Bone mineral density in girls with forearm fractures

Overweight and obese children have low bone mass and area for their weight

OBJECTIVES

To determine whether girls and boys categorized from body mass index (BMI) values as overweight or obese for their age have lower bone mineral content (BMC) or lower bone area in relation to total body weight than children of normal adiposity.

DESIGN

Cross-sectional study in a university bone research unit.

SUBJECTS

Two hundred girls and 136 boys aged 3-19 y recruited from the general population by advertisement.

MEASUREMENTS

Total body BMC (g) and bone area (cm2) measured by dual energy X-ray absorptiometry (DXA) in relation to body weight (kg), lean tissue mass (kg) and fat mass (kg) in boys and girls of three different BMI percentile groupings: normal weight (BMI<85th percentile); overweight (85 to 94th BMI percentile); obese (> or =95th BMI percentile).

RESULTS

Obese children had higher BMC, bone area, and fat mass for chronological age than those of normal body weight (P<0.001). In spite of this the observed values for age-adjusted total body BMC and bone area relative to body weight were each lower than predicted values, in both overweight and obese children (2.5-10.1% less, P<0.05) than in children of lower adiposity.

CONCLUSION

In overweight and obese boys and girls there is a mismatch between body weight and bone development during growth: their bone mass and bone area are low for their body weight.

The growing years and prevention of osteoporosis in later life

Ca is the major mineral in bone, and 99% of the Ca in the body resides in the skeleton. Skeletal mass is a determinant of risk of fracture in childhood as well as adulthood. Over 40% of adult peak bone mass is acquired during adolescence. This period is when lifestyle choices, including ensuring adequate dietary Ca, regular weight-bearing exercise and avoiding hormonal insufficiency, are especially important. Current Ca intakes for adolescent females are woefully inadequate.

Calcium, dairy products and osteoporosis

Osteoporosis is a multifactorial disorder in which nutrition plays a role but does not account for the totality of the problem. 139 papers published since 1975 and describing studies of the relationship of calcium intake and bone health are briefly analyzed. Of 52 investigator-controlled calcium intervention studies, all but two showed better bone balance at high intakes, or greater bone gain during growth, or reduced bone loss in the elderly, or reduced fracture risk. This evidence firmly establishes that high calcium intakes promote bone health. Additionally, three-fourths of 86 observational studies were also positive, indicating that the causal link established in investigator-controlled trials can be found in free-living subjects as well. The principal reason for failure to find an association in observational studies is the weakness of the methods available for estimating long-term calcium intake. While most of the investigator-controlled studies used calcium supplements, six used dairy sources of calcium; all were positive. Most of the observational studies were based on dairy calcium also, since at the time the studies were done, higher calcium intakes meant higher dairy intakes. All studies evaluating the issue reported substantial augmentation of the osteoprotective effect of estrogen by high calcium intakes. Discussion is provided in regard to the multifactorial complexity of osteoporotic response to interventions and to the perturbing effect in controlled trials of the bone remodeling transient, as well as about how inferences can validly be drawn from the various study types represented in this compilation.

Women and the orthopaedic surgeon. Changing the relationship

Women are disproportionately disabled by musculoskeletal conditions. For biologic and lifestyle reasons, musculoskeletal health is one of the areas of medicine in which the differences between men and women are most marked. Thus, an approach tailored to women, not just an approach based on what has worked for men, often is needed. How orthopaedists treat women will become an even more pressing issue in the years ahead. Demographic trends predict that the majority of senior citizens will be women in whom chronic conditions frequently involve a musculoskeletal problem. Even at earlier ages, women will present more frequently with musculoskeletal conditions because they participate in a broader range of sports and careers. The current study presents a lengthy list of action items that the orthopaedic surgeon should consider as he or she approaches the treatment of women. Many of these items involve anticipating musculoskeletal problems, and convincing patients to take appropriate preventive steps. Because so many patients are treated by physicians who are not orthopaedists for their musculoskeletal problems, a successful preventive approach presents orthopaedists with the opportunity to win the confidence and respect of a new generation of patients.

Nutrition interventions in childhood for the prevention of chronic diseases in adulthood

As it becomes increasingly evident that the seeds of many adult disorders are planted in childhood, it is important that pediatric care providers 1) recognize risk factors for adult disease in children and 2) institute effective interventions. Many adult medical conditions are significantly related to or influenced by nutritional factors. This review evaluates three areas in preventive and therapeutic pediatric nutrition: obesity, lipid disorders, and osteoporosis.

American Academy of Pediatrics. Committee on Nutrition. Calcium requirements of infants, children, and adolescents

This statement is intended to provide pediatric caregivers with advice about the nutritional needs of calcium of infants, children, and adolescents. It will review the physiology of calcium metabolism and provide a review of the data about the relationship between calcium intake and bone growth and metabolism. In particular, it will focus on the large number of recent studies that have identified a relationship between childhood calcium intake and bone mineralization and the potential relationship of these data to fractures in adolescents and the development of osteoporosis in adulthood. The specific needs of children and adolescents with eating disorders are not considered.

The new dietary reference intakes for calcium: implications for osteoporosis

The new Dietary Reference Intakes (DRI) for calcium were released August 13, 1997 by the Food and Nutrition Board of the National Academy of Science. Unlike the RDA's which established the minimal amounts of nutrients needed to be protective against possible deficiency, the new values are designed to reflect the latest understanding about nutrient requirements directed at optimizing health in individuals and groups. Adequate calcium intake recommendations were set at levels associated with desirable retention of body calcium since high bone density is known to be less susceptible to fractures. Recommended intake for adults is 1000 to 1200 mg/day. The majority of people do not consume these levels of calcium. The upper tolerable limit for calcium was set at 2.5 g/day.

Position of the American Dietetic Association and Dietitians of Canada: women's health and nutrition

Within the past 10 years women's health has evolved to a much broader paradigm, beyond reproductive issues. From a physiological perspective, women's health now refers to the prevention, diagnosis, and management of conditions or diseases that may be unique to women, be more prevalent in women, or manifest differently in women than men. Women's health encompasses emotional, social, cultural, spiritual, and physical well-being. It is determined by the social, political, and economic context of women's lives. Nutrition is involved in the etiology or treatment of half of the 10 leading causes of death in women. The incidence of osteoporosis and extremes in body weight are approaching epidemic proportions in women. This position reviews the following health problems: cardiovascular disease, cancer, osteoporosis, weight, and diabetes mellitus. Dietetics professionals are in the perfect position to understand the issues surrounding women's health in order to deliver a message to women that will allow them to make wise decisions regarding their health. Nutrition is a critical component of risk reduction and treatment, and must be included in clinical and preventive services for women. Dietetics professionals must work to increase their knowledge about women's health issues, to promote health and education programs, to influence policy makers, to deliver the highest-quality medical nutrition therapy, and to be proactive in documenting the effectiveness of outcomes-based research.