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Ireland A, Riddell A, Colombo A, Ross-Russell R, Prentice A, Ward KA. Development of musculoskeletal deficits in children with cystic fibrosis in later childhood. Bone 2023; 170:116657. [PMID: 36690166 DOI: 10.1016/j.bone.2022.116657] [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: 06/14/2022] [Revised: 12/08/2022] [Accepted: 12/23/2022] [Indexed: 01/21/2023]
Abstract
Cystic fibrosis (CF) is a genetic condition primarily affecting the respiratory system, with the associated progressive lung damage and loss of function resulting in reduced lifespan. Bone health is also impaired in individuals with CF, leading to much higher fracture risk even in adolescence. However, the development of these deficits during growth and the relative contributions of puberty, body size and muscular loading remain somewhat unexplored. We therefore recruited 25 children with CF (10 girls, mean age 11.3 ± 2.9y) and 147 children without CF (75 girls, mean age 12.4 ± 2.6y). Bone characteristics were assessed using peripheral quantitative computed tomography (pQCT) at 4 % and 66 % distal-proximal tibia. Muscle cross-sectional area (CSA) and density (an indicator of muscle quality) were also assessed at the latter site. Tibial bone microstructure was assessed using high-resolution pQCT (HR-pQCT) at 8 % distal-proximal tibial length. In addition, peak jump power and hop force were measured using jumping mechanography. Group-by-age interactions and group differences in bone and muscle characteristics were examined using multiple linear regression, adjusted for age, sex and pubertal status and in additional models, height and muscle force. In initial models group-by-age interactions were evident for distal tibial total bone mineral content (BMC) and trabecular volumetric bone mineral density (vBMD), with a lower rate of age-related accrual evident in children with CF. In assessments of distal tibial microstructure, similar patterns were observed for trabecular number and thickness, and cortical CSA. In the tibial shaft, group-by-age interactions indicating slower growth in CF were evident for total BMC and cortical CSA, whilst age-independent deficits in CF were observed for several other variables. Peak jump power and hop force also exhibited similar interactions. Group-by-age interactions for bone were partially attenuated at the distal tibia and fully attenuated at the tibial shaft by adjustment for muscle force. These results suggest that bone and muscle deficits in children with CF develop throughout later childhood, independent of differences in pubertal stage and body size. These diverging growth patterns appear to be mediated by differences in muscle function, particularly for bone characteristics in the tibial shaft. Given the high fracture risk in this population from childhood onwards, development of interventions to improve bone health would be of substantial clinical value.
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Affiliation(s)
- Alex Ireland
- Musculoskeletal Science and Sports Medicine Research Centre, Department of Life Sciences, Manchester Metropolitan University, Manchester, UK
| | - Amy Riddell
- Institute for Infection and Immunity, Paediatric Infectious Diseases Research Group, St. George's University of London, UK; Previously at MRC Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge, UK
| | - Antony Colombo
- Musculoskeletal Science and Sports Medicine Research Centre, Department of Life Sciences, Manchester Metropolitan University, Manchester, UK; UMR 5199 PACEA, EPHE-PSL University, Pessac, France; Department of Biological, Geological and Environmental Sciences, University of Bologna, Bologna, Italy; Department of Anthropology, Pennsylvania State University, PA, USA
| | - Robert Ross-Russell
- Department of Paediatric Respiratory Medicine, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Ann Prentice
- Previously at MRC Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge, UK; MRC Nutrition and Bone Health Group, Cambridge, UK
| | - Kate A Ward
- MRC Nutrition and Bone Health Group, Cambridge, UK.
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2
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Tan J, Ng CA, Hart NH, Rantalainen T, Sim M, Scott D, Zhu K, Hands B, Chivers P. Reduced Peak Bone Mass in Young Adults With Low Motor Competence. J Bone Miner Res 2023; 38:665-677. [PMID: 36795323 DOI: 10.1002/jbmr.4788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 01/10/2023] [Accepted: 02/12/2023] [Indexed: 02/17/2023]
Abstract
Although suboptimal bone health has been reported in children and adolescents with low motor competence (LMC), it is not known whether such deficits are present at the time of peak bone mass. We examined the impact of LMC on bone mineral density (BMD) in 1043 participants (484 females) from the Raine Cohort Study. Participants had motor competence assessed using the McCarron Assessment of Neuromuscular Development at 10, 14, and 17 years, and a whole-body dual-energy X-ray absorptiometry (DXA) scan at 20 years. Bone loading from physical activity was estimated from the International Physical Activity Questionnaire at the age of 17 years. The association between LMC and BMD was determined using general linear models that controlled for sex, age, body mass index, vitamin D status, and prior bone loading. Results indicated LMC status (present in 29.6% males and 21.9% females) was associated with a 1.8% to 2.6% decrease in BMD at all load-bearing bone sites. Assessment by sex showed that the association was mainly in males. Osteogenic potential of physical activity was associated with increased BMD dependent on sex and LMC status, with males with LMC showing a reduced effect from increasing bone loading. As such, although engagement in osteogenic physical activity is associated with BMD, other factors involved in physical activity, eg, diversity, movement quality, may also contribute to BMD differences based upon LMC status. The finding of lower peak bone mass for individuals with LMC may reflect a higher risk of osteoporosis, especially for males; however, further research is required. © 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)
- Jocelyn Tan
- School of Health Sciences and Physiotherapy, University of Notre Dame Australia, Fremantle, Australia.,Western Australian Bone Research Collaboration, Perth, Australia
| | - Carrie-Anne Ng
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - Nicolas H Hart
- Western Australian Bone Research Collaboration, Perth, Australia.,School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia.,Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia.,Institute for Health Research, University of Notre Dame Australia, Fremantle, Australia.,School of Sport, Exercise and Rehabilitation, University of Technology Sydney, Sydney, Australia
| | - Timo Rantalainen
- Western Australian Bone Research Collaboration, Perth, Australia.,School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia.,Institute for Health Research, University of Notre Dame Australia, Fremantle, Australia.,Gerontology Research Center, University of Jyväskylä, Jyväskylä, Finland.,Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Marc Sim
- Western Australian Bone Research Collaboration, Perth, Australia.,Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia.,Medical School, The University of Western Australia, Perth, Australia
| | - David Scott
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia.,Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Australia
| | - Kun Zhu
- Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia.,Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Australia
| | - Beth Hands
- Institute for Health Research, University of Notre Dame Australia, Fremantle, Australia
| | - Paola Chivers
- Western Australian Bone Research Collaboration, Perth, Australia.,Institute for Health Research, University of Notre Dame Australia, Fremantle, Australia
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3
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Tan J, Murphy M, Hart NH, Rantalainen T, Bhoyroo R, Chivers P. Association of developmental coordination disorder and low motor competence with impaired bone health: A systematic review. RESEARCH IN DEVELOPMENTAL DISABILITIES 2022; 129:104324. [PMID: 35970085 DOI: 10.1016/j.ridd.2022.104324] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 07/10/2022] [Accepted: 08/08/2022] [Indexed: 06/15/2023]
Abstract
AIMS Individuals with developmental coordination disorder (DCD) and low motor competence (LMC) may be at increased risk of low bone health due to their lifetime physical activity patterns. Impaired bone health increases an individual's risk of osteoporosis and fracture; therefore, it is necessary to determine whether a bone health detriment is present in this group. Accordingly, this systematic review explores the association between DCD/LMC and bone health. METHODS AND PROCEDURES Studies were included with assessment of bone health in a DCD/LMC population. Study bias was assessed using the JBI critical appraisal checklist. Due to heterogeneity, meta-analysis was not possible and narrative synthesis was performed with effect size and direction assessed via harvest plots. OUTCOMES AND RESULTS A total of 16 (15 paediatric/adolescent) studies were included. Deficits in bone measures were reported for the DCD/LMC group and were more frequent in weight-bearing sites. Critical appraisal indicated very low confidence in the results, with issues relating to indirectness and imprecision relating to comorbidities. CONCLUSIONS AND IMPLICATIONS Individuals with DCD or LMC are at increased risk of bone health deficits. Bone impairment locations indicate insufficient loading via physical activity as a potential cause of bone deficits. Results indicate a potential for earlier osteoporosis onset.
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Affiliation(s)
- Jocelyn Tan
- School of Nursing, Midwifery, Health Sciences & Physiotherapy, University of Notre Dame Australia, Fremantle, Australia; Western Australian Bone Research Collaboration, Perth, WA, Australia.
| | - Myles Murphy
- School of Nursing, Midwifery, Health Sciences & Physiotherapy, University of Notre Dame Australia, Fremantle, Australia; Western Australian Bone Research Collaboration, Perth, WA, Australia; School of Medical and Health Science, Edith Cowan University, Joondalup, Australia
| | - Nicolas H Hart
- Western Australian Bone Research Collaboration, Perth, WA, Australia; Institute for Health Research, University of Notre Dame Australia, Fremantle, Australia; School of Medical and Health Science, Edith Cowan University, Joondalup, Australia; School of Nursing, Queensland University of Technology, Brisbane, Australia; Caring Futures Institute, Flinders University, Adelaide, Australia
| | - Timo Rantalainen
- Western Australian Bone Research Collaboration, Perth, WA, Australia; Institute for Health Research, University of Notre Dame Australia, Fremantle, Australia; School of Medical and Health Science, Edith Cowan University, Joondalup, Australia; Gerontology Research Center, University of Jyväskylä, Jyväskylä, Finland
| | - Ranila Bhoyroo
- School of Population Health, Curtin University, Perth, Australia; Disciplines of Psychology and Exercise Health, Murdoch University, Perth, Australia
| | - Paola Chivers
- Western Australian Bone Research Collaboration, Perth, WA, Australia; Institute for Health Research, University of Notre Dame Australia, Fremantle, Australia; School of Medical and Health Science, Edith Cowan University, Joondalup, Australia
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4
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Garvey ME, Shi L, Lichtenstein AH, Must A, Hayman LL, Crouter SE, Camhi SM. Association of Bone Mineral Density with Lean Mass, Fat Mass, and Physical Activity in Young Overweight and Obese Women. INTERNATIONAL JOURNAL OF EXERCISE SCIENCE 2022; 15:585-598. [PMID: 36896025 PMCID: PMC9987430 DOI: 10.70252/poyu6849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/15/2025]
Abstract
To examine the associations between bone mineral density (BMD), body composition and habitual physical activity in women who are overweight/obese. We measured whole-body bone, and body composition (lean mass, fat mass, and total fat percent) via dual-energy x-ray absorptiometry (model General Electric Lunar whole-body scanner) in a diverse group of women (N=48, age 26.6+/-4.7 years, 63% Black) living in an urban setting. The relations between BMD with total fat percent [%]), lean mass (kg), fat mass (kg), and physical activity were examined using Pearson correlations and multiple linear regression models, adjusted for race, age, and dietary calcium. BMD was positively correlated with lean mass (r=0.43, p=0.002) and negatively correlated with total fat percentage (r=-0.31, p=0.03). Multiple linear regression models indicated BMD was positively associated with lean mass (β: 0.007, p<0.001), and negatively associated with fat mass (kg) and total fat percentage (β: -0.003, p=0.03; β: -0.004, p=0.03, respectively). When stratified by race, these relations were maintained in white women but only lean mass in Black women. When stratified by age, the positive correlation between BMD and lean mass was significant in younger women (<30y) only. There were no significant relationships between BMD and any physical activity measures. Our results indicate that in young women who are overweight/obese BMD is significantly associated with body composition, both lean mass and total fat percentage, but not habitual physical activity. An emphasis on lean mass accrual may be valuable for young women, particularly Black women, to improve bone health.
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Affiliation(s)
- Meghan E Garvey
- Department of Exercise and Health Sciences, University of Massachusetts, Boston, MA, USA
| | - Ling Shi
- Department of Nursing, University of Massachusetts, MA USA
| | | | - Aviva Must
- Department of Public Health and Community Medicine, Tufts University School of Medicine; Boston, MA
| | - Laura L Hayman
- Department of Nursing, University of Massachusetts, MA USA
| | - Scott E Crouter
- Department of Kinesiology, Recreation, and Sports Studies, The University of Tennessee Knoxville; Knoxville, TN, USA
| | - Sarah M Camhi
- Department of Exercise and Health Sciences, University of Massachusetts, Boston, MA, USA
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5
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Ireland A, Riddell A, Prentice A, Eelloo J, Mughal MZ, Ward KA. Development of tibia & fibula bone deficits in children with neurofibromatosis type I - A longitudinal case-control comparison. Bone 2022; 154:116183. [PMID: 34600162 DOI: 10.1016/j.bone.2021.116183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 09/01/2021] [Accepted: 09/07/2021] [Indexed: 11/25/2022]
Abstract
Neurofibromatosis type 1 (NF1) is associated with lower bone mass and increased risk of fracture. Children with NF1 display faltering growth from mid-childhood. However, to date tibia bone development in children with NF1 across childhood and the role of body size have not been explored. Therefore, we recruited 24 children with NF1 (12 girls, mean age 8.2 ± 1.1y) and 104 children without NF1 (52 girls, mean age 11 ± 1.7y). Tibia and fibula bone characteristics were assessed at 4% and 38% distal-proximal tibia length in all children at baseline using peripheral quantitative computed tomography (pQCT). Longitudinal scans were obtained in 21 children with NF1 (12 girls) over 3.4 ± 0.3y and 71 children without NF1 (34 girls) over 1.1 ± 0.1y, such that at follow-up mean age of both groups (NF1 10.9 ± 1.3y, controls 11.4 ± 1.4y) were similar. Effects of group (NF1/control) on bone outcomes as well as group-by-age interactions, indicating differences in rate of change in bone outcome bone outcomes were assessed via linear mixed effects models with adjustment for sex, age, pubertal status and in additional models with adjustment for height and weight Z-scores. Group (NF1/control)-by-age interactions indicated a slower rate of tibia and fibula bone mass accrual in children with NF1 at all measured sites. These associations were attenuated by 25-50% by adjustment for height and weight Z-scores. At the 4% site, deficits in bone mass at older ages were related to slower trabecular BMD accrual. At the 38% site, group-by-age interactions suggested that bone mass deficits resulted from poorer accrual of cortical CSA and to a lesser extent cortical BMD. Lower limb bone mass deficits evident in children with NF1 appear to be progressive and emerge in mid-childhood. In part, they are related to development of a similar pattern of deficits in longitudinal growth and body weight in NF1. Interventions promoting muscle development or physical activity may be partially effective in attenuating bone mass accrual deficits in this population.
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Affiliation(s)
- Alex Ireland
- Musculoskeletal Science and Sports Medicine Research Centre, Department of Life Sciences, Manchester Metropolitan University, Manchester, UK.
| | - Amy Riddell
- Institute for Infection and Immunity, Paediatric Infectious Diseases Research Group, St. George's University of London, UK; previously at MRC Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge, UK
| | - Ann Prentice
- previously at MRC Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge, UK; MRC Nutrition and Bone Health Group, Cambridge, UK
| | - Judith Eelloo
- Nationally Commissioned Complex NF1 Service, Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - M Zulf Mughal
- Nationally Commissioned Complex NF1 Service, Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK; Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK; School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Kate A Ward
- MRC Lifecourse Epidemiology Unit, Human Development and Health, University of Southampton, Southampton, UK
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6
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Ghatan S, Costantini A, Li R, De Bruin C, Appelman-Dijkstra NM, Winter EM, Oei L, Medina-Gomez C. The Polygenic and Monogenic Basis of Paediatric Fractures. Curr Osteoporos Rep 2021; 19:481-493. [PMID: 33945105 PMCID: PMC8551106 DOI: 10.1007/s11914-021-00680-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/15/2021] [Indexed: 01/19/2023]
Abstract
PURPOSE OF REVIEW Fractures are frequently encountered in paediatric practice. Although recurrent fractures in children usually unveil a monogenic syndrome, paediatric fracture risk could be shaped by the individual genetic background influencing the acquisition of bone mineral density, and therefore, the skeletal fragility as shown in adults. Here, we examine paediatric fractures from the perspective of monogenic and complex trait genetics. RECENT FINDINGS Large-scale genome-wide studies in children have identified ~44 genetic loci associated with fracture or bone traits whereas ~35 monogenic diseases characterized by paediatric fractures have been described. Genetic variation can predispose to paediatric fractures through monogenic risk variants with a large effect and polygenic risk involving many variants of small effects. Studying genetic factors influencing peak bone attainment might help in identifying individuals at higher risk of developing early-onset osteoporosis and discovering drug targets to be used as bone restorative pharmacotherapies to prevent, or even reverse, bone loss later in life.
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Affiliation(s)
- S Ghatan
- Translational Skeletal Genomics Group, Department of Internal Medicine, Erasmus MC University Medical Centre, Doctor Molewaterplein 40, Ee-571, 3015, GD, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - A Costantini
- Department of Molecular Medicine and Surgery and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - R Li
- Translational Skeletal Genomics Group, Department of Internal Medicine, Erasmus MC University Medical Centre, Doctor Molewaterplein 40, Ee-571, 3015, GD, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - C De Bruin
- Department of Paediatrics, Leiden University Medical Centre, Leiden, The Netherlands
| | - N M Appelman-Dijkstra
- Department of Internal Medicine, Leiden University Medical Centre, Leiden, The Netherlands
| | - E M Winter
- Department of Internal Medicine, Leiden University Medical Centre, Leiden, The Netherlands
| | - L Oei
- Translational Skeletal Genomics Group, Department of Internal Medicine, Erasmus MC University Medical Centre, Doctor Molewaterplein 40, Ee-571, 3015, GD, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
- Department of Internal Medicine, Leiden University Medical Centre, Leiden, The Netherlands
| | - Carolina Medina-Gomez
- Translational Skeletal Genomics Group, Department of Internal Medicine, Erasmus MC University Medical Centre, Doctor Molewaterplein 40, Ee-571, 3015, GD, Rotterdam, The Netherlands.
- Department of Epidemiology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands.
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7
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Chevalier T, Colard T, Colombo A, Golovanova L, Doronichev V, Hublin JJ. Early ontogeny of humeral trabecular bone in Neandertals and recent modern humans. J Hum Evol 2021; 154:102968. [PMID: 33774376 DOI: 10.1016/j.jhevol.2021.102968] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 02/09/2021] [Accepted: 02/10/2021] [Indexed: 11/27/2022]
Abstract
Trabecular bone ontogeny is well known in modern humans and unknown in Neandertals. Yet the bone developmental pattern is useful for interpreting fossils from evolutionary and functional perspectives. Interestingly, microstructure in early ontogeny is supposedly not influenced by high and specific mechanical loading related to the lifestyle of a human group and consequently does not directly depend on the activities of hunter-gatherers. Here, we specifically explored the early growth trajectories of the trabecular bone structure of the humerus and emphasized in particular how bone fraction (bone volume/total volume [BV/TV]) was built up in Neandertals, given the specific modern human bone loss after birth and the use of BV/TV in functional studies. Six Neandertals and 26 recent modern humans ranging from perinates to adolescents were included in this study. Six trabecular parameters were measured within a cubic region of interest extracted from the proximal metaphysis of the humerus. We found that the microstructural changes in Neandertals during early ontogeny (<1 year) fit with modern human growth trajectories for each parameter. The specific bone loss occurring immediately after birth in modern humans also occurred in Neandertals (but not in chimpanzees). However, the early childhood fossil Ferrassie 6 presented unexpectedly high BV/TV, whereas the high BV/TV in the Crouzade I adolescent was predictable. These results suggest that Neandertals and modern humans shared predetermined early growth trajectories and developmental mechanisms. We assume that the close relationship between skeletal characteristics in early ontogeny and adults in modern humans also existed in Neandertals. However, it was difficult to ensure that the high BV/TV in Neandertal early childhood, represented by only one individual, was at the origin of the high BV/TV observed in adults. Consequently, our study does not challenge the mechanical hypothesis that explains the trabecular gracilization of the humerus during the Holocene.
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Affiliation(s)
- Tony Chevalier
- UMR 7194 HNHP, University of Perpignan Via Domitia, EPCC-CERP de Tautavel, Avenue Léon Jean Grégory 66720 Tautavel, France.
| | - Thomas Colard
- UMR 5199 PACEA, University of Bordeaux, CNRS, MCC; LabEx Sciences Archéologiques de Bordeaux, N°ANR-10-LABX-52, Bâtiment B8, Allée Geoffroy Saint-Hilaire, CS50023, F-33615 Pessac, France; Department of Orthodontics, University of Lille, F-59000, Lille, France
| | - Antony Colombo
- Ecole Pratique des Hautes Etudes, PSL University, Chair of Biological Anthropology Paul Broca, 4-14 Rue Ferrus, F-75014 Paris, France
| | | | | | - Jean-Jacques Hublin
- Department of Human Evolution, Max Planck Institute for Evolutionary Anthropology, Deutscher Platz 6, D-04103 Leipzig, Germany; Chaire Internationale de Paléoanthropologie du Collège de France, 11 Place Marcelin Berthelot, 75005 Paris, France
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8
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Saunders FR, Gregory JS, Pavlova AV, Muthuri SG, Hardy RJ, Martin KR, Barr RJ, Adams JE, Kuh D, Aspden RM, Cooper R, Ireland A. Motor development in infancy and spine shape in early old age: Findings from a British birth cohort study. J Orthop Res 2020; 38:2740-2748. [PMID: 32162719 PMCID: PMC8641380 DOI: 10.1002/jor.24656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 02/21/2020] [Accepted: 03/06/2020] [Indexed: 02/04/2023]
Abstract
Spine shape changes dramatically in early life, influenced by attainment of developmental milestones such as independent walking. Whether these associations persist across life is unknown. Therefore, we investigated associations between developmental milestones and spine shape, as determined using statistical shape models (SSMs) of lumbar spine from dual-energy X-ray absorptiometry scans in 1327 individuals (688 female) at 60 to 64 years in the MRC National Survey of Health and Development. Lumbar lordosis angle (L4 inferior endplate to T12 superior endplate) was measured using the two-line Cobb method. In analyses adjusted for sex, height, lean and fat mass, socioeconomic position, and birthweight, later walking age was associated with greater lordosis described by SSM1 (regression coefficient, 0.023; 95% CI, 0.000-0.047; P = .05) and direct angle measurement. Modest associations between walking age and less variation in anterior-posterior vertebral size caudally (SSM6) were also observed (0.021; 95% CI, -0.002 to 0.044; P = .07). Sex interactions showed that later walking was associated with larger relative vertebral anterior-posterior dimensions in men (SSM3; -0.043; 95% CI, -0.075 to 0.01; P = .01) but not women (0.018; 95% CI, -0.0007 to 0.043; P = .17). Similar associations were observed between age at independent standing and SSMs but there was little evidence of association between sitting age and spine shape. Unadjusted associations between walking age and SSMs 1 and 6 remained similar after adjustment for potential confounders and mediators. This suggests that these associations may be explained by altered mechanical loading of the spine during childhood growth, although other factors could contribute. Early life motor development, particularly walking, may have a lasting effect on the features of spine morphology with clinical significance.
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Affiliation(s)
- Fiona R. Saunders
- School of Medicine, Medical Sciences and Nutrition, Aberdeen Centre for Arthritis and Musculoskeletal Health, Institute of Medical SciencesUniversity of AberdeenAberdeenUK
| | - Jennifer S. Gregory
- School of Medicine, Medical Sciences and Nutrition, Aberdeen Centre for Arthritis and Musculoskeletal Health, Institute of Medical SciencesUniversity of AberdeenAberdeenUK
| | - Anastasia V. Pavlova
- School of Medicine, Medical Sciences and Nutrition, Aberdeen Centre for Arthritis and Musculoskeletal Health, Institute of Medical SciencesUniversity of AberdeenAberdeenUK,School of Health SciencesRobert Gordon UniversityAberdeenUK
| | | | - Rebecca J. Hardy
- MRC Unit for Lifelong Health and Ageing at UCLLondonUK,Cohort and Longitudinal Studies Enhancement Resources (CLOSER)UCL Institute of EducationLondonUK
| | - Kathryn R. Martin
- School of Medicine, Medical Sciences and Nutrition, Aberdeen Centre for Arthritis and Musculoskeletal Health, Institute of Medical SciencesUniversity of AberdeenAberdeenUK
| | - Rebecca J. Barr
- School of Medicine, Medical Sciences and Nutrition, Aberdeen Centre for Arthritis and Musculoskeletal Health, Institute of Medical SciencesUniversity of AberdeenAberdeenUK,Medicines Monitoring Unit (MEMO), School of Medicine, Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical SchoolUniversity of DundeeDundeeUK
| | - Judith E. Adams
- Manchester Academic Health Science Centre and Radiology, Manchester Royal InfirmaryCentral Manchester University Hospitals NHS Foundation Trust and University of ManchesterManchesterUK
| | - Diana Kuh
- MRC Unit for Lifelong Health and Ageing at UCLLondonUK
| | - Richard M. Aspden
- School of Medicine, Medical Sciences and Nutrition, Aberdeen Centre for Arthritis and Musculoskeletal Health, Institute of Medical SciencesUniversity of AberdeenAberdeenUK
| | - Rachel Cooper
- Department of Sport and Exercise Sciences, Research Centre for Musculoskeletal Science and Sports MedicineManchester Metropolitan UniversityManchesterUK
| | - Alex Ireland
- Department of Life Sciences, Research Centre for Musculoskeletal Science and Sports MedicineManchester Metropolitan UniversityManchesterUK
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9
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Jenkins M, Hart NH, Nimphius S, Chivers P, Rantalainen T, Rothacker KM, Beck BR, Weeks BK, McIntyre F, Hands B, Beeson BP, Siafarikas A. Characterisation of peripheral bone mineral density in youth at risk of secondary osteoporosis - a preliminary insight. JOURNAL OF MUSCULOSKELETAL & NEURONAL INTERACTIONS 2020; 20:27-52. [PMID: 32131368 PMCID: PMC7104582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To describe peripheral long bone material and structural differences in youth at risk of secondary osteoporosis across disease-specific profiles. METHODS Upper- and lower limbs of children and adolescents were scanned at 4% distal and 66% mid-shaft sites using peripheral Quantitative Computed Tomography sub-categorised as (1) increased risk of secondary osteoporosis (neuromuscular disorders; chronic diseases; endocrine diseases; inborn errors of metabolism; iatrogenic conditions), (2) low motor competence and (3) non-affected controls. RESULTS Children with disease-specific profiles showed a range of bone deficits compared to the control group with these predominantly indicated for neuromuscular disorders, chronic diseases and low motor competence. Deficits between upper arm and lower leg long bone parameters were different for disease-specific profiles compared to the control group. Endocortical radius, muscle area, and mid-cortical ring density were not significantly different for any disease-specific profile compared to the control group for any bone sites. CONCLUSIONS Neuromuscular disorders, chronic diseases and low motor competence have a strong correlation to bone health for appendicular bone parameters in youth, suggesting a critical mechanical loading influence which may differ specific to disease profile. As mechanical loading effects are observed in regional bone analyses, targeted exercise interventions to improve bone strength should be implemented to examine if this is effective in reducing the risk of secondary osteoporosis in youth.
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Affiliation(s)
- Mark Jenkins
- School of Medical and Health Science, Edith Cowan University, Perth, W.A., Australia,Western Australian Bone Research Collaboration, Perth, W.A., Australia
| | - Nicolas H. Hart
- School of Medical and Health Science, Edith Cowan University, Perth, W.A., Australia,Western Australian Bone Research Collaboration, Perth, W.A., Australia,Institute for Health Research, University of Notre Dame Australia, Perth, W.A., Australia,Exercise Medicine Research Institute, Edith Cowan University, Perth, W.A., Australia,Corresponding author: Dr Nicolas H. Hart - PhD, AES, CSCS, ESSAM, Senior Research Fellow, Exercise Medicine Research Institute. Building 21, Room 222 - Edith Cowan University, 270 Joondalup Drive, JOONDALUP, Perth, W.A., Australia E-mail:
| | - Sophia Nimphius
- School of Medical and Health Science, Edith Cowan University, Perth, W.A., Australia,Western Australian Bone Research Collaboration, Perth, W.A., Australia
| | - Paola Chivers
- School of Medical and Health Science, Edith Cowan University, Perth, W.A., Australia,Western Australian Bone Research Collaboration, Perth, W.A., Australia,Institute for Health Research, University of Notre Dame Australia, Perth, W.A., Australia,Exercise Medicine Research Institute, Edith Cowan University, Perth, W.A., Australia
| | - Timo Rantalainen
- School of Medical and Health Science, Edith Cowan University, Perth, W.A., Australia,Western Australian Bone Research Collaboration, Perth, W.A., Australia,Institute for Health Research, University of Notre Dame Australia, Perth, W.A., Australia,Exercise Medicine Research Institute, Edith Cowan University, Perth, W.A., Australia,Gerontology Research Center, University of Jyväskylä, Jyväskylä, Finland
| | - Karen M. Rothacker
- Department of Endocrinology and Diabetes, Perth Children’s Hospital, Perth, W.A., Australia,Keogh Institute for Medical Research, Perth, W.A., Australia,Telethon Kids Institute for Child Health Research, Perth, W.A., Australia
| | - Belinda R. Beck
- Menzies Health Institute Queensland, Bone Densitometry Research Laboratory, School of Allied Health Sciences, Griffith University, Gold Coast, QLD, Australia
| | - Benjamin K. Weeks
- Menzies Health Institute Queensland, Bone Densitometry Research Laboratory, School of Allied Health Sciences, Griffith University, Gold Coast, QLD, Australia
| | - Fleur McIntyre
- Western Australian Bone Research Collaboration, Perth, W.A., Australia,School of Health Sciences, University of Notre Dame Australia, Perth, W.A., Australia
| | - Beth Hands
- Western Australian Bone Research Collaboration, Perth, W.A., Australia,Institute for Health Research, University of Notre Dame Australia, Perth, W.A., Australia
| | - Brendan P. Beeson
- Department of Medical Imaging, Perth Children’s Hospital, Perth, W.A., Australia
| | - Aris Siafarikas
- School of Medical and Health Science, Edith Cowan University, Perth, W.A., Australia,Western Australian Bone Research Collaboration, Perth, W.A., Australia,Institute for Health Research, University of Notre Dame Australia, Perth, W.A., Australia,Exercise Medicine Research Institute, Edith Cowan University, Perth, W.A., Australia,Department of Endocrinology and Diabetes, Perth Children’s Hospital, Perth, W.A., Australia,Telethon Kids Institute for Child Health Research, Perth, W.A., Australia,University of Western Australia, Medical School, Division of Paediatrics, Perth, W.A., Australia
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10
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Frysz M, Tobias JH, Lawlor DA, Aspden RM, Gregory JS, Ireland A. Associations between prenatal indicators of mechanical loading and proximal femur shape: findings from a population-based study in ALSPAC offspring. JOURNAL OF MUSCULOSKELETAL & NEURONAL INTERACTIONS 2020; 20:301-313. [PMID: 32877967 PMCID: PMC7493447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Hip development is influenced by mechanical loading, but associations between prenatal loading and hip shape in later life remain unexplored. METHODS We examined associations between prenatal loading indicators (gestation length, oligohydramnios (OH) and breech) obtained from obstetric records and hip shape modes (HSMs) generated using dual-energy X-ray absorptiometry images taken at age 14- and 18-years in participants from the UK Avon Longitudinal Study of Parents and Children (ALSPAC). These associations were examined in 2453 (30 OH, 105 breech) and 2330 (27 OH, 95 breech) participants with complete data at age 14- and 18-years respectively using confounder-adjusted models. RESULTS At 14 years HSM2 was 0.59SD lower in OH males, and HSM5 (-0.31SD) and HSM9 (-0.32SD) were lower in OH in both sexes. At 18 years HSM1 (-0.44SD) and HSM2 (-0.71SD) were lower and HSM6 (0.61SD) and HSM8 (1.06SD) were higher in OH males, whilst HSM5 was lower in OH in both sexes. OH appeared to be associated with a wider femoral neck and head, and larger lesser/greater trochanters. Only weak associations were observed between gestation length/breech and HSMs. CONCLUSIONS These results suggest that prenatal skeletal loading, in particular oligohydramnios, may influence adolescent joint shape with associations generally stronger in males.
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Affiliation(s)
- Monika Frysz
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, UK,MRC Integrative Epidemiology Unit at the University of Bristol, UK
| | - Jon H Tobias
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, UK,MRC Integrative Epidemiology Unit at the University of Bristol, UK
| | - Deborah A Lawlor
- MRC Integrative Epidemiology Unit at the University of Bristol, UK,Population Health Science, Bristol Medical School, Bristol University, UK,Bristol NIHR Biomedical Research Centre, Medical Sciences and Nutrition, Medical Sciences and Nutrition, University of Aberdeen
| | - Richard M. Aspden
- Aberdeen Centre for Arthritis and Musculoskeletal Health, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen
| | - Jennifer S. Gregory
- Aberdeen Centre for Arthritis and Musculoskeletal Health, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen
| | - Alex Ireland
- Musculoskeletal Science and Sports Medicine Research Centre, Department of Life Sciences, Manchester Metropolitan University, Manchester, UK
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11
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Tobias JH, Sayers A, Deere KC, Heazell AEP, Lawlor DA, Ireland A. Breech presentation is associated with lower adolescent tibial bone strength. Osteoporos Int 2019; 30:1423-1432. [PMID: 31020365 DOI: 10.1007/s00198-019-04945-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 03/18/2019] [Indexed: 12/28/2022]
Abstract
We compared bone outcomes in adolescents with breech and cephalic presentation. Tibia bone mineral content, density, periosteal circumference, and cross-sectional moment of inertia were lower in breech presentation, and females with breech presentation had lower hip CSA. These findings suggest that prenatal loading may exert long-lasting influences on skeletal development. INTRODUCTION Breech position during pregnancy is associated with reduced range of fetal movement, and with lower limb joint stresses. Breech presentation at birth is associated with lower neonatal bone mineral content (BMC) and area, but it is unknown whether these associations persist into later life. METHODS We examined associations between presentation at onset of labor, and tibia and hip bone outcomes at age 17 years in 1971 participants (1062 females) from a UK prospective birth cohort that recruited > 15,000 pregnant women in 1991-1992. Cortical BMC, cross-sectional area (CSA) and bone mineral density (BMD), periosteal circumference, and cross-sectional moment of inertia (CSMI) were measured by peripheral quantitative computed tomography (pQCT) at 50% tibia length. Total hip BMC, bone area, BMD, and CSMI were measured by dual-energy X-ray absorptiometry (DXA). RESULTS In models adjusted for sex, age, maternal education, smoking, parity, and age, singleton/multiple births, breech presentation (n = 102) was associated with lower tibial cortical BMC (- 0.14SD, 95% CI - 0.29 to 0.00), CSA (- 0.12SD, - 0.26 to 0.02), BMD (- 0.16SD, - 0.31 to - 0.01), periosteal circumference (- 0.14SD, - 0.27 to - 0.01), and CSMI (- 0.11SD, - 0.24 to 0.01). In females only, breech presentation was associated with lower hip CSA (- 0.24SD, - 0.43 to 0.00) but not with other hip outcomes. Additional adjustment for potential mediators (delivery method, birthweight, gestational age, childhood motor competence and adolescent height and body composition) did not substantially affect associations with either tibia or hip outcomes. CONCLUSIONS These findings suggest that prenatal skeletal loading may exert long-lasting influences on skeletal size and strength but require replication.
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Affiliation(s)
- J H Tobias
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - A Sayers
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - K C Deere
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - A E P Heazell
- Division of Developmental Biology and Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - D A Lawlor
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Science, Bristol Medical School, Bristol University, Bristol, UK
- Bristol NIHR Biomedical Research Centre, Bristol, UK
| | - A Ireland
- School of Healthcare Science, Manchester Metropolitan University, John Dalton Building, Chester Street, Manchester, M1 5GD, UK.
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12
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Pate RR, Hillman C, Janz K, Katzmarzyk PT, Powell KE, Torres A, Whitt-Glover MC, for the 2018 Physical Activity Guidelines Advisory Committee. Physical Activity and Health in Children Younger than 6 Years: A Systematic Review. Med Sci Sports Exerc 2019; 51:1282-1291. [PMID: 31095085 PMCID: PMC6527328 DOI: 10.1249/mss.0000000000001940] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE Physical activity is known to provide important health benefits in school-age youth. However, until recently, few studies have examined associations between physical activity and health in young children. The purpose of this study was to conduct a systematic review of the relationship between physical activity and selected health outcomes in children younger than 6 yr. METHODS A systematic search identified randomized controlled trials and prospective cohort studies examining the associations between physical activity and adiposity/weight status, bone health, cardiometabolic health, and cognition in children younger than 6 yr. RESULTS Twenty-seven studies met inclusion criteria and served as the basis for this systematic review. For weight status/adiposity, 12 of 15 studies found negative associations between physical activity and one or more measures of the outcome. For bone health, 10 articles based on four studies were identified, and nine studies showed stronger bone in more active children. For cardiometabolic health, three studies were identified and findings were limited and inconsistent. For cognition, two systematic reviews were identified and findings were limited. For all four health outcomes, evidence of dose-response relationships and effect modification by demographic factors was very limited. CONCLUSIONS There is strong evidence indicating that higher amounts of physical activity are associated with better indicators of bone health and with reduced risk for excessive increases in weight and adiposity in children 3 to 6 yr. Evidence was too limited to support conclusions regarding the effects of physical activity on cardiometabolic health and cognition.
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Affiliation(s)
- Russell R. Pate
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Charles Hillman
- Departments of Psychology and Physical Therapy, Movement and Rehabilitation Sciences, Northeastern University, Boston, MA
| | - Kathleen Janz
- Departments of Health and Human Physiology and Epidemiology, University of Iowa, Iowa City, IA
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13
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Ireland A, Saunders FR, Muthuri SG, Pavlova AV, Hardy RJ, Martin KR, Barr RJ, Adams JE, Kuh D, Aspden RM, Gregory JS, Cooper R. Age at Onset of Walking in Infancy Is Associated With Hip Shape in Early Old Age. J Bone Miner Res 2019; 34:455-463. [PMID: 30496618 PMCID: PMC6446733 DOI: 10.1002/jbmr.3627] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 09/21/2018] [Accepted: 10/06/2018] [Indexed: 12/12/2022]
Abstract
Bones' shapes and structures adapt to the muscle and reaction forces they experience during everyday movements. Onset of independent walking, at approximately 12 months, represents the first postnatal exposure of the lower limbs to the large forces associated with bipedal movements; accordingly, earlier walking is associated with greater bone strength. However, associations between early life loading and joint shape have not been explored. We therefore examined associations between walking age and hip shape at age 60 to 64 years in 1423 individuals (740 women) from the MRC National Survey of Health and Development, a nationally representative British birth cohort. Walking age in months was obtained from maternal interview at age 2 years. Ten modes of variation in hip shape (HM1 to HM10), described by statistical shape models, were ascertained from DXA images. In sex-adjusted analyses, earlier walking age was associated with higher HM1 and HM7 scores; these associations were maintained after further adjustment for height, body composition, and socioeconomic position. Earlier walking was also associated with lower HM2 scores in women only, and lower HM4 scores in men only. Taken together, this suggests that earlier walkers have proportionately larger (HM4) and flatter (HM1, HM4) femoral heads, wider (HM1, HM4, HM7) and flatter (HM1, HM7) femoral necks, a smaller neck-shaft angle (HM1, HM4), anteversion (HM2, HM7), and early development of osteophytes (HM1). These results suggest that age at onset of walking in infancy is associated with variations in hip shape in older age. Early walkers have a larger femoral head and neck and smaller neck-shaft angle; these features are associated with reduced hip fracture risk, but also represent an osteoarthritic-like phenotype. Unlike results of previous studies of walking age and bone mass, associations in this study were not affected by adjustment for lean mass, suggesting that associations may relate directly to skeletal loading in early life when joint shape changes rapidly. © 2018 American Society for Bone and Mineral Research.
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Affiliation(s)
- Alex Ireland
- School of Healthcare Science, Manchester Metropolitan University, Manchester, UK
| | - Fiona R Saunders
- Aberdeen Centre for Arthritis and Musculoskeletal Health, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | | | - Anastasia V Pavlova
- Aberdeen Centre for Arthritis and Musculoskeletal Health, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | | | - Kathryn R Martin
- Aberdeen Centre for Arthritis and Musculoskeletal Health, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Rebecca J Barr
- Aberdeen Centre for Arthritis and Musculoskeletal Health, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK.,Medicines Monitoring Unit (MEMO), Division of Molecular & Clinical Medicine, School of Medicine, University of Dundee, Ninewells Hospital & Medical School, Dundee, Scotland
| | - Judith E Adams
- Manchester Academic Health Science Centre and Radiology, Central Manchester University Hospitals NHS Foundation Trust and University of Manchester, Manchester Royal Infirmary, Manchester, UK
| | - Diana Kuh
- MRC Unit for Lifelong Health and Ageing at UCL, London, UK
| | - Richard M Aspden
- Aberdeen Centre for Arthritis and Musculoskeletal Health, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Jennifer S Gregory
- Aberdeen Centre for Arthritis and Musculoskeletal Health, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Rachel Cooper
- MRC Unit for Lifelong Health and Ageing at UCL, London, UK
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14
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Chivers P, Rantalainen T, McIntyre F, Hands B, Weeks B, Beck B, Nimphius S, Hart N, Siafarikas A. Suboptimal bone status for adolescents with low motor competence and developmental coordination disorder-It's sex specific. RESEARCH IN DEVELOPMENTAL DISABILITIES 2019; 84:57-65. [PMID: 30119956 DOI: 10.1016/j.ridd.2018.07.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 07/26/2018] [Accepted: 07/27/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Australian adolescents with low motor competence (LMC) have higher fracture rates and poorer bone health compared to European normative data, but currently no normative data exists for Australians. AIMS To examine whether there were bone health differences in Australian adolescents with LMC or Developmental Coordination Disorder (DCD) when compared to typically developing age-matched Australian adolescents. METHODS AND PROCEDURES Australian adolescents aged 12-18 years with LMC/DCD (n = 39; male = 27; female = 12) and an Australian comparison sample (n = 188; boys = 101; girls = 87) undertook radial and tibial peripheral Quantitative Computed Tomography (pQCT) scans. Stress Strain Index (SSI (mm3)), Total Bone Area (TBA (mm2)), Muscle Density (MuD [mgcm3]), Muscle Area (MuA [cm2]), Subcutaneous Fat Area (ScFA [cm2]), Cortical Density (CoD [mgcm3]), Cortical Area (CoD [mm2]), cortical concentric ring volumetric densities, Functional Muscle Bone Unit Index (FMBU: (SSI/bone length)) and Robustness Index (SSI/bone length^3), group and sex differences were examined. OUTCOME AND RESULTS The main finding was a significant sex-x-group interaction for Tibial FMBU (p = .021), Radial MuD (p = .036), and radial ScFA (p = .002). Boys with LMC/DCD had lower tibial FMBU scores, radial MuD and higher ScFA than the typically developing age-matched sample. CONCLUSION AND IMPLICATIONS Comparisons of bone measures with Australian comparative data are similar to European findings however sex differences were found in the present study. Australian adolescent boys with LMC/DCD had less robust bones compared to their well-coordinated Australian peers, whereas there were no differences between groups for girls. These differences may be due to lower levels of habitual weight-bearing physical activity, which may be more distinct in adolescent boys with LMC/DCD compared to girls.
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Affiliation(s)
- Paola Chivers
- Institute for Health Research, The University of Notre Dame Australia, WA, Australia; Western Australian Bone Research Collaboration, WA, Australia; School of Medical and Health Sciences, Edith Cowan University, WA, Australia.
| | - Timo Rantalainen
- Western Australian Bone Research Collaboration, WA, Australia; School of Medical and Health Sciences, Edith Cowan University, WA, Australia; Institute for Physical Activity and Nutrition, Deakin University, VIC, Australia
| | - Fleur McIntyre
- Western Australian Bone Research Collaboration, WA, Australia; School of Health Sciences, The University of Notre Dame Australia, WA, Australia
| | - Beth Hands
- Institute for Health Research, The University of Notre Dame Australia, WA, Australia; Western Australian Bone Research Collaboration, WA, Australia
| | - Benjamin Weeks
- Menzies Health Institute Queensland, Griffith University, QLD, Australia
| | - Belinda Beck
- Menzies Health Institute Queensland, Griffith University, QLD, Australia
| | - Sophia Nimphius
- Western Australian Bone Research Collaboration, WA, Australia; School of Medical and Health Sciences, Edith Cowan University, WA, Australia; Centre of Exercise and Sport Science Research, Edith Cowan University, WA, Australia
| | - Nicolas Hart
- Western Australian Bone Research Collaboration, WA, Australia; School of Medical and Health Sciences, Edith Cowan University, WA, Australia; Exercise Medicine Research Institute, Edith Cowan University, WA, Australia
| | - Aris Siafarikas
- Institute for Health Research, The University of Notre Dame Australia, WA, Australia; Western Australian Bone Research Collaboration, WA, Australia; School of Medical and Health Sciences, Edith Cowan University, WA, Australia; Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, WA, Australia; Telethon Kids Institute and School of Paediatrics and Child Health, University of Western Australia, WA, Australia
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15
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Skeletal disproportion in glucocorticoid-treated boys with Duchenne muscular dystrophy. Eur J Pediatr 2019; 178:633-640. [PMID: 30762116 PMCID: PMC6459782 DOI: 10.1007/s00431-019-03336-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 01/13/2019] [Accepted: 01/30/2019] [Indexed: 12/30/2022]
Abstract
We aimed to compare body segment and bone lengths in glucocorticoid-treated boys with Duchenne muscular dystrophy (DMD) with healthy controls using dual-energy absorptiometry (DXA) images. Total height (Ht), sitting height (SH), leg length (LL) and bone lengths (femur, tibia) in boys with DMD and age-matched control boys were measured using DXA. Thirty boys with DMD (median age 10.0 years (6.1, 16.8)) were compared with 30 controls. SH in DMD was 3.3 cm lower (95% CI - 6.1, - 0.66; p = 0.016). LL in DMD was 7.3 cm lower (95% CI - 11.2, - 3.4; p < 0.0001). SH:LL of boys with DMD was higher by 0.08 (95% CI 0.04, 0.12; p < 0.0001). Femur length in DMD was 2.4 cm lower (95% CI - 4.6, - 0.12; p = 0.04), whereas tibial length in DMD was 4.8 cm lower (95% CI - 6.7, - 2.9; p < 0.0001). SH:LL was not associated with duration of glucocorticoid use (SH:LL β = 0.003, 95% CI - 0.01 to 0.002, p = 0.72).Conclusion: Glucocorticoid-treated boys with DMD exhibit skeletal disproportion with relatively shorter leg length and more marked reduction of distal long bones. As glucocorticoid excess is not associated with such disproportion, our findings raise the possibility of an intrinsic disorder of growth in DMD. What is Known • Severe growth impairment and short stature are commonly observed in boys with Duchenne muscular dystrophy (DMD), especially those treated with long-term glucocorticoids (GC). • In other groups of children with chronic conditions and/or disorders of puberty, skeletal disproportion with lower spinal length has been reported. What is New • Growth impairment in GC-treated boys with DMD was associated with skeletal disproportion in relation to age, with lower limbs and distal long bones affected to a greater degree.
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16
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Xie LF, Alos N, Cloutier A, Béland C, Dubois J, Nuyt AM, Luu TM. The long-term impact of very preterm birth on adult bone mineral density. Bone Rep 2018; 10:100189. [PMID: 30627597 PMCID: PMC6319299 DOI: 10.1016/j.bonr.2018.100189] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 12/05/2018] [Accepted: 12/11/2018] [Indexed: 12/31/2022] Open
Abstract
Introduction Preterm infants are at increased risk of osteopenia of prematurity due to insufficient bone mineral accretion. Data on long term effects of prematurity on bone health are conflicting. This study aimed to compare bone mineral density (BMD) in young adults born very preterm and full-term controls and to examine factors associated with long-term bone health. Methods This observational cross-sectional study enrolled 101 young adults (18–29 years) born <29 weeks of gestation and 95 sex- and age-matched full-term controls. Participants underwent dual-energy X-ray absorptiometry to measure areal BMD and body composition. Generalized estimated equations were used to compare groups adjusting for height Z-score, lean body mass and fat mass. Results Adults born preterm were shorter and lighter than full-term controls. Areal BMD was reduced at the lumbar spine, the femoral neck and whole body in the preterm versus full-term group, but after adjustment, areal BMD Z-score was only significantly lower at the femoral neck by −0.3 unit (95% confidence interval −0.6 to −0.0). Low BMD (Z-score ≤ −1 standard deviation) at any site was observed in 53% of adults born preterm versus 28% of full-term controls, but this was not statistically significantly different. We did not identify any neonatal factors associated with lower BMD within the preterm group. Conclusions Very preterm birth is associated with lower areal BMD at the femoral neck in young adulthood, even after accounting for body size. Whether this will translate into higher risk of osteoporotic fractures later in life remains unknown.
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Affiliation(s)
- Li Feng Xie
- Research Center, Centre Hospitalier Universitaire Sainte-Justine, 3175 Chemin de la Côte-Ste-Catherine, Montreal, Quebec H3T 1C5, Canada
| | - Nathalie Alos
- Research Center, Centre Hospitalier Universitaire Sainte-Justine, 3175 Chemin de la Côte-Ste-Catherine, Montreal, Quebec H3T 1C5, Canada.,Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, 3175 Chemin de la Côte-Ste-Catherine, Montreal, Quebec H3T 1C5, Canada
| | - Anik Cloutier
- Research Center, Centre Hospitalier Universitaire Sainte-Justine, 3175 Chemin de la Côte-Ste-Catherine, Montreal, Quebec H3T 1C5, Canada
| | - Chanel Béland
- Research Center, Centre Hospitalier Universitaire Sainte-Justine, 3175 Chemin de la Côte-Ste-Catherine, Montreal, Quebec H3T 1C5, Canada
| | - Josée Dubois
- Research Center, Centre Hospitalier Universitaire Sainte-Justine, 3175 Chemin de la Côte-Ste-Catherine, Montreal, Quebec H3T 1C5, Canada.,Department of Radiology, Centre Hospitalier Universitaire Sainte-Justine, 3175 Chemin de la Côte-Ste-Catherine, Montreal, Quebec H3T 1C5, Canada
| | - Anne Monique Nuyt
- Research Center, Centre Hospitalier Universitaire Sainte-Justine, 3175 Chemin de la Côte-Ste-Catherine, Montreal, Quebec H3T 1C5, Canada.,Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, 3175 Chemin de la Côte-Ste-Catherine, Montreal, Quebec H3T 1C5, Canada
| | - Thuy Mai Luu
- Research Center, Centre Hospitalier Universitaire Sainte-Justine, 3175 Chemin de la Côte-Ste-Catherine, Montreal, Quebec H3T 1C5, Canada.,Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, 3175 Chemin de la Côte-Ste-Catherine, Montreal, Quebec H3T 1C5, Canada
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17
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Ireland A, Crozier SR, Heazell AEP, Ward KA, Godfrey KM, Inskip HM, Cooper C, Harvey NC. Breech presentation is associated with lower bone mass and area: findings from the Southampton Women's Survey. Osteoporos Int 2018; 29:2275-2281. [PMID: 30003305 PMCID: PMC6173302 DOI: 10.1007/s00198-018-4626-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 06/27/2018] [Indexed: 02/01/2023]
Abstract
UNLABELLED We compared bone outcomes in children with breech and cephalic presentation at delivery. Neonatal whole-body bone mineral content (BMC) and area were lower in children with breech presentation. At 4 years, no differences in whole-body or spine measures were found, but hip BMC and area were lower after breech presentation. INTRODUCTION Breech presentation is associated with altered joint shape and hip dysplasias, but effects on bone mineral content (BMC), area (BA) and density (BMD) are unknown. METHODS In the prospective Southampton Women's Survey mother-offspring cohort, whole-body bone outcomes were measured using dual-energy X-ray absorptiometry (DXA) in 1430 offspring, as neonates (mean age 6 days, n = 965, 39 with a breech presentation at birth) and/or at age 4.1 years (n = 999, 39 breech). Hip and spine bone outcomes were also measured at age 4 years. RESULTS Neonates with breech presentation had 4.2 g lower whole-body BMC (95% CI -7.4 to - 0.9 g, P = 0.012) and 5.9 cm2 lower BA (- 10.8 to - 1.0 cm2, P = 0.019), but BMD was similar between groups (mean difference - 0.007, - 0.016 to 0.002 g/cm2, P = 0.146) adjusting for sex, maternal smoking, gestational diabetes, mode of delivery, social class, parity, ethnicity, age at scan, birthweight, gestational age and crown-heel length. There were no associations between breech presentation and whole-body outcomes at age 4 years, but, in similarly adjusted models, regional DXA (not available in infants) showed that breech presentation was associated with lower hip BMC (- 0.51, - 0.98 to - 0.04 g, P = 0.034) and BA (- 0.67, - 1.28 to - 0.07 cm2, P = 0.03) but not with BMD (- 0.009, - 0.029 to 0.012 g, P = 0.408), or spine outcomes. CONCLUSIONS These results suggest that breech presentation is associated with lower neonatal whole-body BMC and BA, which may relate to altered prenatal loading in babies occupying a breech position; these differences did not persist into later childhood. Modest differences in 4-year hip BMC and BA require further investigation.
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Affiliation(s)
- A Ireland
- School of Healthcare Science, Manchester Metropolitan University, Manchester, UK
| | - S R Crozier
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - A E P Heazell
- Division of Developmental Biology and Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - K A Ward
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - K M Godfrey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - H M Inskip
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - N C Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.
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18
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Chadwick KP, Mueske NM, Horenstein RE, Shefelbine SJ, Wren TAL. Children with myelomeningocele do not exhibit normal remodeling of tibia roundness with physical development. Bone 2018; 114:292-297. [PMID: 29991457 PMCID: PMC7173944 DOI: 10.1016/j.bone.2018.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 06/14/2018] [Accepted: 07/03/2018] [Indexed: 11/25/2022]
Abstract
Skeletal loading through daily movement is an important factor in the normal development of bones. This loading is affected by the neurological and muscle deficits that result from myelominingocele (MM). While children with MM have been shown to have atypical gait, decreased bone accrual, and increased fracture risk, it is still unclear what morphological bone differences exist and to what extent they relate to physical developmental and ambulation level. This study analyzed computed tomography images of the tibia from 77 children with MM and 124 typically developing (TD) children between the ages of 6 and 16 years. Differences in cross-sectional roundness along the length of the tibia diaphysis were observed across developmental stages (pre-pubertal, pubertal, post-pubertal) and ambulation level (MM non-ambulatory, MM assistive devices, MM independent, and TD). The results showed that tibia cross-sectional morphology becomes less round with development in TD children (p < 0.017). In children with MM, however, roundness is maintained throughout adolescence (p > 0.017), with greater roundness in less ambulatory children (p < 0.0083). These in vivo results align with mechanobiological modeling studies suggesting that intracortical loads (caused by joint loading) as well as periosteal loads (imposed by surrounding muscles) are critical in promoting non-circular cross-sectional bone shape remodeling.
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Affiliation(s)
- Kyle P Chadwick
- Children's Hospital Los Angeles, Los Angeles, CA, United States of America.
| | - Nicole M Mueske
- Children's Hospital Los Angeles, Los Angeles, CA, United States of America
| | | | | | - Tishya A L Wren
- Children's Hospital Los Angeles, Los Angeles, CA, United States of America; University of Southern California, Los Angeles, CA, United States of America
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19
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Fong SSM, Vackova D, Choi AWM, Cheng YTY, Yam TTT, Guo X. Diversity of activity participation determines bone mineral content in the lower limbs of pre-pubertal children with developmental coordination disorder. Osteoporos Int 2018; 29:917-925. [PMID: 29285628 DOI: 10.1007/s00198-017-4361-0] [Citation(s) in RCA: 6] [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: 05/30/2017] [Accepted: 12/19/2017] [Indexed: 01/02/2023]
Abstract
UNLABELLED This study examined the relationships between activity participation and bone mineralization in children with developmental coordination disorder. Limited participation in physical, recreational, social, and skill-based and self-improvement activities contributed to lower bone mineral content. For improved bone health, these children should participate in a variety of activities, not only physical activities. INTRODUCTION Limited activity participation in children with developmental coordination disorder (DCD) may have a negative impact on bone mineral accrual. The objectives of this study were to compare bone mineralization and activity participation patterns of pre-pubertal children with DCD and those with typical development, and to determine the association between activity participation patterns and bone mineralization in children with DCD. METHODS Fifty-two children with DCD (mean age = 7.51 years) and 61 children with typical development (mean age = 7.22 years) participated in the study. Appendicular and total body (less head) bone mineral content (BMC) and bone mineral density (BMD) were evaluated by a whole-body dual-energy X-ray absorptiometry scan. Activity participation patterns were assessed using the Children's Assessment of Participation and Enjoyment (CAPE) questionnaire. RESULTS Children with DCD had lower appendicular and total body BMCs and BMDs than children with typical development overall (p < 0.05). They also had lower CAPE total activity and physical activity diversity scores (p < 0.05). After accounting for the effects of age, sex, height, lean mass, and fat mass, the total activity diversity score remained independently associated with leg BMC in children with DCD, explaining 5.1% of the variance (p = 0.030). However, the physical activity diversity score was no longer associated with leg BMC (p = 0.090). CONCLUSIONS Diversity of activity participation and bone mineralization were lower in pre-pubertal children with DCD. Decreased total activity participation diversity was a contributing factor to lower BMC in the legs of children with DCD.
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Affiliation(s)
- S S M Fong
- School of Public Health, University of Hong Kong, Pokfulam, Hong Kong.
| | - D Vackova
- School of Public Health, University of Hong Kong, Pokfulam, Hong Kong
| | - A W M Choi
- Department of Social Work and Social Administration, University of Hong Kong, Pokfulam, Hong Kong
| | - Y T Y Cheng
- School of Public Health, University of Hong Kong, Pokfulam, Hong Kong
| | - T T T Yam
- School of Public Health, University of Hong Kong, Pokfulam, Hong Kong
| | - X Guo
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hung Hom, Hong Kong
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20
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Hart N, Nimphius S, Rantalainen T, Ireland A, Siafarikas A, Newton R. Mechanical basis of bone strength: influence of bone material, bone structure and muscle action. JOURNAL OF MUSCULOSKELETAL & NEURONAL INTERACTIONS 2017; 17:114-139. [PMID: 28860414 PMCID: PMC5601257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/19/2017] [Indexed: 11/09/2022]
Abstract
This review summarises current understanding of how bone is sculpted through adaptive processes, designed to meet the mechanical challenges it faces in everyday life and athletic pursuits, serving as an update for clinicians, researchers and physical therapists. Bone's ability to resist fracture under the large muscle and locomotory forces it experiences during movement and in falls or collisions is dependent on its established mechanical properties, determined by bone's complex and multidimensional material and structural organisation. At all levels, bone is highly adaptive to habitual loading, regulating its structure according to components of its loading regime and mechanical environment, inclusive of strain magnitude, rate, frequency, distribution and deformation mode. Indeed, the greatest forces habitually applied to bone arise from muscular contractions, and the past two decades have seen substantial advances in our understanding of how these forces shape bone throughout life. Herein, we also highlight the limitations of in vivo methods to assess and understand bone collagen, and bone mineral at the material or tissue level. The inability to easily measure or closely regulate applied strain in humans is identified, limiting the translation of animal studies to human populations, and our exploration of how components of mechanical loading regimes influence mechanoadaptation.
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Affiliation(s)
- N.H. Hart
- Exercise Medicine Research Institute, Edith Cowan University, Perth, W.A., Australia
- Western Australian Bone Research Collaboration, Perth, W.A., Australia
| | - S. Nimphius
- Western Australian Bone Research Collaboration, Perth, W.A., Australia
- Centre for Exercise and Sport Science Research, Edith Cowan University, Perth, W.A., Australia
| | - T. Rantalainen
- Western Australian Bone Research Collaboration, Perth, W.A., Australia
- School of Exercise and Nutrition Sciences, Deakin University, Melbourne, VIC, Australia
| | - A. Ireland
- School of Healthcare Science, Manchester Metropolitan University, Manchester, United Kingdom
| | - A. Siafarikas
- Western Australian Bone Research Collaboration, Perth, W.A., Australia
- Department of Endocrinology, Princess Margaret Hospital, Perth, W.A., Australia
- School of Paediatrics and Child Health, University of Western Australia, Perth, W.A., Australia
- Institute of Health Research, University of Notre Dame Australia, Perth, W.A., Australia
| | - R.U. Newton
- Exercise Medicine Research Institute, Edith Cowan University, Perth, W.A., Australia
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21
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Ireland A, Rittweger J. Exercise for osteoporosis: how to navigate between overeagerness and defeatism. JOURNAL OF MUSCULOSKELETAL & NEURONAL INTERACTIONS 2017; 17:155-161. [PMID: 28860417 PMCID: PMC5601260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Osteoporosis and associated fractures remain a common and costly health problem. Public fears about rare side effects of efficacious drug treatments for osteoporosis have contributed to decreased prescription and compliance. Exercise and physical activity-based interventions have long been proposed as an alternative treatment for osteoporosis. However despite compelling evidence from experimental studies in animals and from observational studies in humans, the use of exercise to improve bone mass in clinical practice does not seem to be justifiable by current human interventional studies. In this perspective, we summarise the available evidence in support of exercise on bone mass. We review the modest effects observed in current exercise trials, and propose a number of factors which may contribute to these discrepancies. We also highlight the successful application of exercise to attenuating or even partially reversing bone loss in musculoskeletal disuse. We then propose how collaboration between basic science and clinical partners, and consideration of factors such as exercise modality, exercise intensity and participation motivation could improve exercise efficacy.
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Affiliation(s)
- A. Ireland
- School of Healthcare Science, Manchester Metropolitan University, United Kingdom,Corresponding author: Alex Ireland, Manchester Metropolitan University, John Dalton Building, Chester Street, Manchester, M1 5GD, UK E-mail:
| | - J. Rittweger
- Institute of Aerospace Medicine, German Aerospace Center (DLR), D-51147 Cologne, Germany,Department of Pediatrics and Adolescent Medicine, University of Cologne, Germany
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22
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Duran I, Schütz F, Hamacher S, Semler O, Stark C, Schulze J, Rittweger J, Schoenau E. The functional muscle-bone unit in children with cerebral palsy. Osteoporos Int 2017; 28:2081-2093. [PMID: 28365851 DOI: 10.1007/s00198-017-4023-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 03/27/2017] [Indexed: 11/24/2022]
Abstract
UNLABELLED Our results suggest that the prevalence of bone health deficits in children with CP was overestimated, when using only age- and height-adjusted bone mineral content (BMC) and areal bone mineral density (aBMD). When applying the functional muscle-bone unit diagnostic algorithm (FMBU-A), the prevalence of positive results decreased significantly. We recommend applying the FMBU-A when assessing bone health in children with CP. INTRODUCTION The prevalence of bone health deficits in children with cerebral palsy (CP) might be overestimated because age- and height-adjusted reference percentiles for bone mineral content (BMC) and areal bone mineral density (aBMD) assessed by dual-energy X-ray absorptiometry (DXA) do not consider reduced muscle activity. The aim of this study was to compare the prevalence of positive DXA-based indicators for bone health deficits in children with CP to the prevalence of positive findings after applying a functional muscle-bone unit diagnostic algorithm (FMBU-A) considering reduced muscle activity. METHODS The present study was a monocentric retrospective analysis of 297 whole body DXA scans of children with CP. The prevalence of positive results of age- and height-adjusted BMC and aBMD defined as BMC and aBMD below the P3 percentile and of the FMBU-A was calculated. RESULTS In children with CP, the prevalence of positive results of age-adjusted BMC were 33.3% and of aBMD 50.8%. Height-adjusted results for BMC and aBMD were positive in 16.8 and 36.0% of cases. The prevalence of positive results applying the FMBU-A regarding BMC and aBMD were significantly (p < 0.001) lower than using age- and height-adjusted BMC and aBMD (8.8 and 14.8%). CONCLUSIONS Our results suggest that the prevalence of bone health deficits in children with CP was overestimated, when using age- and height-adjusted BMC and aBMD. When applying the FMBU-A, the prevalence decreased significantly. We recommend applying the FMBU-A when assessing bone health in children with CP.
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Affiliation(s)
- I Duran
- Center of Prevention and Rehabilitation, University of Cologne, Lindenburger Allee 44, 50931, Cologne, Germany.
| | - F Schütz
- Center of Prevention and Rehabilitation, University of Cologne, Lindenburger Allee 44, 50931, Cologne, Germany
| | - S Hamacher
- Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Cologne, Germany
| | - O Semler
- Center of Prevention and Rehabilitation, University of Cologne, Lindenburger Allee 44, 50931, Cologne, Germany
- Children's Hospital, University of Cologne, Cologne, Germany
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
| | - C Stark
- Center of Prevention and Rehabilitation, University of Cologne, Lindenburger Allee 44, 50931, Cologne, Germany
- Children's Hospital, University of Cologne, Cologne, Germany
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
| | - J Schulze
- Center of Prevention and Rehabilitation, University of Cologne, Lindenburger Allee 44, 50931, Cologne, Germany
| | - J Rittweger
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
| | - E Schoenau
- Center of Prevention and Rehabilitation, University of Cologne, Lindenburger Allee 44, 50931, Cologne, Germany
- Children's Hospital, University of Cologne, Cologne, Germany
- Cologne Center for Musculoskeletal Biomechanics (CCMB), University of Cologne, Cologne, Germany
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23
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Ireland A, Muthuri S, Rittweger J, Adams JE, Ward KA, Kuh D, Cooper R. Later Age at Onset of Independent Walking Is Associated With Lower Bone Strength at Fracture-Prone Sites in Older Men. J Bone Miner Res 2017; 32:1209-1217. [PMID: 28181695 PMCID: PMC5466883 DOI: 10.1002/jbmr.3099] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 01/20/2017] [Accepted: 01/27/2017] [Indexed: 12/21/2022]
Abstract
Later age at onset of independent walking is associated with lower leg bone strength in childhood and adolescence. However, it is unknown whether these associations persist into older age or whether they are evident at axial (central) or upper limb sites. Therefore, we examined walking age obtained at age 2 years and bone outcomes obtained by dual-energy X-ray absorptiometry (DXA) and peripheral quantitative computed tomography (pQCT) scans at ages 60 to 64 years in a nationally representative cohort study of British people, the MRC National Survey of Health and Development. It was hypothesized that later walking age would be associated with lower bone strength at all sites. Later independent walking age was associated with lower height-adjusted hip (standardized regression coefficients with 95% confidence interval [CI] -0.179 [-0.251 to -0.107]), spine (-0.157 [-0.232 to -0.082]), and distal radius (-0.159 [-0.245 to -0.073]) bone mineral content (BMC, indicating bone compressive strength) in men (all p < 0.001). Adjustment for covariates partially attenuated these associations, primarily because of lower lean mass and adolescent sporting ability in later walkers. These associations were also evident for a number of hip geometric parameters (including cross-sectional moment of inertia [CSMI], indicating bone bending/torsional strength) assessed by hip structural analysis (HSA) from DXA scans. Similar height-adjusted associations were also observed in women for several hip, spine, and upper limb outcomes, although adjustment for fat or lean mass led to complete attenuation for most outcomes, with the exception of femoral shaft CSMI and spine bone area (BA). In conclusion, later independent walking age appears to have a lifelong association with bone strength across multiple skeletal sites in men. These effects may result from direct effects of early life loading on bone growth and mediation by adult body composition. Results suggest that late walking age may represent a novel risk factor for subsequent low bone strength. Existing interventions effective in hastening walking age may have positive effects on bone across life. © 2017 The Authors. Journal of Bone and Mineral Research Published by Wiley Periodicals Inc.
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Affiliation(s)
- Alex Ireland
- School of Healthcare Science, Manchester Metropolitan University, Manchester, UK
| | - Stella Muthuri
- MRC Unit for Lifelong Health and Ageing at UCL, London, UK
| | - Joern Rittweger
- Division of Space Physiology, Institute of Aerospace Medicine, German Aerospace Center, Cologne, Germany.,Department of Pediatrics and Adolescent Medicine, University of Cologne, Cologne, Germany
| | - Judith E Adams
- Clinical Radiology, Manchester Royal Infirmary, Manchester, UK.,Academic Health Science, Manchester University Hospital NHS Foundation Trust, Manchester, UK.,Division of Informatics, Imaging, and Data Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, UK
| | - Kate A Ward
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.,MRC Elsie Widdowson Laboratory, Cambridge, UK
| | - Diana Kuh
- MRC Unit for Lifelong Health and Ageing at UCL, London, UK
| | - Rachel Cooper
- MRC Unit for Lifelong Health and Ageing at UCL, London, UK
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