Physical activity throughout adolescence and bone mineral density in early adulthood: the 1993 Pelotas (Brazil) Birth Cohort Study

Association between Bone Quality and Physical Activity in Community-Dwelling Older Adults

Bone quality is an essential factor determining bone strength. However, the relationship between physical activity (PA) and bone quality remains unclear. This study aimed to ascertain the relationship between bone quality and PA using a cortical bone quantitative ultrasound device that measures components of bone quality. In this cross-sectional study, bone quality was assessed in community-dwelling older adults by measuring the cortical speed of sound (cSOS) at the mid-tibia using a quantitative ultrasound device. Using a wrist-worn accelerometer, we calculated the daily duration of moderate-to-vigorous physical activity (MVPA) and light physical activity (LPA) based on estimated METs from the accelerometer data, without differentiating between types of activities. A multiple regression analysis was performed to examine the association between PA and the cSOS. The participants' physical activity averaged 42.0 min/day for MVPA and 483.6 min/day for LPA. No significant association was observed between PA and bone quality in either men or women in the crude models. Furthermore, PA was not significantly correlated with the cSOS in the models adjusted for age, body mass index, nutrient intake, number of medications, and kidney disease. This study was a cross-sectional study which focused on the association between bone quality in older adults and their current amount of PA. The cSOS, as a measure of bone quality, was not associated with PA in men or women. Higher amounts of daily PA, as estimated from metabolic equivalents with an accelerometer, may not necessarily maintain or improve bone quality in older adults. This study does not rule out the potential for a positive association between PA levels or types and bone quality in younger or middle-aged individuals. It was specifically targeted at older adults, and its findings should not be generalized to younger populations. Further longitudinal studies are required to better understand the relationship between PA and bone quality.

One-Year Changes in Bioelectrical Impedance Data in Adolescent Athletes

Raw bioelectrical impedance (BI) data and vector analysis (BIVA) have been used to evaluate fat-free mass (FFM) cross-sectionally in adolescent athletes; however, there have been no longitudinal studies about it. This study aimed to assess the magnitude of changes in raw BI data (resistance [R], reactance [Xc], and phase angle [PhA]), BIVA, and FFM in adolescent athletes (n = 137, 40% female). BI data were collected using a single-frequency device at baseline and after one year of sports practice. Baseline chronological age categorized the participants (11, 12, or 13 years [y]). In females, Xc/H increased (13 to 14 y, p = 0.04) while R/H decreased in all age groups (p = 0.001). PhA (11 to 12 y, p = 0.048) and FFM (11 to 12 y and 12 to 13 y groups p = 0.001) increased and showed the lowest magnitude of changes in the 13 to 14 y group (p = 0.05). In males, Xc/H decreased (11 to 12 and 12 to 13 y groups, p = 0.001) with a higher magnitude of changes in the 13 to 14 y group (p = 0.004); R/H decreased (p = 0.001); FFM increased in all groups (p = 0.001); however, no magnitude of changes was observed. PhA increased in the 13 to 14 y group (p = 0.004). BIVA showed no differences among ellipse distances in females. In males, a high distance was observed in the 11 to 12 y group. "Time interval" influenced PhA and Xc/H in the female group and R/H and Xc/H in the male group. "Initial age" and "time interval" influenced the increase in PhA in the male group. Raw BI data and BIVA patterns can detect the magnitude of the changes in a sex-dependent manner.

Interrelationship between muscle fitness in childhood and bone mineral density in adulthood: mediation analysis of muscle fitness in adulthood

BACKGROUND

This study was aimed to examine the relationship between muscular fitness indicators in childhood and areal bone mineral density (aBMD) in adulthood and to verify whether the relationship is mediated by performance on muscular fitness indicators in adulthood.

METHODS

A sample of 138 healthy adults (69 males; 22.3 years) were followed after a previous assessment at the age of 7-10 years. Stature, body mass and muscular fitness indicators (handgrip strength, standing long jump and sit-ups tests) were assessed in childhood and adulthood. Additionally, total body, upper limbs, lower limbs, right femoral neck and lumbar spine aBMD was assessed in adulthood using dual X-ray absorptiometry. Analysis included descriptive statistics; t-test or Mann-Whitney U-test for comparison between males and females, multiple linear regression for the prediction aBMD from muscular fitness indicators in childhood, mediation analysis of the respective muscular fitness indicators in adulthood and the relationship between muscular fitness indicators in childhood and aBMD.

RESULTS

Males were stronger compared to females regarding muscular fitness indicators in childhood and adulthood, and presented higher mean values for aBMD in adulthood, except for lumbar spine (p < 0.05). Regression analysis revealed that some muscular fitness indicators in childhood showed significant positive relationship with bone health indicators in adulthood, such as: handgrip strength and total body aBMD (β = 0.005; R² = 0.35; p = 0.040) and upper limbs aBMD (β = 0.005; R² = 0.55; p = 0.019); and sit-ups test was a significant predictors of lumbar spine BMD (β = 0.003; R² = 0.06; p = 0.039). Mediation analysis pointed out the following: adulthood handgrip strength mediated relationships between childhood handgrip strength and total aBMD (indirect effect (IE) = 0.0025; 95%CI = 0.0005-0.0048), and upper limbs aBMD (IE = 0.0040; 95%CI = 0.0017-0.0069).

CONCLUSIONS

Muscular fitness indicators in childhood showed significant relationship with bone health indicators in adulthood and the sit-ups test in childhood had direct effect on lumbar spine aBMD in adulthood. Adulthood handgrip strength mediated the relationship between childhood handgrip strength and total body and upper limb aBMD, pointing out that muscular fitness in childhood may be a aBMD determinant in adulthood, especially when higher muscle fitness performance is maintained in adulthood.

Examining the Health-Related Needs of Females during Menopause: A Systematic Review Study

Menopause is one the most crucial stages in a female's life. Identifying the education gaps regarding menopause is important, thus this study aims to explain the health-related needs of females during menopause. Scopus, PubMed, Scientific Information Database, and Web of Science databases were searched for the available observational (cohort, case-control, and cross-sectional), systematic review, meta-analysis, and clinical trial studies (2007-2021) using keywords, such as 'Educational Needs Assessment,' 'Assessment of Healthcare Needs,' 'menopause,' 'climacteric,' 'premenopause,' and 'postmenopause.' A total of 180 out of 5,705 papers were evaluated after considering the inclusion and exclusion criteria. The educational needs of females during menopause in the reviewed studies include osteoporosis, oral and dental problems, metabolic disorders, cardiovascular diseases, hypertension, lung diseases, infectious diseases, musculoskeletal problems, urinary problems, breast cancer, defecation problems, genital disorders, special diseases such as eye diseases and hypothyroidism and hormone therapy, mental disorders, cognitive function, sleep disorders, sexual disorders, physical activity, supplement consumption, public health issues, health education, fall, and nutrition. The study results reveal that females during postmenopause require training, counseling, and support in all aspects to get through this challenging time, and providing these services, infrastructure, appropriate policy, and the use and support of the medical team's capacity are all required.

Osteoporosis Remains Constant in Patients with Hemophilia-Long-Term Course in Consideration of Comorbidities

INTRODUCTION

 Patients with hemophilia (PWHs) suffer from an increased risk of osteoporosis. Multiple hemophilia and hemophilic arthropathy associated factors correlate with a low bone mineral density (BMD) in PWHs. The aim of this study was to assess the long-term development of BMD in PWH as well as to analyze potentially influencing factors.

METHODS

 A total of 33 adult PWHs were evaluated in a retrospective study. General medical history, specific-hemophilia-associated comorbidities, joint status using the Gilbert score, calcium level, and vitamin D level as well as at least two results of bone density measurements with a minimum range of 10 years per patient were taken into account.

RESULTS

 The BMD did not change significantly from one point of measurement to the other. A total of 7 (21.2%) cases of osteoporosis and 16 (48.5%) cases of osteopenia were identified. The two following significant correlations could be revealed: the higher the patients' body mass index, the higher their BMD (r = 0.41; p = 0.022). Moreover, a high Gilbert score came along with a low BMD (r = -0.546; p = 0.003).

CONCLUSION

 Even if PWHs frequently suffer from a reduced BMD, our data suggest that their BMD remains constant on a low level in the course of time. A risk factor of osteoporosis often found in PWHs is a vitamin D deficiency and joint destruction. Therefore, a standardized screening of PWHs on BMD reduction by collecting vitamin D blood level and assessing joint status seems appropriate.

Bioimpedance Vector Patterns according to Age and Handgrip Strength in Adolescent Male and Female Athletes

Bioelectric Impedance Vector Analysis (BIVA) can be used to qualitatively compare individuals’ hydration and cell mass independently of predictive equations. This study aimed to analyze the efficiency of BIVA considering chronological age and handgrip strength in adolescent athletes. A total of 273 adolescents (male; 59%) engaged in different sports were evaluated. Bioelectrical impedance (Z), resistance (R), reactance (Xc), and phase angle (PhA) were obtained using a single-frequency bioelectrical impedance analyzer. Fat-free mass (FFM) and total body water were estimated using bioimpedance-based equations specific for adolescents. Female showed higher values of R (5.5%, p = 0.001), R/height (3.8%, p = 0.041), Z (5.3%, p = 0.001), and fat mass (53.9%, p = 0.001) than male adolescents. Male adolescents showed higher values of FFM (5.3%, p = 0.021) and PhA (3.1%, p = 0.033) than female adolescents. In both stratifications, adolescents (older > 13 years or stronger > median value) shifted to the left on the R-Xc graph, showing patterns of higher hydration and cell mass. The discrimination of subjects older than 13 years and having higher median of handgrip strength values was possibly due to maturity differences. This study showed that BIVA identified age and strength influence in vector displacement, assessing qualitative information and offering patterns of vector distribution in adolescent athletes.

Position Statement: Exercise Guidelines to Increase Peak Bone Mass in Adolescents

Background

An increase in bone mineral density during adolescence increases resistance to fractures in older age. The Korean Society for Bone and Mineral Research and the Korean Society of Exercise Physiology developed exercise guidelines to increase the peak bone mass (PBM) in adolescents based on evidence through a systematic review of previous research.

Methods

Articles were selected using the systematic method, and the exercise guidelines were established by selecting key questions (KQs) and defining the effects of exercises based on evidence through a literature review for selecting the final exercise method. There were 9 KQs. An online search was conducted on articles published since 2000, and 93 articles were identified.

Results

An increase in PBM in adolescence was effective for preventing osteoporosis and fractures in older age. Exercise programs as part of vigorous physical activity (VPA) including resistance and impact exercise at least 5 to 6 months were effective for improving PBM in adolescents. It is recommended that resistance exercise is performed 10 to 12 rep·set⁻¹ 1-2 set·region⁻¹ and 3 days·week⁻¹ using the large muscles. For impact exercises such as jumping, it is recommended that the exercise is performed at least 50 jumps·min⁻¹, 10 min·day⁻¹ and 2 days·week⁻¹.

Conclusions

Exercise guidelines were successfully developed, and they recommend at least 5 to 6 months of VPA, which includes both resistance and impact exercises. With the development of exercise guidelines, the incidence of osteoporosis and fractures in the aging society can be reduced in the future, thus contributing to improved public health.

Is vigorous-intensity physical activity required for improving bone mass in adolescence? Findings from a Brazilian birth cohort

The association between moderate and vigorous physical activity throughout adolescence and areal bone density (aBMD) at 18 years of age was evaluated. Vigorous-intensity physical activity at 11, 15, and 18 years was associated with aBMD in early adulthood, especially in boys. Cross-sectional analyses showed a positive association between moderate physical activity and aBMD.

INTRODUCTION

To evaluate independent associations of moderate and vigorous physical activity (MPA, VPA) across adolescence with areal bone mineral density (aBMD).

METHODS

Physical activity (PA) was assessed at 11, 15, and 18 years of age by self-report and at 18 years by accelerometry in the 1993 Pelotas Birth Cohort Study. Time spent in MPA and VPA was determined using metabolic equivalents and specific cutoffs based on raw acceleration. Lumbar spine and femoral neck aBMD were measured by DXA at 18 years. Statistical analyses evaluated the association of MPA and VPA with aBMD, after adjusting for skin color, asset index, current height and age at menarche, and peak strain score (based on ground reaction forces of PA).

RESULTS

Lumbar spine and femoral neck aBMD were available for 3947 (49.9% of boys) and 3960 (49.6% of boys) individuals, respectively. Time spent in MPA at 11 and 15 years was not associated with aBMD. VPA at all time points was positively related to both lumbar spine and femoral neck aBMD in boys. Results were consistent for objectively measured VPA. Girls who achieved 75+ minutes/week of VPA in at least two follow-ups showed higher aBMD at 18 years of age. Boys who reached 75+ minutes/week of VPA at all follow-ups had on average 0.117 g/cm² (95% CI: 0.090; 0.144) higher femoral neck aBMD than those who never achieved this threshold.

CONCLUSIONS

Self-reported VPA but not MPA throughout adolescence was associated with aBMD. Recommendation for PA in young people should consider the importance of VPA.

Impact of Artistic Gymnastics on Bone Formation Marker, Density and Geometry in Female Adolescents: ABCD-Growth Study

Background

To compare bone density accrual and markers of bone geometry and formation between female adolescents engaged and not engaged in artistic gymnastics (AGs).

Methods

This was a 12-month longitudinal study involving 20 female adolescents, including 10 controls and 10 gymnasts (AGs) aged 11 to 16 years. At baseline, the gymnasts had a minimum of 12 months of practice, and the controls reported no participation in any organized sport. Bone mineral density (BMD) was measured in the lower limbs, upper limbs, spine, and whole body. In addition, BMD and geometrical properties of the femur were assessed. As a bone formation marker, osteocalcin level was measured.

Results

Femoral aspects were increased in the gymnasts by 19% (P=0.009), 14% (P=0.047), and 10% (P=0.046) in the Ward's triangle, trochanter, and the overall bone, respectively, than in the control girls. Geometrical parameters, bone accrual, and osteocalcin levels were similar in both groups. The weekly training load explained 30.8% of all bone gains on the lower limbs and affected the density on parts of the femur.

Conclusions

The gymnasts, after a 12-month follow-up, demonstrated a higher BMD in the Ward's triangle and whole femur than the controls, as well as an improvement in femur density. These changes were mainly due to the weekly training load. Lastly, the gymnasts had significant bone accrual (after 12 months) in the upper limbs, lower limbs, and whole body.

Correlation Between Central and Peripheral Bone Mineral Density Around the Elbow Measured by Dual-Energy X-Ray Absorptiometry in Healthy Children and Adolescents

This pilot study was performed to evaluate the correlation between central bone mineral density (BMD) and peripheral BMD around the elbow in children and adolescents and to compare BMD values across skeletal sites. Twenty-seven healthy volunteers between 5 and 18 yr of age were recruited for the study. Anthropometric measurements including height and weight were performed. Central BMD at the lumbar spine and left femur and peripheral BMD at the supracondylar area, medial condyle, lateral condyle, and olecranon were measured using dual-energy X-ray absorptiometry (DXA). Higher BMD levels were found in the central skeleton (lumbar spine and femur) than in peripheral sites around the elbow (p < 0.001). BMD values around the elbow ranged from 44.4% to 63.2% compared to the BMD values of the central skeleton. Among the peripheral sites around the elbow, the highest BMD was observed at the supracondylar area and olecranon, and the lowest BMD was found at the lateral condyle. Peripheral DXA measurements around the elbow were significantly correlated with central DXA measurements at the lumbar spine and femur. In conclusion, this study demonstrated that the measurements of BMD around the elbow were correlated with BMD at central sites. Given the small sample size in this pilot study, further study with a large cohort is required to use the BMD measurements around the elbow as a valid clinical tool for fracture risk assessment and population-based epidemiological studies.

Physical activity throughout adolescence and body composition at 18 years: 1993 Pelotas (Brazil) birth cohort study

Background

Adolescence is a period of accelerated development and increases in body composition. Physical activity (PA) practice has been associated with the development of major components of body composition (bone, muscle and fat). However, the longitudinal effects of PA of different intensities during adolescence are still not well understood. Thus, the main goal this study has investigate the association between practice of moderate- and vigorous-intensity physical activity throughout adolescence and body composition, specifically lean mass (LM) and fat mass (FM), at age 18.

Methods

In this cohort study, physical activity was measured at 11, 15 and 18 years, using questionnaires. Thresholds of 300, 150 and 75 min per week, were used for MVPA, moderate- and vigorous-intensity physical activity, respectively. Consistent physical activity was defined as reaching the thresholds at the three follow-ups. FM and LM at age 18 were assessed by DXA and expressed as fat mass (FMI) and lean mass (LMI) indexes. To verify the association between the trajectories of MVPA, moderate- and vigorous-intensity physical activity in adolescence and FM and LM at 18, multivariate analyses were performed through multiple linear regressions adjusted for co-variables.

Results

A total of 3,176 adolescents were evaluated. The consistent practice of moderate- and vigorous-intensity physical activity according to thresholds during adolescence were directly related to the LMI in boys (moderate-intensity - β = 0.40 and CI95 % 0.13; 0.68 and vigorous-intensity - β = 0.95 and CI95 % 0.69; 1.21) and girls (Moderate-intensity - β = 0.23 and CI95 % 0.02; 0.45 and vigorous-intensity - β = 0.80 and CI95 % 0.29; 1.32). Practice of vigorous-intensity physical activity alone showed to be inversely associated with the FMI in boys (β = -0.53 and CI95 % -0.96;–0.10).

Conclusion

Consistent physical activity practice during adolescence was associated with greater lean mass in both sexes. In boys, vigorous-intensity physical activity was associated with less fat mass.

Haemophilia A and B as a cause for secondary osteoporosis and increased fracture risk

Despite the increasing evidence regarding its association with low bone mineral density (BMD) both in adults and children, haemophilia A or B has not yet been considered among the classic causes of secondary osteoporosis. Although the exact mechanisms are not fully elucidated, physical inactivity and vitamin D deficiency seem to play a fundamental role for such an association. Viral infections and arthropathy further compromise bone mass. Except for low BMD, patients with haemophilia seem to be at increased risk for fracture and falls. The FRAX tool may be of value in this population, for the estimation of fracture risk. Regular exercise, prophylactic factor replacement therapy in severe haemophilia, fall prevention strategies and optimization of calcium and vitamin D intake are recommended. In any case, individualized multidisciplinary approach and careful assessment and management of fracture risk are recommended.

Body mass index at 11 years and bone mass at age 18: path analysis within the 1993 Pelotas (Brazil) birth cohort study

Background

We investigated whether Body Mass Index (BMI) at 11 years old has a direct effect on bone mass at age 18 operating through alterations to bone growth and development, or whether the association is mediated by concurrent BMI, fat mass (FM), and fat free mass (FFM).

Methods

Path analysis was used to explore the association between BMI at age 11 and whole-body bone mineral content (BMC) and bone mineral density (BMD) assessed by dual-energy x-ray absorptiometry (DXA) at age 18 in a prospective birth cohort study comprising 3,307 adolescents; we also evaluated the degree to which this association was mediated by BMI, FM (kg) and FFM (kg) assessed by plethysmography (BOD POD) at age 18.

Results

We found a positive association between BMI at age 11 and BMC (males [β = 179.7 g, 95% CI 161.4; 198.0]; females [β = 179.9 g, 95% CI 165.3; 194.6]) and BMD (males [β = 0.030 g/cm2, 95% CI 0.024; 0.035]; females [β = 0.029 g/cm2, 95% CI 0.025; 0.033]) at age 18. This association was largely mediated by BMI and FFM at age 18 in both female and male adolescents. FM at age 18 was not an important mediator.

Conclusions

Concurrent BMI and FFM were the main mediators of the association between BMC/BMD in late adolescence and BMI in early adolescence.

Electronic supplementary material

The online version of this article (doi:10.1186/s12891-015-0529-y) contains supplementary material, which is available to authorized users.