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Yuh YS, Chou TY, Chow JC. Applicability of the Greulich and Pyle bone age standards to Taiwanese children: A Taipei experience. J Chin Med Assoc 2022; 85:767-773. [PMID: 35648187 DOI: 10.1097/jcma.0000000000000747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The Greulich and Pyle (GP) method is one of the most common radiographic techniques for bone age (BA) assessment. The applicability of this method to ethnic populations outside of the United States has been investigated in several recent studies worldwide. Currently, limited data are available on the accuracy of the GP method for the Taiwanese population. The purpose of this study was to determine whether the GP standards are applicable to contemporary Taipei children. METHODS Clinical data from October 1, 2010, to March 31, 2020, were retrospectively collected from a general hospital in Taipei. BA was determined by a senior pediatrician and was reviewed by a senior pediatric radiologist according to the GP standards. Comparison of BA and chronological age (CA) was performed in children with body weight and height in the 15th to the 85th percentiles of normal children. Ethnic variations in the maturation process in the ulnar bone were investigated. All data were statistically analyzed. RESULTS In total, 2465 medical records were collected. After excluding those with diseases and unqualified data, 654 records of boys and 809 of girls were analyzed. In boys, the mean BA was significantly delayed between 6 and 9 years of age compared with the CA. In girls, the mean BA was generally advanced between 7 and 15 years of age. Ulnar bone maturation tended to be delayed in young boys. CONCLUSION A significant discrepancy between CA and BA was observed in our population. Delayed ulnar bone maturation in young boys was confirmed. Children in Taipei exhibit a different maturation pattern than children on whom the GP standards were based.
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Affiliation(s)
- Yeong-Seng Yuh
- Department of Pediatrics, Cheng-Hsin General Hospital, Taipei, Taiwan, ROC
- Department of Pediatrics, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Ting Ywan Chou
- Department of Radiology, Cardinal Tien General Hospital, Taipei, Taiwan, ROC
- College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan, ROC
| | - Jeffrey C Chow
- Department of Pediatrics, Cheng-Hsin General Hospital, Taipei, Taiwan, ROC
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Khadilkar V, Oza C, Khadilkar A. Relationship between height age, bone age and chronological age in normal children in the context of nutritional and pubertal status. J Pediatr Endocrinol Metab 2022; 35:767-775. [PMID: 35487031 DOI: 10.1515/jpem-2021-0698] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 04/04/2022] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Bone age (BA) is a quantitative determination of skeletal maturation. The role of puberty in variations in BA is poorly understood as hypothalamic-pituitary-gonadal (HPG) axis maturation and skeletal maturation are regulated in parallel but independently by multiple different factors. In countries like India where there is rapid nutrition transition and increase in prevalence of obesity, their impact on height and BA is not well understood. OBJECTIVES To study if in 2-17 year old healthy children, the difference between chronological age (CA), height age (HA) and BA is less than 1 year on either side of the chronological age and to assess relationship of BA with height, weight and BMI with special reference to gender and puberty. METHODS This cross-sectional study included 804 preschool/school-going Indian children. Anthropometric measurements and pubertal assessments were performed using standard protocols and were converted to age and sex standardized z-scores using Indian references while BA was estimated by Tanner-Whitehouse (TW3) method. p<0.05 was considered statistically significant. RESULTS The mean age and gender standardized z-scores for height, weight, body mass index (BMI) and BA were -0.3 ± 0.7, -0.7 ± 0.8, -0.1 ± 1.0, and -0.2 ± 0.9 respectively. HA was more delayed in girls while BA was more delayed in boys. The mean BA z-score increased with increasing BMI. After the onset of puberty, there was higher increment in BA in girls and HA in boys (p<0.05). CONCLUSIONS HA, BA and CA were tightly correlated in healthy Indian children with a significant role of nutritional status and puberty in causing variation in the same.
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Affiliation(s)
- Vaman Khadilkar
- Senior Pediatric Endocrinologist, Jehangir Hospital, Bombay Hospital, Pune, India.,Department of Health Sciences, Savitribai Phule Pune University, Pune, Maharashtra, India
| | - Chirantap Oza
- Hirabai Cowasji Jehangir Medical Research Institute, Pune, India
| | - Anuradha Khadilkar
- Department of Health Sciences, Savitribai Phule Pune University, Pune, Maharashtra, India.,Hirabai Cowasji Jehangir Medical Research Institute, Pune, India
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Klünder-Klünder M, Espinosa-Espindola M, Lopez-Gonzalez D, Loyo MSC, Suárez PD, Miranda-Lora AL. Skeletal Maturation in the Current Pediatric Mexican Population. Endocr Pract 2021; 26:1053-1061. [PMID: 33471706 DOI: 10.4158/ep-2020-0047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 05/01/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The most commonly used methods for bone age (BA) reading were described in the Caucasian population decades ago. However, there are secular trends in skeletal maturation and different BA patterns between ethnic groups. Automated BA reading makes updating references easier and more precise than human reading. The objective of the present study was to present automated BA reference curves according to chronological age and gender in the Mexican population and compare the maturation tempo with that of other populations. METHODS The study included 923 healthy participants aged 5 to 18 years between 2017 and 2018. A hand radio-graph was analyzed using BoneXpert software to obtain the automated BA reading according to Greulich and Pyle (G&P) and Tanner-Whitehouse 2 (TW2) references. We constructed reference curves using the average difference between the BA and chronological age according to sex and age. RESULTS The G&P and TW2 automated reference curves showed that Mexican boys exhibit delays in BA during middle childhood by 0.5 to 0.7 (95% confidence interval [CI], -0.9 to -0.2) years; however, they demonstrate an advanced BA of up to 1.1 (95% CI, 0.8 to 1.4) years at the end of puberty. Mexican girls exhibited a delay in BA by 0.3 to 0.6 (95% CI, -0.9 to -0.1) years before puberty and an advanced BA of up to 0.9 (95% CI, 0.7 to 1.2) years at the end of puberty. CONCLUSION Mexican children aged <10 years exhibited a delay in skeletal maturity, followed by an advanced BA by approximately 1 year at the end of puberty. This may affect the estimation of growth potential in this population.
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Affiliation(s)
- Miguel Klünder-Klünder
- Deputy Director of Research, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - Montserrat Espinosa-Espindola
- Endocrinological and Nutritional Epidemiology Research Unit, Universidad Nacional Autónoma de México and Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - Desiree Lopez-Gonzalez
- Clinical Epidemiology Research Unit, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | | | - Pilar Dies Suárez
- Radiology Department, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - América Liliana Miranda-Lora
- Endocrinological and Nutritional Epidemiology Research Unit, Universidad Nacional Autónoma de México and Hospital Infantil de México Federico Gómez, Mexico City, Mexico.
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Timme M, Karch A, Shay D, Ottow C, Schmeling A. Zur Altersdiagnostik lebender Personen: der Einfluss des sozioökonomischen Status auf die Skelett- und Zahnentwicklung in einer deutschen Studienkohorte. Rechtsmedizin (Berl) 2020. [DOI: 10.1007/s00194-020-00444-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
ZusammenfassungDie forensische Altersdiagnostik kann ein entscheidendes Instrument zur Durchführung rechtstaatlicher Verfahren sein. Bei der Altersdiagnostik wird die Entwicklung von Skelett- und Zahnmerkmalen einer zu begutachtenden Person mit Daten von Referenzpopulationen verglichen. Als möglicher Einflussfaktor auf die Altersdiagnose ist der sozioökonomische Status (SES) der zu begutachtenden Person zu berücksichtigen. Allerdings ist die Studienlage zu diesem Einflussfaktor bislang spärlich. Prospektiv wurde der Zusammenhang zwischen der Skelett- bzw. Zahnentwicklung und dem SES innerhalb einer deutschen Studienpopulation aus freiwilligen Teilnehmern ermittelt. Dazu wurde die Entwicklung der medialen Epiphyse des Schlüsselbeins, der distalen Epiphyse des Radius, der distalen Epiphyse des Femurs, der proximalen Epiphyse der Tibia und des linken unteren dritten Molaren bei 294 Frauen und 287 Männern im Alter von 12 bis 24 Jahren mittels 3‑Tesla-Magnetresonanztomographie (MRT) untersucht. Zusätzlich wurde der SES der Teilnehmer erfasst. Hierzu wurde das Bildungsniveau der Eltern erfragt. Der Einfluss des SES auf die Einzelmerkmale sowie die Gesamtheit der untersuchten Skelettmerkmale wurde mittels linearer Regression ermittelt. Für alle untersuchten Merkmale und Kombinationen konnte keine Evidenz für einen Zusammenhang festgestellt werden. Es wurde geschlussfolgert, dass sich die Lebensumstände der Studienteilnehmer offenbar nicht ausreichend stark unterschieden, um einen Einfluss des SES auf das Skelettalter darzustellen.
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Ke D, Lu D, Cai G, Zhang J, Wang X, Suzuki K. Accelerated skeletal maturation is associated with overweight and obesity as early as preschool age: a cross-sectional study. BMC Pediatr 2020; 20:452. [PMID: 32988365 PMCID: PMC7520956 DOI: 10.1186/s12887-020-02353-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 09/17/2020] [Indexed: 12/20/2022] Open
Abstract
Background Body mass index (BMI) and skeletal age (SA) are important indicators of individual growth and maturation. Although the results have not been unified, most studies indicated that accelerated skeletal maturation is associated with overweight/obesity. However, there have so far been insufficient studies about the association between accelerated skeletal maturation and overweight/obesity in preschoolers, particularly Asian children. A cross-sectional study was conducted on Chinese children to verify the association between accelerated skeletal maturation and overweight/obesity at preschool age. Methods The study involved 1330 participants aged 3.1–6.6 years old (730 males and 600 females) in Shanghai, China. The skeletal age was determined according to the method of TW3-C RUS. Accelerated skeletal maturation was defined as relative SA (SA minus chronological age [CA]) ≥1.0 years. BMI was classified as thinness, normal weight, overweight, and obesity according to the International Obesity Task Force (IOTF) BMI cut-offs. The Chi-square was performed to determine the statistically significant difference in the frequency of accelerated skeletal maturation in BMI and age categories. The logistic regression model analyzed the association between accelerated skeletal maturation and overweight/obesity. Results The percentage of accelerated skeletal maturation increased with BMI (7.8% of children in thinness group had accelerated skeletal maturation; the percentage increased to 30.8% in obese group. x2 = 89.442, df = 3, P < 0.01) and age group (at age 3.5, 3.5% of participants had accelerated skeletal maturation; at age 6.0 years, this increased to 27.8%. x2 = 43.417, df = 5, P < 0.01). Logistic regression analysis showed that children with overweight and obesity are more likely to have accelerated skeletal maturation than children with normal weight after adjusting for gender and age (Overweight, odds ratio [OR] = 3.27, 95% confidence interval [CI]: 2.20–4.87; Obese, OR = 4.73, 95% CI: 2.99–7.48). Conclusions There is an association between accelerated skeletal maturation and overweight/obesity among preschool children. This study suggests that accelerated skeletal maturation might coexist with overweight/obesity in preschool children, and interventions, such as dietary modifications and increasing levels of physical activity, should be employed to prevent both accelerated skeletal maturation and overweight/obesity as early as preschool age.
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Affiliation(s)
- Dandan Ke
- Graduate School of Health and Sports Science, Juntendo University, 1- 1 Hiraka-gakuendai, Inzai-city, Chiba, 270-1695, Japan
| | - Dajiang Lu
- School of Kinesiology, Shanghai University of Sport, No. 650 Qingyuan Ring Road, Yangpu District, Shanghai, 200438, People's Republic of China
| | - Guang Cai
- Shanghai Research Institute of Sports Science, No.87 Wuxing Road, Xuhui District, Shanghai, 200030, People's Republic of China
| | - Jing Zhang
- Shanghai Center for Women and Children's Health, No.339 Luding Road, Putuo District, Shanghai, 200062, People's Republic of China
| | - Xiaofei Wang
- School of Kinesiology, Shanghai University of Sport, No. 650 Qingyuan Ring Road, Yangpu District, Shanghai, 200438, People's Republic of China
| | - Koya Suzuki
- Graduate School of Health and Sports Science, Juntendo University, 1- 1 Hiraka-gakuendai, Inzai-city, Chiba, 270-1695, Japan.
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Alshamrani K, Offiah AC. Applicability of two commonly used bone age assessment methods to twenty-first century UK children. Eur Radiol 2019; 30:504-513. [PMID: 31372785 PMCID: PMC6890594 DOI: 10.1007/s00330-019-06300-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 05/12/2019] [Accepted: 06/04/2019] [Indexed: 11/04/2022]
Abstract
Objectives To assess the effect of secular change on skeletal maturation and thus on the applicability of the Greulich and Pyle (G&P) and Tanner and Whitehouse (TW3) methods. Methods BoneXpert was used to assess bone age from 392 hand trauma radiographs (206 males, 257 left). The paired sample t test was performed to assess the difference between mean bone age (BA) and mean chronological age (CA). ANOVA was used to assess the differences between groups based on socioeconomic status (taken from the Index of Multiple Deprivation). Results CA ranged from 2 to 15 years for females and 2.5 to 15 years for males. Numbers of children living in low, average and high socioeconomic areas were 216 (55%), 74 (19%) and 102 (26%) respectively. We found no statistically significant difference between BA and CA when using G&P. However, using TW3, CA was underestimated in females beyond the age of 3 years, with significant differences between BA and CA (− 0.43 years, SD 1.05, p = < 0.001) but not in males (0.01 years, SD 0.97, p = 0.76). Of the difference in females, 17.8% was accounted for by socioeconomic status. Conclusion No significant difference exists between BoneXpert-derived BA and CA when using the G&P atlas in our study population. There was a statistically significant underestimation of BoneXpert-derived BA compared with CA in females when using TW3, particularly in those from low and average socioeconomic backgrounds. Secular change has not led to significant advancement in skeletal maturation within our study population. Key Points • The Greulich and Pyle method can be applied to the present-day United Kingdom (UK) population. • The Tanner and Whitehouse (TW3) method consistently underestimates the age of twenty-first century UK females by an average of 5 months. • Secular change has not advanced skeletal maturity of present-day UK children compared with those of the mid-twentieth century. Electronic supplementary material The online version of this article (10.1007/s00330-019-06300-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Khalaf Alshamrani
- Department of Oncology & Metabolism, University of Sheffield, Sheffield, UK. .,College of Applied Medical Sciences, Najran University, Najran, Saudi Arabia. .,Academic Unit of Child Health, Sheffield Children's NHS Foundation Trust, Damer Street Building, Western Bank, Sheffield, S10 2TH, UK.
| | - Amaka C Offiah
- Department of Oncology & Metabolism, University of Sheffield, Sheffield, UK.,Sheffield Children's NHS Foundation Trust, Western Bank, Sheffield, UK
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Dahlberg PS, Mosdøl A, Ding Y, Bleka Ø, Rolseth V, Straumann GH, Skjerven-Martinsen M, Delaveris GJM, Vist GE. A systematic review of the agreement between chronological age and skeletal age based on the Greulich and Pyle atlas. Eur Radiol 2018; 29:2936-2948. [DOI: 10.1007/s00330-018-5718-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 07/04/2018] [Accepted: 08/14/2018] [Indexed: 01/07/2023]
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Alcina M, Lucea A, Salicrú M, Turbón D. Reliability of the Greulich and Pyle method for chronological age estimation and age majority prediction in a Spanish sample. Int J Legal Med 2017; 132:1139-1149. [DOI: 10.1007/s00414-017-1760-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 12/12/2017] [Indexed: 11/29/2022]
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Dodwell ER, Garner MR, Bixby E, Luderowski EM, Green DW, Blanco JS, Widmann RF. Percutaneous Epiphysiodesis Using Transphyseal Screws: a Case Series Demonstrating High Efficacy. HSS J 2017; 13:255-262. [PMID: 28983218 PMCID: PMC5617815 DOI: 10.1007/s11420-017-9549-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 02/14/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Percutaneous epiphysiodesis using transphyseal screws (PETS) has been associated with implant failure, implant prominence, angular deformities, and delayed growth inhibition. QUESTIONS/PURPOSES The aim of this study was to assess the complication rate and efficacy (defined as actual growth inhibition divided by expected growth inhibition) of PETS and to identify factors associated with improved efficacy. METHODS Patients who underwent distal femoral and/or proximal tibial PETS between January 2007 and June 2014 were identified. Complications, efficacy, and final limb-length discrepancy (LLD) were calculated using multipliers and inhibition rates based on previous growth. Associations between efficacy and screw insertion angle (SIA), body mass index, and number of threads crossing the physis were calculated. RESULTS Eight-two patients (126 treated physes) were included. The mean pre-operative LLD was 27.7 mm (SD = 7.5). Following epiphysiodesis, 15 had temporary pain (18%), five had temporary effusion (6.1%), four had broken implants (4.9%), four developed mild angulation (4.9%), and three had failed epiphysiodesis requiring revision (3.7%). Thirty-one underwent screw removal (n = 31, 38%). Mean LLD at maturity was 17.3 mm (SD = 5.8 mm). Mean efficacy at the distal femur was 97% (SD = 46%), at the proximal tibia was 108% (SD = 66%) and was 103% (SD = 57%) overall. Increased screw threads across the lateral proximal tibial physis (Spearman's correlation coefficient = 0.67; 95% CI = 0.40-0.94) and higher BMI (Spearman's correlation coefficient = 0.55; 95% CI = 0.34-0.77) were positively associated with increased efficacy. CONCLUSIONS The efficacy of PETS may be more favorable than previously reported. Only 3.7% had serious complications requiring revision epiphysiodesis, lower than previous reports. Attention to sufficient screw threads across the physis may be important in optimizing PETS results.
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Affiliation(s)
- Emily R. Dodwell
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Matthew R. Garner
- Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA 17033 USA
| | - Elise Bixby
- College of Physicians and Surgeons, Columbia University, New York, NY 10032 USA
| | - Eva M. Luderowski
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Daniel W. Green
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - John S. Blanco
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Roger F. Widmann
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
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Forensic use of the Greulich and Pyle atlas: prediction intervals and relevance. Eur Radiol 2016; 27:1032-1043. [DOI: 10.1007/s00330-016-4466-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 04/05/2016] [Accepted: 06/07/2016] [Indexed: 10/21/2022]
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Familial environment in high- and middle–low-income municipalities: A survey in Italy to understand the distribution of potentially obesogenic factors. Public Health 2012; 126:731-9. [DOI: 10.1016/j.puhe.2012.05.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2010] [Revised: 02/19/2012] [Accepted: 05/24/2012] [Indexed: 11/21/2022]
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Socioeconomic status and bone mass in Spanish adolescents. The HELENA Study. J Adolesc Health 2012; 50:484-90. [PMID: 22525112 DOI: 10.1016/j.jadohealth.2011.08.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Revised: 07/01/2011] [Accepted: 08/31/2011] [Indexed: 11/23/2022]
Abstract
PURPOSE Socioeconomic status (SES) has been frequently associated with body composition, particularly fat mass and obesity. However, the SES-bone mass association is not clear. We aimed to evaluate the associations between different SES indicators (Family Affluence Scale, parental education, and occupation) and bone mineral content in Spanish adolescents. METHODS Participants were 322 adolescents (164 boys and 158 girls, 12.5-17.5 years) from the Healthy Lifestyle in Europe by Nutrition in Adolescence study. The social background of the adolescents was self-reported using an SES questionnaire, and the bone variables were measured using dual-energy x-ray absorptiometry. Physical activity was measured using accelerometers. Calcium intake was estimated from two nonconsecutive 24 hours recalls. One-way analysis of covariance was performed to examine the relationships between SES indicators and bone mass using different sets of confounders: basic model (sex + sexual maturation), model 1 (basic model + height), model 2 (basic model + lean mass), and model 3 (basic model + calcium intake + average physical activity). RESULTS Adjusted results showed no association between SES indicators and whole-body or total hip bone mineral content. Additional analyses were performed in lumbar spine, pelvis, and hip subregions (femoral neck, trochanter, and intertrochanter), and no significant associations were observed at these sites either. CONCLUSIONS Our data do not support a link between different SES indicators (Family Affluence Scale, parental education, and occupation) and bone mass in adolescents.
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