID: 17227475 DOI: 10.1111/j.1469-1809.2006.00295.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Osteoporosis is a common multifactorial disorder characterized by low bone mass (BMD) and high susceptibility to low-trauma fractures. Family and twin studies have found a strong genetic component in the determination of BMD, but the mode of inheritance of this trait is not yet fully understood. BMD is a complex trait whose expression is confounded by environmental influences and polygenic inheritance. Detection of potential gene-environment interactions is of great interest in the determination of bone health status. Here we have conducted segregation analyses, using the regressive class D models, in a sample of 100 European pedigrees (NEMO) with 713 subjects (524 measured for phenotypes) identified via a male with low BMD values at either the Lumbar Spine or the Femoral Neck. Segregation analyses were conducted on the residuals of LS-BMD and FN-BMD adjusted for gender, age and BMI. We tested for gene-covariate (GxE) interactions, and investigated the impact of significant GxE interactions on segregation results. Without GxE a major effect was found to be marginally significant in LS-BMD and highly significant in FN-BMD. For both traits the Mendelian hypothesis was rejected. Significant Age x gene and BMI x gene interactions were revealed. Accounting for GxE increased statistical evidence for a major factor in LS-BMD, and improved the fit of the data to the Mendelian transmission model for both traits. The best fitting models suggested a codominant major gene accounting for 45% (LS-BMD) and 44% (FN-BMD) of the adjusted BMDs. However, substantial residual correlations were also found, and these remained highly significant after accounting for the major gene.
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Affiliation(s)
- C Pelat
- INSERM EMI00-06, Evry, France
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26
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Peck JJ, Stout SD. Intraskeletal variability in bone mass. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2007; 132:89-97. [PMID: 16897773 DOI: 10.1002/ajpa.20464] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
For methodological or other reasons, a variety of skeletal elements are analyzed and subsequently used as a basis for describing general bone loss and mass. However, bone loss and mass may not be uniform within and among skeletal elements of the same individual because of biomechanical factors. We test the hypothesis that a homogeneity in bone mass exists among skeletal elements of the same individual. Measures indicative of bone mass were calculated from the midshafts of six skeletal elements from the same individuals (N = 41). The extent of intraskeletal variability in bone mass (relative cortical area) was then examined for the entire sample, according to age, sex, and pathological status. The results of the analysis showed that all measures reflect a heterogeneity in bone mass (P </= 0.001). Specifically, differences were observed between the bones of the upper limb and those of the lower limb. Both sexes showed intraskeletal variability in bone mass, but the difference between the sexes is not significant (P = 0.509). When the sample is subdivided according to age, all groups show intraskeletal variability in bone mass, but the difference did not differ significantly among the groups (P = 0.217). However, significant differences in intraskeletal variability are observed between individuals below and above the age of 50. Pathological individuals show intraskeletal variability in bone mass, but the difference between the pathological and non-pathological groups is not significant (P = 0.095). These results indicate that the bone mass of any particular skeletal element is intricately tethered to its specific mechanical loading environment.
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Affiliation(s)
- Joshua J Peck
- Department of Anthropology, The Ohio State University, Columbus, OH 43210-1364, USA.
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27
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Duren DL, Sherwood RJ, Choh AC, Czerwinski SA, Chumlea WC, Lee M, Sun SS, Demerath EW, Siervogel RM, Towne B. Quantitative genetics of cortical bone mass in healthy 10-year-old children from the Fels Longitudinal Study. Bone 2007; 40:464-70. [PMID: 17056310 PMCID: PMC1945206 DOI: 10.1016/j.bone.2006.09.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2006] [Revised: 08/18/2006] [Accepted: 09/14/2006] [Indexed: 11/15/2022]
Abstract
The genetic influences on bone mass likely change throughout the life span, but most genetic studies of bone mass regulation have focused on adults. There is, however, a growing awareness of the importance of genes influencing the acquisition of bone mass during childhood on lifelong bone health. The present investigation examines genetic influences on childhood bone mass by estimating the residual heritabilities of different measures of second metacarpal bone mass in a sample of 600 10-year-old participants from 144 families in the Fels Longitudinal Study. Bivariate quantitative genetic analyses were conducted to estimate genetic correlations between cortical bone mass measures, and measures of bone growth and development. Using a maximum likelihood-based variance components method for pedigree data, we found a residual heritability estimate of 0.71 for second metacarpal cortical index. Residual heritability estimates for individual measures of cortical bone (e.g., lateral cortical thickness, medial cortical thickness) ranged from 0.47 to 0.58, at this pre-pubertal childhood age. Low genetic correlations were found between cortical bone measures and both bone length and skeletal age. However, after Bonferonni adjustment for multiple testing, rho(G) was not significantly different from 0 for any of these pairs of traits. Results of this investigation provide evidence of significant genetic control over bone mass largely independent of maturation while bones are actively growing and before rapid accrual of bone that typically occurs during puberty.
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Affiliation(s)
- Dana L Duren
- Lifespan Health Research Center, Department of Community Health, Wright State University Boonshoft School of Medicine, 3171 Research Boulevard, Dayton, OH 45420, USA.
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28
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Erbas B, Ristevski S, Poon C, Yeung S, Ebeling PR. Decreased spinal and femoral neck volumetric bone mineral density (BMD) in men with primary osteoporosis and their first-degree male relatives: familial effect on BMD in men. Clin Endocrinol (Oxf) 2007; 66:78-84. [PMID: 17201805 DOI: 10.1111/j.1365-2265.2006.02690.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Low bone mass may be caused by a reduction in the amount of bone or density of bone or both. The purpose of this study was to examine differences in bone volume and volumetric bone mineral density (vBMD) in men with primary osteoporosis and their first-degree male relatives (FDMR). DESIGN We used dual-energy X-ray absorptiometry (DXA) to measure areal density, then calculated bone volume and volumetric density in 121 men with primary osteoporosis, 73 FDMR and 66 normal men. We used regression methods adjusting for age, height and weight to determine deficits in bone volume and vBMD at the spine and femoral neck between men with spinal fractures due to primary osteoporosis, FDMR and normal men. RESULTS Men with osteoporosis had a tendency to smaller bone volume in the spine and femoral neck (P = 0.08 and P = 0.09, respectively) and lower volumetric bone density at the spine (by about 50%) and femoral neck (by about 30%) compared with healthy controls (P < 0.0001). FDMR had no deficit in bone volume but did have lower volumetric density at the spine (by 10.2%) compared with healthy controls (P < 0.0001). CONCLUSIONS A deficit in bone mineral accrual may underlie the pathogenesis of primary osteoporosis in men, resulting in low vBMD. This is likely to be determined by genetic factors, although shared common environmental factors may also be important.
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Affiliation(s)
- Bircan Erbas
- Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, School of Population Health, University of Melbourne, Parkville, Australia
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29
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Xiao P, Shen H, Guo YF, Xiong DH, Liu YZ, Liu YJ, Zhao LJ, Long JR, Guo Y, Recker RR, Deng HW. Genomic regions identified for BMD in a large sample including epistatic interactions and gender-specific effects. J Bone Miner Res 2006; 21:1536-44. [PMID: 16995807 DOI: 10.1359/jbmr.060717] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
UNLABELLED A genome-wide linkage scan was conducted using a large white sample to identify QTLs for BMD. We found QTLs in the total sample and the gender-specific subgroups, as well as significant epistatic interactions underlying BMD variations. INTRODUCTION Low BMD is an important risk factor for osteoporosis and under strong genetic control. MATERIALS AND METHODS To identify quantitative trait loci (QTLs) for regulation of BMD, we performed a large-scale whole genome linkage scan (WGS) involving 4126 individuals from 451 families. In addition to the conventional linkage analyses in the total combined sample of males and females, we conducted epistatic interaction analyses and gender-specific linkage analyses. RESULTS Significant linkage was detected on 5q23 for wrist BMD (LOD = 3.39) and 15q13 for female spine BMD (LOD = 4.49). For spine BMD, we revealed significant epistatic interactions between 3p25 and 2q32 (p = 0.0022) and between 3p25 and 11q23 (p = 0.0007). We replicated several genomic regions that showed linkage with BMD in previous studies by others and ours, such as 3p21, 1p36, and Xq27. CONCLUSIONS This study highlights the importance of large sample size, incorporation of epistatic interaction, and consideration of gender-specific effects in identifying QTLs for BMD variation. The results of this study provide a foundation for the future fine mapping and gene identification in our population.
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Affiliation(s)
- Peng Xiao
- Department of Biomedical Sciences and Osteoporosis Research Center, School of Medicine, Creighton University, Omaha, Nebraska, USA
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30
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Obermayer-Pietsch B. Genetics of Osteoporosis. Wien Med Wochenschr 2006; 156:162-7. [PMID: 16823531 DOI: 10.1007/s10354-005-0249-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2005] [Accepted: 12/02/2005] [Indexed: 01/16/2023]
Abstract
Osteoporosis is a systemic skeletal disease comprising rarefaction of bone structure and loss of bone mass, finally leading to increased fracture risk. As a part of its multifactorial aetiology, twin and family studies have demonstrated an important genetic component of osteoporosis regarding many parameters of bone properties e. g. bone mineral density, with a heredity of 60-80 %. Whole genome screens, linkage analysis and candidate gene research have contributed to our current knowledge about genetic loci in osteoporosis. Genotyping of collagen alpha I, lactose intolerance or estrogen receptor alpha alleles are under investigation for their importance in individual and epidemiological practice, e. g. the European Union "GENOMOS" project with more than 50,000 subjects. In future, improved genotyping methods and design strategies as well as large scale epidemiological studies in the general population will bring the genetics of complex diseases such as osteoporosis to a point of success comparable to where mendelian genetics now firmly resides. Given the potential of these new techniques, a paradigm shift may occur both in diagnosis and prevention as well as in individualized treatment aspects of osteoporosis.
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Affiliation(s)
- Barbara Obermayer-Pietsch
- Department of Internal Medicine, Division of Endocrinology and Nuclear Medicine, Endocrinological-Nuclear-Medical Laboratory, Graz, Austria.
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31
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Micklesfield L, Levitt N, Dhansay M, Norris S, van der Merwe L, Lambert E. Maternal and early life influences on calcaneal ultrasound parameters and metacarpal morphometry in 7- to 9-year-old children. J Bone Miner Metab 2006; 24:235-42. [PMID: 16622737 DOI: 10.1007/s00774-005-0677-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2005] [Accepted: 12/08/2005] [Indexed: 11/26/2022]
Abstract
We investigated the relationship between maternal and early life influences, calcaneal ultrasound parameters, and metacarpal morphometry in 7- to 9-year-old children (n = 109) of mixed ancestral origin from a working class community. Their mothers had participated in a nutrition and pregnancy study at the time of the birth. Demographic and maternal data were collected. Anthropometry was assessed. Broadband ultrasound attenuation (BUA) and speed of sound (SOS) were measured in the children and a subsample of the mothers (n = 94), using calcaneal ultrasound. Hand radiographs were used to measure metacarpal morphometry. There was no relationship between the ultrasound parameters, birthweight, current weight, or height. The ponderal index was correlated with BUA (r = 0.25; P = 0.036). BUA was lower in children whose mothers smoked during pregnancy compared to children whose mothers did not smoke (P = 0.054). Children whose mothers consumed alcohol during pregnancy had a lower Barnett-Nordin metacarpal index compared to children whose mothers did not consume alcohol (P < 0.05), after covarying for sex, age, gestational age, weight, and height of the child. Children's BUA was negatively correlated with housing density (r = -0.23; P = 0.021). In this study, we found an association between maternal and early life influences on calcaneal ultrasound parameters and metacarpal morphometry in prepubertal children, an association that was also influenced by sociodemographic and environmental factors.
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Affiliation(s)
- Lisa Micklesfield
- Department of Human Biology, MRC/UCT Research Unit for Exercise Science and Sports Medicine, Faculty of Health Sciences, University of Cape Town, Private Bag, Rondebosch, 7700, South Africa.
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32
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Blain H, Vuillemin A, Jeandel C, Jouanny P, Guillemin F, Le Bihan E. Lean mass plays a gender-specific role in familial resemblance for femoral neck bone mineral density in adult subjects. Osteoporos Int 2006; 17:897-907. [PMID: 16555018 DOI: 10.1007/s00198-005-0062-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2005] [Accepted: 12/22/2005] [Indexed: 11/27/2022]
Abstract
Whether the femoral neck bone mineral density (FN BMD) of children may be better predicted from that of their parents when taking into account the anthropometry of the children was assessed in a healthy adult sample consisting of 86 mother-daughter, 32 mother-son, 32 father-daughter, and 23 father-son pairs from 128 families. Heritability for FN BMD, which is considered to be a measurement of general resemblance, was defined as the regression coefficient of the mean of the parents' BMD. Among the anthropometric factors, lean mass was the most strongly associated with FN BMD following the adjustment for age in women (r=0.52, p<0.0001) and men (r=0.25, p=0.02). After adjustment for age, calcium intake, physical activity, and menopause and hormonal replacement therapy if relevant, heritability estimates (h2) for FN BMD were 0.68+/-0.23 [95% credible interval (CI): 0.15-0.99] in father-daughter pairs, 0.40+/-0.17 (95% CI: 0.08-0.74) in mother-daughter pairs, and 0.19+/-0.15 (95% CI: 0.01-0.57) in father-son pairs. Adjustment for lean mass of children increased the h2 for FN BMD in mother-son pairs [from 0.24+/-0.17 (95% CI: 0.01-0.57) to 0.66+/-0.18 (95% CI: 0.26-0.95)]. The present results show that FN BMD is heritable in adult father-daughter pairs (7.2% of a daughter's FN BMD variance was explained by the father's FN BMD) and that taking into account the lean mass of sons might improve the prediction of their FN BMD based on that of their mother's (reduction of sons' FN BMD residual variance by 5.1%). Taking the lean mass of children into account might improve the prediction of their FN BMD by 9.1% in daughters and by 18.1% in sons, irrespective of their parent's FN BMD. These results, obtained using a Bayesian regression model, have to be confirmed in further studies involving a greater number of adult parent-offspring pairs of both genders before extrapolation to clinical practice.
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Affiliation(s)
- H Blain
- Service de Médecine Interne-Gériatrie, Centre de Prévention et de traitement des maladies du Vieillissement, 39, avenue Charles Flahault, 34295, Montpellier, Cedex 5, France.
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33
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Peacock M, Koller DL, Lai D, Hui S, Foroud T, Econs MJ. Sex-specific quantitative trait loci contribute to normal variation in bone structure at the proximal femur in men. Bone 2005; 37:467-73. [PMID: 16046210 PMCID: PMC1513190 DOI: 10.1016/j.bone.2005.05.005] [Citation(s) in RCA: 28] [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: 01/19/2005] [Revised: 04/19/2005] [Accepted: 05/06/2005] [Indexed: 10/25/2022]
Abstract
Bone structure is an important determinant of osteoporotic fracture. In women, bone structure is highly heritable, and several quantitative trait loci (QTL) have been reported. There are few comparable data in men. This study in men aimed at establishing the heritability of bone structure at the proximal femur, identifying QTL contributing to normal variation in bone structure, and determining which QTL might be sex-specific. Bone structure at the proximal femur was measured in 205 pairs of brothers age 18-61. Heritability was calculated, and linkage analysis performed on phenotypes at the proximal femur. Heritability estimates ranged from 0.99 to 0.39. A genome wide scan identified suggestive QTL (LOD>2.2) for femoral shaft width on chromosome 14q (LOD=2.69 at position 99 cM), calcar femorale at chromosome 2p (LOD=3.97 at position 194 cM) and at the X chromosome (LOD=3.01 at position 77 cM), femoral neck width on chromosome 5p (LOD=2.28 at position 0 cM), femoral head width on chromosome 11q (LOD=2.30 at position 131 cM) and 15q (LOD=3.11 at position 90 cM), and pelvic axis length on chromosome 4q (LOD=4.16 at position 99 cM) and 17q (LOD=2.80 at position 112 cM). Comparison with published data in 437 pairs of premenopausal sisters from the same geographical region suggested that 3 of the 7 autosomal QTL were male-specific. This study demonstrates that bone structure at the proximal femur in healthy men is highly heritable. The occurrence of sex-specific genes in humans for bone structure has important implications for the pathogenesis and treatment of osteoporosis.
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Affiliation(s)
- Munro Peacock
- Department of Medicine, Indiana University School of Medicine, University Hospital and Out Patient Center, 550 N. University Boulevard, Room 5595, Indianapolis, IN 46202-5250, USA.
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34
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Lei SF, Zhang YY, Deng FY, Liu MY, Liu XH, Zhou XG, Deng HW. Bone mineral density and five prominent candidate genes in Chinese men: associations, interaction effects and their implications. Maturitas 2005; 51:199-206. [PMID: 15917161 DOI: 10.1016/j.maturitas.2004.08.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2003] [Revised: 07/29/2004] [Accepted: 08/03/2004] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Osteoporosis constitutes a serious health problem in old people. Bone mineral density (BMD) is determined by multiple genetic and environmental factors. The genetic control of BMD and osteoporosis is better understood in women, but much less in men. The present study evaluated the relationship of COL1A2, BGP, IL-6, AHSG and PTH genes defined by MspI, HindIII, BsrBI, SacI and BstBI restriction enzymes, respectively, with BMD in Chinese males. METHODS A total of 258 unrelated healthy Chinese men aged 50-80 years were recruited. BMD at spine (L1-4) and femoral neck were measured by a Hologic 2000+ densitometer and adjusted by significant covariates of age, height and weight. All the subjects were genotyped at the upper five polymorphic sites by PCR-RFLP procedure. RESULTS We revealed significant association of the AHSG gene with the spine BMD (P = 0.006), even after adjusting for multiple testing in our study. Carriers of 1*1 and 2*2 genotypes of AHSG gene had, respectively, approximately 5.1 and 8.1% higher spine BMD than those of 1*2 genotype. For the other four genes, no evidence of association was found (P > 0.10). No significant evidence of gene-by-gene interaction was found by two-way factorial ANOVA on the BMD variation. CONCLUSIONS The results suggest that the AHSG gene is associated with the spine BMD in Chinese men. The present study represents the first effort to simultaneously investigate the effects of single gene locus as well as gene-by-gene interactions of multiple genes on BMD variation in Chinese men.
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Affiliation(s)
- Shu-Feng Lei
- Laboratory of Molecular and Statistical Genetics, College of Life Sciences, Hunan Normal University, Changsha, Hunan 410081, PR China
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35
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Long JR, Liu PY, Liu YJ, Lu Y, Shen H, Zhao LJ, Xiong DH, Deng HW. APOE haplotypes influence bone mineral density in Caucasian males but not females. Calcif Tissue Int 2004; 75:299-304. [PMID: 15549644 DOI: 10.1007/s00223-004-0034-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2004] [Accepted: 03/29/2004] [Indexed: 10/26/2022]
Abstract
Low bone mineral density (BMD) is one of the most important risk factors for osteoporosis. Apolipoprotein E (APOE) has been considered as a candidate gene for osteoporosis because of its influence on osteoblast uptake of lipoprotein-borne vitamin K. Using the quantitative transmission disequilibrium test QTDT, we examined linkage and/or association of APOE and BMD at the lumbar spine and the total hip in a sample of 387 Caucasian nuclear families with 715 parents and 953 children. The children were aged 20-50 years and female offspring were premenopausal as well. Four single nucleotide polymorphisms (SNP1-4) in the APOE gene, 4-locus haplotypes and 2-locus haplotypes (epsilon1, epsilon2, epsilon3, epsilon4 isoforms, reconstructed by SNP3 and SNP4) were analyzed. In the whole sample and the female offspring families we found no evidence of linkage or association for either single SNP or haplotype with BMD at the two studied skeletal sites. In the male offspring families, within-family associations were observed at the haplotypes CGTC (P = 0.001), GGTT (P = 0.002), and GATC (P = 0.006) for the lumbar spine BMD, and GATC (P = 0.008) for the total hip BMD. These data suggested that in our studied Caucasian population, APOE may have effects on BMD variation in males but not females. Further studies with a larger sample size are required to confirm such results.
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Affiliation(s)
- Ji-Rong Long
- Osteoporosis Research Center, Creighton University, Omaha, NE 68131, USA
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36
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Liu PY, Qin YJ, Zhou Q, Recker RR, Deng HW. Complex segregation analyses of bone mineral density in Chinese. Ann Hum Genet 2004; 68:154-64. [PMID: 15008794 DOI: 10.1046/j.1529-8817.2003.00082.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
China has the largest population in the world; approximately 7% of the total population suffers from primary osteoporosis. Osteoporosis is mainly characterized by low bone mineral density (BMD). In the present study, familial correlation and segregation analyses for spine and hip BMDs have been undertaken for the first time in a Chinese sample composed of 401 nuclear families with a total of 1260 individuals. The results indicate a major gene of additive inheritance for hip BMD, whereas there is no evidence of a major gene influencing spine BMD. Significant familial residual effects are found for both traits, and heritability estimates (+/-SE) for spine and hip BMDs are 0.807(0.099) and 0.897(0.101), respectively. Sex and age differences in genotype-specific average BMD are also observed. This study provides the first evidence quantifying the high degree of genetic determination of BMD variation in the Chinese.
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Affiliation(s)
- P Y Liu
- Laboratory of Molecular and Statistical Genetics, College of Life Sciences, Hunan Normal University, ChangSha, Hunan 410081, PR China
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37
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Econs MJ, Koller DL, Hui SL, Fishburn T, Conneally PM, Johnston CC, Peacock M, Foroud TM. Confirmation of linkage to chromosome 1q for peak vertebral bone mineral density in premenopausal white women. Am J Hum Genet 2004; 74:223-8. [PMID: 14730478 PMCID: PMC1181920 DOI: 10.1086/381401] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2003] [Accepted: 11/13/2003] [Indexed: 11/03/2022] Open
Abstract
Peak bone mineral density (BMD) is a highly heritable trait and is a good predictor of the risk of osteoporosis and fracture in later life. Recent studies have sought to identify the genes underlying peak BMD. Linkage analysis in a sample of 464 premenopausal white sister pairs detected linkage of spine BMD to chromosome 1q (LOD 3.6). An independent sample of 254 white sister pairs has now been genotyped, and it also provides evidence of linkage to chromosome 1q (LOD 2.5) for spine BMD. Microsatellite markers were subsequently genotyped for a 4-cM map in the chromosome 1q region in all available white sister pairs (n=938), and a LOD score of 4.3 was obtained near the marker D1S445. Studies in the mouse have also detected evidence of linkage to BMD phenotypes in the region syntenic to our linkage finding on chromosome 1q. Thus, we have replicated a locus on 1q contributing to BMD at the spine and have found further support for the region in analyses employing an enlarged sample. Studies are now ongoing to identify the gene(s) contributing to peak spine BMD in women.
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Affiliation(s)
- Michael J Econs
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, 46202, USA.
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Nurmi-Lawton JA, Baxter-Jones AD, Mirwald RL, Bishop JA, Taylor P, Cooper C, New SA. Evidence of sustained skeletal benefits from impact-loading exercise in young females: a 3-year longitudinal study. J Bone Miner Res 2004; 19:314-22. [PMID: 14969402 DOI: 10.1359/jbmr.0301222] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2003] [Revised: 07/07/2003] [Accepted: 09/05/2003] [Indexed: 11/18/2022]
Abstract
UNLABELLED The skeletal effects from intensive exercise throughout puberty are undefined. Forty-five female gymnasts and 52 controls were studied over 3 years, including a heredity aspect. The effects of size, maturity, exercise, and diet were identified using a multilevel regression model. Results demonstrated sustained skeletal benefits resulting from exercise throughout all stages of pubertal development. INTRODUCTION Weight-bearing exercise is beneficial for peak bone mass development. However, whether skeletal benefits achieved with exercise are maintained if training remains intensive throughout the pubertal years is not entirely clear. The influence of familial resemblance for bone mass remains undefined in physically active versus inactive children. The aim of this study was to investigate the long-term influences of impact-loading exercise on bone quantity and quality in young females after controlling for growth, maturation, and hereditary factors. MATERIALS AND METHODS At baseline, 45 gymnasts (G) and 52 normally active controls (C) 8-17 years of age were recruited. Anthropometry, diet, physical activity, and quantitative ultrasound (QUS) were measured annually for 3 consecutive years. DXA scans of total body (TB) and lumbar spine (LS) bone mineral content (BMC) and density (BMD) were taken three times at 1-year intervals. A multilevel regression model was fitted, and the independent effects of body size, maturity, physical activity, and diet were identified over time. To assess heredity influences, 27 G mothers and 26 C mothers volunteered for cross-sectional measurements of anthropometry, QUS, and BMC/BMD. RESULTS AND CONCLUSIONS Gymnasts were smaller and lighter (as were their mothers) than controls, but they had significantly higher QUS and axial and appendicular BMC and BMD, with > 170 g more bone mineral in TB across puberty (after adjustment for maturity [years from peak height velocity], height, weight, energy, and protein intake). Gymnasts had up to 24-51% higher BMC and 13-28% higher BMD, depending on skeletal site. These results provide evidence of sustained skeletal benefits from impact-loading exercise, which are unlikely to result entirely from heredity, throughout pubertal years.
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Affiliation(s)
- Jaana A Nurmi-Lawton
- Centre for Nutrition and Food Safety, School of Biomedical and Molecular Sciences, University of Surrey, Guildford, United Kingdom.
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Masuda S, Gao M, Zhang A, Kaufmann M, Jones G. Importance of cytochrome P450-mediated metabolism in the mechanism of action of vitamin D analogs. Recent Results Cancer Res 2003; 164:189-202. [PMID: 12899523 DOI: 10.1007/978-3-642-55580-0_14] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
The elucidation of the metabolic pathway for vitamin D, including the delineation of the specific cytochrome P450s (CYPs) involved in activation and catabolism, has emphasized the overall importance of metabolic considerations in vitamin D analog design. This short review attempts to summarize recent findings with isolated CYPs and animal models in which CYPs are genetically manipulated to draw attention to structural features of vitamin D analogs that make them more or less resistant to metabolic enzymes. We conclude by placing metabolic considerations in the context of the other important aspects of vitamin D analogs.
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Affiliation(s)
- Sonoko Masuda
- Department of Biochemistry, Queen's University, Kingston, ON K7L 3N6, Canada
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Duncan EL, Cardon LR, Sinsheimer JS, Wass JAH, Brown MA. Site and gender specificity of inheritance of bone mineral density. J Bone Miner Res 2003; 18:1531-8. [PMID: 12929944 DOI: 10.1359/jbmr.2003.18.8.1531] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
UNLABELLED Differences in genetic control of BMD by skeletal sites and genders were examined by complex segregation analysis in 816 members of 147 families with probands with extreme low BMD. Spine BMD correlated more strongly in male-male comparisons and hip BMD in female-female comparisons, consistent with gender- and site-specificity of BMD heritability. INTRODUCTION Evidence from studies in animals and humans suggests that the genetic control of bone mineral density (BMD) may differ at different skeletal sites and between genders. This question has important implications for the design and interpretation of genetic studies of osteoporosis. METHODS We examined the genetic profile of 147 families with 816 individuals recruited through probands with extreme low BMD (T-score < -2.5, Z-score < -2.0). Complex segregation analysis was performed using the Pedigree Analysis Package. BMD was measured by DXA at both lumbar spine (L1-L4) and femoral neck. RESULTS Complex segregation analysis excluded purely monogenic and environmental models of segregation of lumbar spine and femoral neck BMD in these families. Pure polygenic models were excluded at the lumbar spine when menopausal status was considered as a covariate, but not at the femoral neck. Mendelian models with a residual polygenic component were not excluded. These models were consistent with the presence of a rare Mendelian genotype of prevalence 3-19%, causing high BMD at the hip and spine in these families, with additional polygenic effects. Total heritability range at the lumbar spine was 61-67% and at the femoral neck was 44-67%. Significant differences in correlation of femoral neck and lumbar spine BMD were observed between male and female relative pairs, with male-male comparisons exhibiting stronger lumbar spine BMD correlation than femoral neck, and female-female comparisons having greater femoral neck BMD correlation than lumbar spine. These findings remained true for parent-offspring correlations when menopausal status was taken into account. The recurrence risk ratio for siblings of probands of a Z-score < -2.0 was 5.4 at the lumbar spine and 5.9 at the femoral neck. CONCLUSIONS These findings support gender- and site-specificity of the inheritance of BMD. These results should be considered in the design and interpretation of genetic studies of osteoporosis.
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Affiliation(s)
- Emma L Duncan
- Metabolic Bone Unit, Nuffield Orthopaedic Centre, Oxford, United Kingdom
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Van Pottelbergh I, Goemaere S, Zmierczak H, De Bacquer D, Kaufman JM. Deficient acquisition of bone during maturation underlies idiopathic osteoporosis in men: evidence from a three-generation family study. J Bone Miner Res 2003; 18:303-11. [PMID: 12568407 DOI: 10.1359/jbmr.2003.18.2.303] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
To address the issue whether deficient acquisition of bone during maturation or adult-onset bone loss is primarily to blame for idiopathic osteoporosis in men, we assessed indices of bone mineral density and size, as well as biochemical markers of bone turnover in 61 probands (ages 20-65 years) with idiopathic osteoporosis (z-score < or = -2.0 at the spine or hip), their first-degree relatives (n = 130), and age-matched controls. There was no indication of accelerated bone loss. Indeed, in probands, the observed bone deficit versus controls was unrelated to the age of probands, and indices of bone turnover were not significantly different from controls. On the other hand, a specific deficit in bone acquisition was suggested by findings of lower bone mineral density values in three generations of male and female relatives of the probands, including their offspring; bone turnover in relatives was not different from controls. The bone mineral density deficit was more pronounced in male compared with female relatives; approximately 60% of the sons had a spinal bone mineral density z-score of less than -2.0. There also was a skeletal site-specificity in probands and their male relatives with a larger areal bone mineral density deficit at the spine compared with the hip and the forearm. The deficit at the spine corresponded to a reduction of both volumetric bone mineral density and bone size; a similar less pronounced deficit in volumetric bone mineral density, but not in bone size, was observed at the femoral neck. These findings in probands and their first-degree relatives point toward a major contributory role of a genetically determined maturational defect in bone acquisition in the pathogenesis of idiopathic osteoporosis in men.
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Affiliation(s)
- I Van Pottelbergh
- Department of Endocrinology, Ghent University Hospital, De Pintelaan, Ghent, Belgium.
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Taha W, Chin D, Silverberg AI, Lashiker L, Khateeb N, Anhalt H. Reduced spinal bone mineral density in adolescents of an Ultra-Orthodox Jewish community in Brooklyn. Pediatrics 2001; 107:E79. [PMID: 11331729 DOI: 10.1542/peds.107.5.e79] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Bone mass increases throughout childhood, with maximal bone mass accrual rate occurring in early to mid-puberty and slowing in late puberty. Prevention of osteoporosis and its morbidities depends primarily on the establishment of adequate peak bone mass. Physical activity, calcium intake, and vitamin D stores (from sunlight conversion of precursors of vitamin D and to a lesser degree from dietary intake) are vital determinants of bone mineral density (BMD). BMD is further controlled by genetic and environmental factors that are poorly understood. Observance of ultra-Orthodox Jewish customs may have a negative effect on the factors that promote bone health, and there have been anecdotal reports of higher fracture rates in this population. The ultra-Orthodox Jewish lifestyle encourages scholarly activity in preference to physical activity. Additionally, modest dress codes and inner-city dwelling reduce sunlight exposure. Orthodox Jews do not consume milk products for 6 hours after meat ingestion, leading to potentially fewer opportunities to consume calcium. Foods from the milk group are some of the best sources of dietary calcium. Our aims are to examine BMD in a group of healthy ultra-Orthodox Jewish adolescents in an urban community and to attempt to correlate it to physical activity and dietary factors. DESIGN AND METHODS We recruited 50 healthy, ultra-Orthodox Jews, ages 15 to 19 years (30 males and 20 females). None were taking corticosteroids or had evidence of malabsorption. All girls were postmenarchal and nulliparous. Pubic hair Tanner stage for boys and breast Tanner stage for girls were determined. Weight and height standard deviation scores were calculated. Calcium, phosphorus, protein, vitamin D, and calorie intake were assessed using a comprehensive food questionnaire referring to what has been eaten over the last year. Hours per week of weight-bearing exercise and walking were determined. Serum levels of calcium, intact parathyroid hormone (PTH), 25 hydroxyvitamin D (25[OH]D) and 1,25 dihydroxyvitamin D (1,25[OH](2)D) were measured. Lumbar spine (L) BMD was assessed by dual energy radiograph absorptiometry. The pediatric software supplied by Lunar Radiation Corporation, which contains gender- and age-specific norms, provided a z score for the lumbar BMD for each participant. L2 to L4 bone mineral apparent density (BMAD) was calculated from L2 to L4 BMD. RESULTS BMD of L2 to L4 was significantly decreased compared with age/sex-matched normative data: mean z score was -1.25 +/- 1.25 (n = 50). The mean L2 to L4 BMD z score +/- standard deviation was -1.71 +/- 1.18 for boys and -0.58 +/- 1.04 for girls. Eight boys (27%) had L2 to L4 BMD z scores <-2.5, which defines osteoporosis in adulthood. Twenty-seven adolescents (54%), 16 boys and 11 girls, had Tanner stage V. Two participants (4%) had delayed development of Tanner stage V. Mean consumption of calcium by participants under 19 years old was 908 +/- 506 mg/day (n = 46), which is lower than the adequate intake of 1300 mg/day for this age. The consumption of phosphorus was 1329 +/- 606 mg/day, and the consumption of vitamin D was 286 +/- 173 IU/day (n = 50). The mean serum 25(OH)D level was 18.4 +/- 7.6 ng/mL, and the mean serum 1,25(OH)(2)D level was 71.1 +/- 15.7 pg/mL (n = 50). Boys had significantly higher serum levels of 1,25(OH)(2)D than did girls (74.9 +/- 16.46 pg/mL vs 65.25 +/- 12.8 pg/mL, respectively). The serum levels of PTH, calcium, and protein were (mean +/- standard deviation): 33 +/- 16 pg/mL, 9.5 +/- 0.69 mg/dL, and 7.8 +/- 0.6 g/dL, respectively (n = 50). L2 to L4 BMD z score had positive correlation with walking hours (r = 0.4). L2 to L4 BMD z score had negative correlation with serum level of 1,25(OH)(2)D )r = -0.33; n = 50). We could not find significant correlation between L2 to L4 BMD z scores for the entire cohort and any of calcium, vitamin D, phosphorus, or protein intake. However, the L2 to L4 BMD z scores of boys had positive correlation with calcium, phosphorus, and protein intake (r = 42, r = 44, and r = 43, respectively). After adjustment for Tanner stage, boys who had Tanner stage V (n = 16) had stronger positive correlation between L2 to L4 BMD z scores and calcium and protein intake (r = 0.55 and r = 0.57, respectively), as was the correlation between L2 to L4 BMD z score and weight-bearing activity and walking hours (r = 0.77 and r = 0.72, respectively; n = 16). By multiple regression analysis with stepwise selection, sex, walking hours, weight-standard deviation scores, and serum PTH predicted 54% of the variability in L2 to L4 BMD z score. Sex, walking hours, and age predicted 65% of the variability in L2 to L4 BMAD. CONCLUSIONS Lumbar BMD is significantly decreased in ultra-Orthodox Jewish adolescents living in an urban community. Boys had profoundly lower spinal BMD than did girls. Previous studies have introduced estrogen as a critical factor in bone mineralization. (ABSTRACT TRUNCATED)
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Affiliation(s)
- W Taha
- Division of Pediatric Endocrinology, Maimonides Medical Center, Brooklyn, New York 11219, USA
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