1
|
Wasserman H, Jenkins T, Inge T, Ryder J, Michalsky M, Sisley S, Xie C, Kalkwarf HJ. Bone mineral density in young adults 5 to 11 years after adolescent metabolic and bariatric surgery for severe obesity compared to peers. Int J Obes (Lond) 2024; 48:575-583. [PMID: 38177697 DOI: 10.1038/s41366-023-01453-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/06/2023] [Accepted: 12/14/2023] [Indexed: 01/06/2024]
Abstract
OBJECTIVE Metabolic and bariatric surgery (MBS) is associated with decreased bone mineral density (BMD) in adults. The long-term impact of MBS during adolescence on BMD is unknown. We report bone health status 5 to 11 years after Roux-en-Y gastric bypass (RYGB) and vertical sleeve gastrectomy (VSG) from the Teen-LABS study cohort. METHODS Between 2016 and 2022, BMD was measured by dual energy x-ray absorptiometry (DXA) in 106 young adults who had undergone MBS as adolescents. Volumetric BMD by peripheral quantitative computed tomography was measured on a subset. Ninety-one controls who had not undergone MBS were recruited for comparison. RESULTS In cases (RYGB: mean age 26.8 ± 1.9 years, mean BMI 42.1 ± 9.9 kg/m2, VSG: mean age 25.1 ± 2.1 years, mean BMI 37.1 ± 8.4 kg/m2), compared to controls (mean age 26.5 ± 2.7 years, mean BMI 40.2 ± 8.7 kg/m2) (age p < 0.001, BMI p = 0.02), adjusted mean DXA-BMD (g/cm2) of the RYGB (n = 58) and VSG (n = 48) groups were lower at the hip (-10.0% and -6.3%), femoral neck (-9.6% and -5.7%) and ultra-distal radius (-7.9% and -7.0%; all p < 0.001), respectively. DXA-BMD did not differ between RYGB and VSG groups. Trabecular volumetric BMD at the radius and tibia were lower in the RYGB (-30% and -26%) and VSG (-15% and -14%) groups compared to the control group (p < 0.001). Greater time since MBS was associated with lower BMD Z-scores at the hip (p = 0.05) and femoral neck (p = 0.045). Percent change in body mass index (BMI) from baseline or in the first year after MBS were not associated with bone measures at a median of 9.3 years post MBS. CONCLUSION BMD, especially of the hip and femoral neck, was lower in young adults who underwent MBS during adolescence compared to matched peers who had not undergone MBS. BMD Z-scores of the femoral neck were inversely associated with time since MBS but were not associated with BMI change.
Collapse
Affiliation(s)
- Halley Wasserman
- Department of Pediatrics, Cincinnati Children's Hospital, Cincinnati, OH, USA.
- University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Todd Jenkins
- Department of Pediatrics, Cincinnati Children's Hospital, Cincinnati, OH, USA
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Thomas Inge
- Department of Surgery, Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - Justin Ryder
- Department of Surgery, Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - Marc Michalsky
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA
- The Ohio State University, College of Medicine, Columbus, OH, USA
| | - Stephanie Sisley
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
- ARS/USDA Children's Nutrition Research Center, Houston, TX, USA
| | - Changchun Xie
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Heidi J Kalkwarf
- Department of Pediatrics, Cincinnati Children's Hospital, Cincinnati, OH, USA
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| |
Collapse
|
2
|
Gajewska J, Chełchowska M, Rowicka G, Klemarczyk W, Głąb-Jabłońska E, Ambroszkiewicz J. Assessment of Biochemical Bone Turnover Markers in Polish Healthy Children and Adolescents. J Mother Child 2024; 28:14-22. [PMID: 38639100 PMCID: PMC11027035 DOI: 10.34763/jmotherandchild.20242801.d-23-00105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 02/09/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Assessing bone turnover in paediatric populations is crucial for understanding the physiological changes occurring during skeletal development and identifying potential abnormalities. The objective of this study was to assess osteocalcin (OC), bone alkaline phosphatase (BALP), and C-terminal telopeptide of type I collagen (CTX-I) levels reflecting bone formation and resorption for age and sex in Polish healthy children and adolescents. MATERIALS AND METHODS A total of 355 healthy normal-weight children and adolescents (46.5% girls) aged 1-18 years old were recruited. Total body less head (TBLH) and spine L1-L4 were used in children to assess bone mineral density (BMD) by dual-energy X-ray absorptiometry (DXA). Bone marker concentrations were determined by immunoenzymatic methods. RESULTS Bone marker levels in girls and boys started with higher values in the first year of life and subsequently decreased until reaching a nadir during the prepubertal period. The pubertal peak values of bone markers were reached at 11-13 years old in boys and at 9-11 years old in girls. After puberty, the adolescents showed a gradual decline in bone marker concentrations to the values observed in adults. We found positive correlations between OC level and TBLH-BMD (r = 0.329, p = 0.002), TBLH-BMD Z-score (r = 0.245, p = 0.023), and L1-L4 BMD (r = 0.280, p = 0.009) in the prepubertal group. CONCLUSIONS We showed serum levels of bone turnover markers-BALP, OC, and CTX-I-in relation to age and sex in healthy Polish children and adolescents. The age intervals of these markers for girls and boys aged 1-18 years old may be clinically useful in the assessment of bone metabolism in individuals with skeletal disorders.
Collapse
Affiliation(s)
- Joanna Gajewska
- Department of Screening Tests and Metabolic Diagnostics, Institute of Mother and Child, Warsaw01-211, Kasprzaka 17a, Poland
| | - Magdalena Chełchowska
- Department of Screening Tests and Metabolic Diagnostics, Institute of Mother and Child, Warsaw01-211, Kasprzaka 17a, Poland
| | - Grażyna Rowicka
- Department of Nutrition, Institute of Mother and Child, Warsaw01-211, Kasprzaka 17aPoland
| | - Witold Klemarczyk
- Department of Nutrition, Institute of Mother and Child, Warsaw01-211, Kasprzaka 17aPoland
| | - Ewa Głąb-Jabłońska
- Department of Screening Tests and Metabolic Diagnostics, Institute of Mother and Child, Warsaw01-211, Kasprzaka 17a, Poland
| | - Jadwiga Ambroszkiewicz
- Department of Screening Tests and Metabolic Diagnostics, Institute of Mother and Child, Warsaw01-211, Kasprzaka 17a, Poland
| |
Collapse
|
3
|
Mateo-Orcajada A, Abenza-Cano L, Cano-Martínez A, Vaquero-Cristóbal R. The Importance of Healthy Habits to Compensate for Differences between Adolescent Males and Females in Anthropometric, Psychological and Physical Fitness Variables. Children (Basel) 2022; 9:children9121926. [PMID: 36553369 PMCID: PMC9777149 DOI: 10.3390/children9121926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 11/30/2022] [Accepted: 12/07/2022] [Indexed: 12/13/2022]
Abstract
Adolescence is a crucial stage in human development, and differences in psychological, physical and body composition variables between males and females have been amply demonstrated. However, the role played by certain healthy habits, such as the practice of physical activity, adherence to the Mediterranean diet (AMD) or the maintenance of an adequate weight status, in compensating for the differences found between males and females in these variables, is not well known. For this reason, the study aimed to analyze whether the practice of physical activity, optimal AMD, and adequate weight status can compensate for the differences between adolescent males and females in anthropometric variables, psychological state, and physical fitness. The sample was composed of 791 adolescents (404 males and 387 females) aged twelve to sixteen years old, whose anthropometric, psychological (autonomy, competence, relatedness, and life satisfaction), and physical fitness variables (cardiorespiratory fitness, upper strength and explosive lower limb power, hamstring and lower back flexibility, and speed) were measured. All measurements were carried out in a single day using the sports pavilion of the four participating schools. The most novel results of this research show that the practice of physical activity was determinant mainly in females, as it reduced the differences found in comparison with males in psychological (p < 0.001−0.045) and anthropometric variables (p < 0.001). Regarding weight status and AMD, these were still relevant for the adolescent population, mainly the achievement of optimal AMD, but males continued to present higher values in physical fitness tests (p < 0.001) and lower values in fat accumulation (p < 0.001), regardless of weight status or AMD. Thus, physical activity seems to be the most determining factor that compensates for the differences between adolescent boys and girls.
Collapse
Affiliation(s)
| | - Lucía Abenza-Cano
- Facultad de Deporte, UCAM Universidad Católica de Murcia, 30107 Murcia, Spain
- Correspondence: ; Tel.: +34-968-27-82-17
| | | | - Raquel Vaquero-Cristóbal
- Facultad de Deporte, UCAM Universidad Católica de Murcia, 30107 Murcia, Spain
- Kinanthropometry International, UCAM Universidad Católica de Murcia, 30107 Murcia, Spain
| |
Collapse
|
4
|
Kitase Y, Vallejo JA, Dallas SL, Xie Y, Dallas M, Tiede-Lewis L, Moore D, Meljanac A, Kumar C, Zhao C, Rosser J, Brotto M, Johnson ML, Liu Z, Wacker MJ, Bonewald L. Body weight influences musculoskeletal adaptation to long-term voluntary wheel running during aging in female mice. Aging (Albany NY) 2022; 15:308-352. [PMID: 36403149 PMCID: PMC9925690 DOI: 10.18632/aging.204390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 11/02/2022] [Indexed: 11/19/2022]
Abstract
Frailty is the hallmark of aging that can be delayed with exercise. The present studies were initiated based on the hypothesis that long-term voluntary wheel running (VWR) in female mice from 12 to 18 or 22 months of age would have beneficial effects on the musculoskeletal system. Mice were separated into high (HBW) and low (LBW) body weight based on final body weights upon termination of experiments. Bone marrow fat was significantly higher in HBW than LBW under sedentary conditions, but not with VWR. HBW was more protective for soleus size and function than LBW under sedentary conditions, however VWR increased soleus size and function regardless of body weight. VWR plus HBW was more protective against muscle loss with aging. Similar effects of VWR plus HBW were observed with the extensor digitorum longus, EDL, however, LBW with VWR was beneficial in improving EDL fatigue resistance in 18 mo mice and was more beneficial with regards to muscle production of bone protective factors. VWR plus HBW maintained bone in aged animals. In summary, HBW had a more beneficial effect on muscle and bone with aging especially in combination with exercise. These effects were independent of bone marrow fat, suggesting that intrinsic musculoskeletal adaptions were responsible for these beneficial effects.
Collapse
Affiliation(s)
- Yukiko Kitase
- Department of Anatomy, Cell Biology and Physiology, School of Medicine, Indiana University, Indianapolis, IN 46202, USA
| | - Julian A. Vallejo
- Department of Oral and Craniofacial Sciences, School of Dentistry, University of Missouri, Kansas City, MO 64108, USA
- Department of Biomedical Sciences, School of Medicine, University of Missouri, Kansas City, MO 64108, USA
| | - Sarah L. Dallas
- Department of Oral and Craniofacial Sciences, School of Dentistry, University of Missouri, Kansas City, MO 64108, USA
| | - Yixia Xie
- Department of Oral and Craniofacial Sciences, School of Dentistry, University of Missouri, Kansas City, MO 64108, USA
| | - Mark Dallas
- Department of Oral and Craniofacial Sciences, School of Dentistry, University of Missouri, Kansas City, MO 64108, USA
| | - LeAnn Tiede-Lewis
- Department of Oral and Craniofacial Sciences, School of Dentistry, University of Missouri, Kansas City, MO 64108, USA
| | - David Moore
- Department of Oral and Craniofacial Sciences, School of Dentistry, University of Missouri, Kansas City, MO 64108, USA
| | - Anthony Meljanac
- Department of Oral and Craniofacial Sciences, School of Dentistry, University of Missouri, Kansas City, MO 64108, USA
| | - Corrine Kumar
- Department of Anatomy, Cell Biology and Physiology, School of Medicine, Indiana University, Indianapolis, IN 46202, USA
| | - Carrie Zhao
- Department of Anatomy, Cell Biology and Physiology, School of Medicine, Indiana University, Indianapolis, IN 46202, USA
| | - Jennifer Rosser
- Department of Oral and Craniofacial Sciences, School of Dentistry, University of Missouri, Kansas City, MO 64108, USA
| | - Marco Brotto
- Bone-Muscle Research Center, College of Nursing and Health Innovation, University of Texas, Arlington, TX 76019, USA
| | - Mark L. Johnson
- Department of Oral and Craniofacial Sciences, School of Dentistry, University of Missouri, Kansas City, MO 64108, USA
| | - Ziyue Liu
- Department of Biostatistics and Health Data Science, School of Medicine, Indiana University, Indianapolis, IN 46202, USA
| | - Michael J. Wacker
- Department of Biomedical Sciences, School of Medicine, University of Missouri, Kansas City, MO 64108, USA
| | - Lynda Bonewald
- Department of Orthopaedic Surgery, School of Medicine, Indiana University, Indianapolis, IN 46202, USA
| |
Collapse
|
5
|
Mateo-Orcajada A, Vaquero-Cristóbal R, Esparza-Ros F, Abenza-Cano L. Physical, Psychological, and Body Composition Differences between Active and Sedentary Adolescents According to the "Fat but Fit" Paradigm. Int J Environ Res Public Health 2022; 19:ijerph191710797. [PMID: 36078538 PMCID: PMC9518456 DOI: 10.3390/ijerph191710797] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/23/2022] [Accepted: 08/25/2022] [Indexed: 05/16/2023]
Abstract
The practice of physical activity during adolescence is essential for the proper development of the population. In recent decades, the relevance of physical activity has been increasing, due to the development of the "fat but fit" paradigm. This paradigm shows that adolescents with a high level of physical fitness are healthier than adolescents with poorer physical fitness, regardless of their weight, giving importance to sports practice over other aspects. However, few previous studies have analyzed the differences in physical and body composition between active and sedentary adolescents in this paradigm. For this reason, the objectives of the present study were to establish the differences in body composition, physical performance, and adherence to the Mediterranean diet between active and sedentary adolescents; and to analyze the differences between active and sedentary adolescents according to the "fat but fit" paradigm. The sample consisted of 791 adolescent whose body composition, level of physical activity, adherence to the Mediterranean diet, and physical fitness were measured. It was found significant between active and sedentary adolescents in most of the anthropometric, AMD, and physical fitness variables, with a significant effect of the covariates gender, age, BMI, and biological maturation on the model. The binary logistic regression analysis performed shows that anthropometric variables, AMD, and VO2 max can be considered as primary outcomes to distinguish between active and sedentary groups of adolescents. Furthermore, the results showed that the active adolescents, regardless of their weight status, had lower fat mass and greater muscle mass, as well as a higher performance in the physical fitness tests, and greater adherence to the Mediterranean diet than the sedentary adolescents. To conclude, the practice of physical activity is a determinant for the improvement of body composition, physical performance, and adherence to the Mediterranean diet of the adolescent population, regardless of their gender, age, weight, or maturity status.
Collapse
Affiliation(s)
| | - Raquel Vaquero-Cristóbal
- Faculty of Sport, Catholic University San Antonio of Murcia, 30107 Murcia, Spain
- Kinanthropometry International Chair, Catholic University San Antonio of Murcia, 30107 Murcia, Spain
- Correspondence: ; Tel.: +34-968-27-82-17
| | - Francisco Esparza-Ros
- Kinanthropometry International Chair, Catholic University San Antonio of Murcia, 30107 Murcia, Spain
| | - Lucía Abenza-Cano
- Faculty of Sport, Catholic University San Antonio of Murcia, 30107 Murcia, Spain
| |
Collapse
|
6
|
Franceschi R, Radetti G, Soffiati M, Maines E. Forearm Fractures in Overweight-Obese Children and Adolescents: A Matter of Bone Density, Bone Geometry or Body Composition? Calcif Tissue Int 2022; 111:107-115. [PMID: 35316361 DOI: 10.1007/s00223-022-00971-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 03/10/2022] [Indexed: 01/06/2023]
Abstract
Forearm fractures in children and adolescents are associated with increased body mass index (BMI). This bone site is non-weight-bearing and therefore is appropriate to explore the effect of BMI on bone mineral density (BMD) and bone geometry, avoiding the confounding effect of increased weight-associated mechanical loading. The aim of this review was to summarize available evidence on bone indices and body composition assessed by peripheral quantitative computed tomography (pQCT) or dual X-ray absorptiometry (DXA) at the forearm level in overweight (Ow) or obese (Ob) subjects. We conducted a review of the literature according to the PICOS model. A total of 46 studies were identified following the literature search. A final number of 12 studies were included in this review. pQCT studies evidenced that Ow and Ob children typically have normal or increased volumetric BMD (vBMD), total bone area and cortical area, with normal or reduced cortical thickness at the forearm. Outcomes from DXA evaluations are less conclusive. In almost all the studies fat mass and lean mass area at the forearm are increased. A higher fat-to-lean mass ratio has been observed in few studies. Bone strength was reported as normal or increased compared to normal weight peers. In Ow or Ob children-adolescents, vBMD, bone size and bone strength are not reduced compared to normal weight peers. The local higher fat-to-lean mass ratio may give a mismatch between bone strength and the load experienced by the distal forearm during a fall, resulting in increased risk of forearm fractures.
Collapse
Affiliation(s)
- Roberto Franceschi
- Pediatric Department, S. Chiara General Hospital, Largo Medaglie d'Oro, 9, 38122, Trento, Italy.
| | - Giorgio Radetti
- Division of Pediatrics, General Hospital Bolzano, Bolzano, Italy
| | - Massimo Soffiati
- Pediatric Department, S. Chiara General Hospital, Largo Medaglie d'Oro, 9, 38122, Trento, Italy
| | - Evelina Maines
- Pediatric Department, S. Chiara General Hospital, Largo Medaglie d'Oro, 9, 38122, Trento, Italy
| |
Collapse
|
7
|
López-Peralta S, Romero-Velarde E, Vásquez-Garibay EM, González-Hita M, Robles-Robles LC, Ruiz-González FJ, Pérez-Romero MA. Bone mineral density and body composition in normal weight, overweight and obese children. BMC Pediatr 2022; 22:249. [PMID: 35513881 PMCID: PMC9074210 DOI: 10.1186/s12887-022-03317-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 04/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is a possibility that excess body fat affects bone mass gain and may compromise skeletal health in obese children. The purpose of the study was to identify the relationship between bone mineral density (BMD) and body composition in normal weight, overweight and obese children. METHODS This was a cross-sectional study of 6- to 11-year-old children who attended the hospital's outpatient clinic. They were apparently healthy and had no history of prematurity, low birth weight, or chronic diseases. Body mass index (BMI) was used to identify subjects as normal weight, overweight or obese. BMD and body composition were assessed by dual energy X-ray absorptiometry. The BMD values (total and lumbar spine) were compared between normal weight, overweight and obese children. Correlation coefficients were calculated, and multivariate models were performed. RESULTS Forty-nine children were included: 16 with normal weight, 15 that were overweight and 18 with obesity; the mean age was 8.4 ± 1.7 years. All the participants had a normal BMD (> - 2 SD). BMD was higher in obese children and had a positive correlation with total and trunk lean mass in the three study groups (p < 0.001). In obese children, an inverse correlation of lumbar spine BMD (Z score) with total and trunk fat mass (p < 0.05) was identified. In the multivariate models (with the whole group), the total lean mass was the only significant variable that explained BMD variability. CONCLUSIONS BMD in obese children was higher than that in normal weight children, which is explained by their greater lean mass and not by excess body fat. In obese children, a higher fat mass was related to a lower lumbar spine BMD. Lean mass had a direct correlation with BMD in the three study groups and was the most important predictor of BMD, reflecting the importance of strengthening the muscular system through performing physical activity and practicing a healthy lifestyle.
Collapse
Affiliation(s)
- Samantha López-Peralta
- Departamento de Reproducción Humana Crecimiento Y Desarrollo Infantil, Instituto de Nutrición Humana, Guadalajara, Jalisco, México
| | - Enrique Romero-Velarde
- Departamento de Reproducción Humana Crecimiento Y Desarrollo Infantil, Instituto de Nutrición Humana, Guadalajara, Jalisco, México. .,División de Pediatría del Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", Guadalajara, Jalisco, México.
| | - Edgar M Vásquez-Garibay
- Departamento de Reproducción Humana Crecimiento Y Desarrollo Infantil, Instituto de Nutrición Humana, Guadalajara, Jalisco, México
| | - Mercedes González-Hita
- Departamento de Biología Molecular Y Genómica, Centro Universitario de Ciencias de La Salud de La Universidad de Guadalajara, Guadalajara, Jalisco, México
| | - Laura C Robles-Robles
- División de Pediatría del Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", Guadalajara, Jalisco, México
| | - Francisco J Ruiz-González
- Clínica de Osteoporosis del Hospital Civil de Guadalajara "Fray Antonio Alcalde", Guadalajara, Jalisco, México
| | | |
Collapse
|
8
|
Szabo E, Rimnac C. Biomechanics of immature human cortical bone: A systematic review. J Mech Behav Biomed Mater 2021; 125:104889. [PMID: 34736022 DOI: 10.1016/j.jmbbm.2021.104889] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 09/10/2021] [Accepted: 10/06/2021] [Indexed: 12/31/2022]
Abstract
The whole bone geometry, microstructure, and mechanical properties of mature human bone are widely reported; however, immature bone (0-18 years) has not been similarly robustly characterized. There is an interest in analyzing and predicting the mechanical loading conditions associated with long bone diaphyseal fractures attributed to trauma in children. Thus, understanding the mechanical properties of immature bone in a temporal reference frame is an essential first step to understand diaphyseal fractures of pediatric long bones. The purpose of this systematic review was to ask, what is the state of knowledge regarding the 1) evolution of whole bone geometry and microstructure of immature pediatric bone as a function of maturation and 2) cortical bone density and experimental quasi-static mechanical properties at the tissue level in the diaphyseal region of immature pediatric long bones? The systematic search yielded 36 studies of the whole bone geometry, microstructure, and mechanical properties of immature pediatric long bones. The elastic modulus, yield stress, and ultimate stress were shown to generally increase with maturation, whereas the yield strain was approximately invariant; however, the specific year-to-year progression of these properties could not be characterized from the limited studies available. The results of this systematic search indicate there is a dearth of knowledge associated with the biomechanics of cortical bone from immature pediatric long bones; it also provides a basis for computational studies of immature human long bones. Additional biomechanical studies of immature human bone are necessary to develop a robust catalogue, which can be used in broad applications to understand fracture mechanics, bone pathologies, and athletic injury in the pediatric setting.
Collapse
Affiliation(s)
- Emily Szabo
- Case Western Reserve University, Department of Mechanical and Aerospace Engineering, 2123 Martin Luther King Jr Dr, Cleveland, OH, 44106, USA.
| | - Clare Rimnac
- Case Western Reserve University, Department of Mechanical and Aerospace Engineering, 2123 Martin Luther King Jr Dr, Cleveland, OH, 44106, USA.
| |
Collapse
|
9
|
Kurajoh M, Inaba M, Motoyama K, Kuriyama N, Ozaki E, Koyama T, Yamada S, Morioka T, Imanishi Y, Emoto M. Inverse association of plasma leptin with cortical thickness at distal radius determined with a quantitative ultrasound device in patients with type 2 diabetes mellitus. J Diabetes Investig 2020; 11:174-183. [PMID: 31074113 PMCID: PMC6944815 DOI: 10.1111/jdi.13071] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 01/27/2019] [Accepted: 05/07/2019] [Indexed: 12/22/2022] Open
Abstract
AIMS/INTRODUCTION Osteoporosis is known to be intimately related to sympathetic nerve activity. We examined the relationship of plasma leptin with cortical and trabecular bone components in patients with type 2 diabetes mellitus. MATERIALS AND METHODS The present cross-sectional study included 182 type 2 diabetes mellitus patients (93 men, 89 women). Cortical thickness (CoTh) and trabecular bone mineral density (BMD) were determined at the 5.5% distal radius using an LD-100 ultrasonic bone densitometry device. Plasma leptin along with physical and laboratory measurements was simultaneously determined. RESULTS Plasma leptin, but not body mass index (BMI), was inversely correlated with CoTh (ρ = -0.487, P < 0.001), while BMI, but not plasma leptin, was positively correlated with trabecular BMD (ρ = 0.369, P < 0.001). In multivariable regression analysis, after adjustments for age, sex, duration of diabetes, glycated hemoglobin A1c, albumin, estimated glomerular filtration rate, parathyroid hormone and handgrip strength, plasma leptin was inversely associated with CoTh (β = -0.258, P < 0.001), but not trabecular BMD. Furthermore, plasma leptin level retained a significant association with CoTh after further adjustment for BMI (β = -0.237, P < 0.001) and BMI plus waist-to-hip ratio (β = -0.243, P < 0.001). In contrast, the "sex × leptin" interaction was not significant (P = 0.596). CONCLUSIONS Leptin level in plasma, independent of BMI and BMI plus waist-to-hip ratio, was shown to be inversely associated with CoTh, but not trabecular BMD, suggesting that hyperleptinemia resulting from obesity might contribute to cortical porosis in patients with type 2 diabetes mellitus.
Collapse
Affiliation(s)
- Masafumi Kurajoh
- Department of Metabolism, Endocrinology and Molecular MedicineOsaka City University Graduate School of MedicineOsakaJapan
| | - Masaaki Inaba
- Department of Metabolism, Endocrinology and Molecular MedicineOsaka City University Graduate School of MedicineOsakaJapan
| | - Koka Motoyama
- Department of DiabetesOsaka City General HospitalOsakaJapan
| | - Nagato Kuriyama
- Department of Epidemiology for Community Health and MedicineKyoto Prefectural University of MedicineKyotoJapan
| | - Etsuko Ozaki
- Department of Epidemiology for Community Health and MedicineKyoto Prefectural University of MedicineKyotoJapan
| | - Teruhide Koyama
- Department of Epidemiology for Community Health and MedicineKyoto Prefectural University of MedicineKyotoJapan
| | - Shinsuke Yamada
- Department of Metabolism, Endocrinology and Molecular MedicineOsaka City University Graduate School of MedicineOsakaJapan
| | - Tomoaki Morioka
- Department of Metabolism, Endocrinology and Molecular MedicineOsaka City University Graduate School of MedicineOsakaJapan
| | - Yasuo Imanishi
- Department of Metabolism, Endocrinology and Molecular MedicineOsaka City University Graduate School of MedicineOsakaJapan
| | - Masanori Emoto
- Department of Metabolism, Endocrinology and Molecular MedicineOsaka City University Graduate School of MedicineOsakaJapan
| |
Collapse
|
10
|
Pillatt AP, Berlezi EM, Jesus LBD, Schneider RH, Franz LBB. Influência da obesidade nos critérios de classificação de sarcopenia em idosos. Rev bras geriatr gerontol 2020. [DOI: 10.1590/1981-22562020023.200083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Objetivo identificar a prevalência de obesidade sarcopênica em idosos residentes na comunidade e analisar a relação da obesidade com os critérios de classificação da sarcopenia. Método Trata-se de um corte transversal analítico vinculado ao projeto “Atenção Integral à Saúde do Idoso”. A avaliação da sarcopenia foi realizada a partir dos critérios do Consenso Europeu de Sarcopenia. Para classificação dos idosos como obesos sarcopênicos considerou-se aqueles que se apresentaram como provável sarcopênico, sarcopênico ou sarcopênico severo associado ao percentual de gordura >27% para homens e >38% para mulheres. Os dados foram analisados utilizando estatística bivariada e um modelo de regressão linear. Resultados Dos 209 idosos residentes na comunidade foi verificado uma prevalência de 23,9% de sarcopenia, 28,2% de obesidade e 4,3% de obesidade sarcopênica. Ainda, pode-se observar que os homens apresentaram maior prevalência de sarcopenia (p=0,006) e de obesidade (p=0,005) que as mulheres; os obesos tiveram menor prevalência de perda de massa muscular que os idosos não obesos (p<0,001); e os obesos apresentaram incremento na força (p=0,003) e na massa muscular (p<0,001) em relação aos não obesos, mesmo quando ajustado para sexo, faixa etária, multicomorbidades e incapacidade funcional. Conclusão levando em consideração a prevalência de obesidade sarcopênica na população estudada e a influência positiva da obesidade na predição de força e massa muscular, destaca-se a importância da avaliação multidimensional do idoso, a fim de averiguar a real necessidade de intervenções para perda de peso corporal, com intuito de prevenção de perda de força e massa muscular.
Collapse
Affiliation(s)
- Ana Paula Pillatt
- Pontifícia Universidade Católica do Rio Grande do Sul (PUC-RS), Brasil
| | | | | | | | | |
Collapse
|
11
|
Abstract
Excess adiposity in childhood may affect bone development, ultimately leading to bone frailty. Previous reports showing an increased rate of extremity fractures in children with obesity support this fear. On the other hand, there is also evidence suggesting that bone mineral content is higher in obese children than in normal weight peers. Both adipocytes and osteoblasts derive from multipotent mesenchymal stem cells (MSCs) and obesity drives the differentiation of MSCs toward adipocytes at the expense of osteoblast differentiation. Furthermore, adipocytes in bone marrow microenvironment release a number of pro-inflammatory and immunomodulatory molecules that up-regulate formation and activation of osteoclasts, thus favoring bone frailty. On the other hand, body adiposity represents a mechanical load, which is beneficial for bone accrual. In this frame, bone quality, and structure result from the balance of inflammatory and mechanical stimuli. Diet, physical activity and the hormonal milieu at puberty play a pivotal role on this balance. In this review, we will address the question whether the bone of obese children and adolescents is unhealthy in comparison with normal-weight peers and discuss mechanisms underlying the differences in bone quality and structure. We anticipate that many biases and confounders affect the clinical studies conducted so far and preclude us from achieving robust conclusions. Sample-size, lack of adequate controls, heterogeneity of study designs are the major drawbacks of the existing reports. Due to the increased body size of children with obesity, dual energy absorptiometry might overestimate bone mineral density in these individuals. Magnetic resonance imaging, peripheral quantitative CT (pQCT) scanning and high-resolution pQCT are promising techniques for the accurate estimate of bone mineral content in obese children. Moreover, no longitudinal study on the risk of incident osteoporosis in early adulthood of children and adolescents with obesity is available. Finally, we will address emerging dietary issues (i.e., the likely benefits for the bone health of polyunsaturated fatty acids and polyphenols) since an healthy diet (i.e., the Mediterranean diet) with balanced intake of certain nutrients associated with physical activity remain the cornerstones for achieving an adequate bone accrual in young individuals regardless of their adiposity degree.
Collapse
Affiliation(s)
- Danilo Fintini
- Endocrinology Unit, Pediatric University Department, Bambino Gesù Children's Hospital, Rome, Italy
- *Correspondence: Danilo Fintini
| | - Stefano Cianfarani
- Diabetes and Growth Disorders Unit, Dipartimento Pediatrico Universitario Ospedaliero Bambino Gesù Children's Hospital, Tor Vergata University, Rome, Italy
- Department of Women's and Children's Health, Karolinska Institute and University Hospital, Stockholm, Sweden
| | - Marta Cofini
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Angela Andreoletti
- Pediatric Resident, Pediatric Clinic, University of Brescia, Brescia, Italy
| | - Grazia Maria Ubertini
- Endocrinology Unit, Pediatric University Department, Bambino Gesù Children's Hospital, Rome, Italy
| | - Marco Cappa
- Endocrinology Unit, Pediatric University Department, Bambino Gesù Children's Hospital, Rome, Italy
| | - Melania Manco
- Research Area for Multifactorial Diseases, Bambino Gesù Children's Hospital, Rome, Italy
- Melania Manco
| |
Collapse
|
12
|
Kolluri H, Deplewski D. Dilemmas in Vitamin D Management in Children and Adolescents. Pediatr Ann 2019; 48:e298-e303. [PMID: 31426097 DOI: 10.3928/19382359-20190724-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The importance of vitamin D and its role in several biological processes has been a topic of interest in recent years. Vitamin D is an essential nutrient that is needed for metabolic bone health and for maintaining bone calcium homeostasis. It is primarily synthesized in the skin on exposure to sunlight. Of late, vitamin D deficiency has been associated with conditions such as obesity, poor control of asthma and other autoimmune diseases, which has led to questions about its potential role in causation and management of these conditions. Given the increase in data about this topic, providers may often have questions about whom to screen and what to tell patients. In this article, we address screening guidelines for vitamin D in children and adolescents, management of vitamin D deficiency, and current literature on the role of vitamin D in conditions such as obesity, asthma, and type 1 diabetes mellitus. [Pediatr Ann. 2019;48(8):e298-e303.].
Collapse
|
13
|
Bierhals IO, Dos Santos Vaz J, Bielemann RM, de Mola CL, Barros FC, Gonçalves H, Wehrmeister FC, Assunção MCF. Associations between body mass index, body composition and bone density in young adults: findings from a southern Brazilian cohort. BMC Musculoskelet Disord 2019; 20:322. [PMID: 31288773 PMCID: PMC6617655 DOI: 10.1186/s12891-019-2656-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 05/27/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND This study aimed to evaluate the association of body composition components and obesity with bone density. METHODS Prospective study with data on 2968 members of the 1993 Pelotas Birth Cohort from follow-ups at 18 and 22 years of age. Areal bone mineral density (aBMD, g/cm2) was evaluated for whole body, lumbar spine, and femoral neck at 22 years using dual-energy X-ray absorptiometry. Simple and multiple linear regression, stratified by sex, were used to assess the effect of BMI, fat mass (FMI) and lean mass index (LMI), evaluated at 18 and 22 years, and obesity trajectories classified by FMI and categorized as "never", "only at 18 years", "only at 22 years" or "always" on aBMD. RESULTS Among men, the largest coefficients were observed for BMI, followed by lean mass and fat mass. Compared to fat mass, lean mass presented the largest coefficients for all sites, with the strongest associations observed for the femoral neck (β: 0.035 g/cm2; 95% CI: 0.031; 0.039 for both follow-ups), while the largest effect for FMI was observed for whole-body aBMD at 18 years (β: 0.019 g/cm2; 95% CI: 0.014; 0.024). Among women, the strongest associations were observed for LMI. The largest coefficients for LMI and FMI were observed for femoral neck at age 18, presented β: 0.030 g/cm2, 95% CI: 0.026, 0.034 for LMI and β: 0.012 g/cm2; 95% CI: 0.009; 0.015) for FMI. Men who were "always obese" according to FMI had smallest aBMD for spine (β: -0.014; 95%CI: - 0.029; - 0.001). Women who were obese "only at 18 years" had smallest aBMD for the whole-body (β: -0.013; 95%CI: - 0.023; - 0.002), whereas those who were obese "only at 22 years" had larger whole-body and femoral neck aBMD (β: 0.013; 95%CI: 0.009; 0.017 and β: 0.027; 95%CI: 0.016; 0.038, respectively) and those "always obese" for whole-body aBMD (β: 0.005; 95%CI: 0.001; 0.011) compared to the reference category. CONCLUSIONS The indexes were positively associated with aBMD in this sample. Fat mass had smaller positive influence on these outcomes than lean mass, suggesting the most important body composition component for bone density is the lean mass.
Collapse
Affiliation(s)
- Isabel Oliveira Bierhals
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, 1160 - 3o andar, Pelotas/RS, 96020-220, Brazil.
| | - Juliana Dos Santos Vaz
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, 1160 - 3o andar, Pelotas/RS, 96020-220, Brazil
| | - Renata Moraes Bielemann
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, 1160 - 3o andar, Pelotas/RS, 96020-220, Brazil
| | - Christian Loret de Mola
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, 1160 - 3o andar, Pelotas/RS, 96020-220, Brazil
| | - Fernando Celso Barros
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, 1160 - 3o andar, Pelotas/RS, 96020-220, Brazil
| | - Helen Gonçalves
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, 1160 - 3o andar, Pelotas/RS, 96020-220, Brazil
| | - Fernando César Wehrmeister
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, 1160 - 3o andar, Pelotas/RS, 96020-220, Brazil
| | - Maria Cecília Formoso Assunção
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, 1160 - 3o andar, Pelotas/RS, 96020-220, Brazil
| |
Collapse
|
14
|
Mantovani A. Nonalcoholic Fatty Liver Disease and Bone Mineral Density in Children and Adolescents: Specific Considerations for Future Studies. Dig Dis Sci 2019; 64:898-900. [PMID: 30430297 DOI: 10.1007/s10620-018-5370-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 11/07/2018] [Indexed: 01/16/2023]
Affiliation(s)
- Alessandro Mantovani
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Piazzale A. Stefani, 1, 37126, Verona, Italy.
| |
Collapse
|
15
|
Laakso S, Viljakainen H, Lipsanen-Nyman M, Turpeinen U, Ivaska KK, Anand-Ivell R, Ivell R, Mäkitie O. Testicular Function and Bone in Young Men with Severe Childhood-Onset Obesity. Horm Res Paediatr 2018; 89:442-449. [PMID: 29961074 DOI: 10.1159/000489818] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 04/29/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Previous studies suggest increased risk for hypoandrogenism and fractures in men with obesity. We aimed to describe the effects of severe childhood-onset obesity on the cross talk between metabolic state, testes, and skeleton at late puberty. METHODS A cohort of adolescent and young adult males with severe childhood-onset obesity (n = 21, mean age 18.5 years) and an age-matched control group were assessed for testicular hormones and X-ray absorptiometry-derived bone mass. RESULTS Current median body mass indexes for the obese and control subjects were 37.4 and 22.9. Severe early-onset obesity manifested with lower free testosterone (median [interquartile range] 244 [194-332] vs. 403 [293-463] pmol/L, p = 0.002). Lower insulin-like 3 (1.02 [0.82-1.23] vs. 1.22 [1.01-1.46] ng/mL, p = 0.045) and lower ratio of testosterone to luteinizing hormone (2.81 [1.96-3.98] vs. 4.10 [3.03-5.83] nmol/IU, p = 0.008) suggested disrupted Leydig cell function. The degree of current obesity inversely correlated with free testosterone (τ = -0.516, p = 0.003), which in turn correlated positively with bone area at all measurement sites in males with childhood-onset obesity. CONCLUSIONS Severe childhood-onset obesity is associated with impaired Leydig cell function in young men and lower free testosterone may contribute to impaired skeletal characteristics.
Collapse
Affiliation(s)
- Saila Laakso
- Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Heli Viljakainen
- Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.,Folkhälsan Research Center, Biomedicum, Helsinki, Finland
| | - Marita Lipsanen-Nyman
- Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | | | - Kaisa K Ivaska
- Department of Cell Biology and Anatomy, University of Turku, Turku, Finland
| | | | - Richard Ivell
- School of Biosciences, University of Nottingham, Nottingham, United Kingdom
| | - Outi Mäkitie
- Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.,Folkhälsan Research Center, Biomedicum, Helsinki, Finland.,Department of Molecular Medicine and Surgery and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
16
|
Öberg D, Salemyr J, Örtqvist E, Juul A, Bang P. A longitudinal study of serum insulin-like growth factor-I levels over 6 years in a large cohort of children and adolescents with type 1 diabetes mellitus: A marker reflecting diabetic retinopathy. Pediatr Diabetes 2018; 19:972-978. [PMID: 29663652 DOI: 10.1111/pedi.12681] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 03/08/2018] [Accepted: 04/09/2018] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To evaluate longitudinal serum insulin-like growth factor-I (IGF-I) in a large cohort of children and adolescents with type 1 diabetes in relation to hemoglobin A1c (HbA1c), age, diabetes duration, and body mass index (BMI), its association to height and retinopathy, and in comparison with healthy subject references. METHODS A total of 2683 serum IGF-I values were obtained from 806 children and adolescents with T1DM, from annual blood samples for up to 6 consecutive years. RESULTS In a multiple regression analysis IGF-I values were negatively correlated to HbA1c and diabetes duration, and positively correlated to BMI (P < .001, P < .001, and P < .001, respectively, adjusted r2 = 0.102). Children and adolescents with T1DM had lower mean IGF-I levels and reference interval limits compared to healthy subjects. In boys, mean (SD) IGF-I SD score (SDS) levels were -1.04 (±1.3) calculated from the healthy reference. IGF-I peaked at 15 years of age, similarly to healthy controls, but with markedly lower levels in late puberty. Girls were more affected at later stages of puberty but with a slightly less depressed overall mean IGF-I SDS of -0.69 (±1.2). In a subgroup of 746 subjects with fundus photography, a negative correlation was seen between individual mean IGF-I SDS and preproliferative retinopathy (P = .004, adjusted r2 = 0.021). In another subgroup of 84 adolescents, no correlation was seen between individual mean IGF-I SDS and target height SDS or distance to target height SDS. CONCLUSION Poor metabolic control and diabetes duration impact negatively on serum IGF-I levels. A low individual mean IGF-I level was associated with progression of retinopathy independently of HbA1c, age, gender, and diabetes duration. Disease, sex and age related IGF-I SDS may become clinical helpful as a supplement to HbA1c in predicting the long-term outcome for children and adolescents with T1DM.
Collapse
Affiliation(s)
- Daniel Öberg
- Pediatric Department, Västervik Hospital, Västervik, Sweden
| | - Jenny Salemyr
- Pediatric Endocrinology and Diabetes Unit, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - Eva Örtqvist
- Pediatric Endocrinology and Diabetes Unit, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - Anders Juul
- Department of Growth and Reproduction, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
| | - Peter Bang
- Division of Pediatrics, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| |
Collapse
|
17
|
Steinberg N, Nemet D, Pantanowitz M, Eliakim A. Gait Pattern, Impact to the Skeleton and Postural Balance in Overweight and Obese Children: A Review. Sports (Basel) 2018; 6:E75. [PMID: 30065150 DOI: 10.3390/sports6030075] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Revised: 07/18/2018] [Accepted: 07/26/2018] [Indexed: 12/13/2022] Open
Abstract
The article reviews the biomechanical factors that may cause overweight/obese children to reduce their level of physical activity, while increasing their risk of overuse injuries and exercise-related pain. Recommendations would be to screen those children for any gait or postural impairments before they join any exercise program, and to provide them with specific gait treatments and/or physical exercise programs, in order to decrease their risk for future musculoskeletal injuries and pain.
Collapse
|
18
|
Rupp T, Butscheidt S, Jähn K, Simon MJ, Mussawy H, Oheim R, Barvencik F, Amling M, Rolvien T. Low physical performance determined by chair rising test muscle mechanography is associated with prevalent fragility fractures. Arch Osteoporos 2018; 13:71. [PMID: 29968169 DOI: 10.1007/s11657-018-0490-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 06/18/2018] [Indexed: 02/03/2023]
Abstract
UNLABELLED This study examined associations between physical performance assessed by chair rising test muscle mechanography and DXA T-score as well as body composition in a large patient cohort. Next to various significant interrelationships between these muscle and bone parameters, lower physical performance was associated with prevalent fragility fractures. PURPOSE Although the interaction between muscle and bone has been demonstrated in various aspects, the clinical focus in the diagnosis of musculoskeletal disorders mainly lies on the skeletal assessments. Accordingly, the association between muscle function, bone mineral density (BMD), and fragility fractures remains to be further elucidated with a feasible muscle assessment in a clinical setting. METHODS Patient data (2076 patients, 1538 women, 538 men) were evaluated retrospectively from a large dual energy X-ray absorptiometry (DXA) database as well as from chair rising test (CRT) that was performed on a muscle mechanograph. To determine potential predictors of the CRT time and maximum force, a multivariate regression analysis was performed including age, DXA T-score, and body composition indices. Furthermore, CRT results were compared between non-fracture and fracture cases. RESULTS We determined independent predictors for CRT time such as age, femoral DXA T-score, and total fat mass, whereas CRT force was only influenced by total lean mass. Both women and men with previous fragility fractures displayed a longer CRT time (women p = 0.009, men p = 0.001) and lower CRT force (women p < 0.001, men p < 0.001) than those with no fractures, while no clear differences in CRT results could be detected between normal BMD, osteopenia, and osteoporosis based on DXA T-scores. CONCLUSIONS Our study demonstrates that in addition to the associations between chair rising time and femoral T-score assessed by DXA, low muscle strength is associated with previous fragility fractures.
Collapse
|
19
|
Abstract
Obese children with high-energy injuries present with more severe injuries, more extremity injuries, and higher Injury Severity Scores. They are at increased risk for complications, prolonged ventilation, and ICU stay and have increased mortality. Obesity is associated with altered bone mass accrual and higher fracture rates. Obese patients have a higher risk of loss of reduction of forearm fractures, more severe supracondylar fractures, and a higher likelihood of lateral condyle fractures. Obese patients are more likely to have complications with femur fractures and have higher rates of foot and ankle fracture.
Collapse
|
20
|
Gajewska J, Ambroszkiewicz J, Klemarczyk W, Chełchowska M, Weker H, Szamotulska K. The effect of weight loss on body composition, serum bone markers, and adipokines in prepubertal obese children after 1-year intervention. Endocr Res 2018; 43:80-89. [PMID: 29192796 DOI: 10.1080/07435800.2017.1403444] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
UNLABELLED Purpose/Aim: The influence of weight loss on bone turnover and bone quality in childhood remains controversial, but it may implicate interactions between adiposity and bone metabolism. Therefore, we studied the relationships between bone markers and adipokines during weight loss in obese children. MATERIALS AND METHODS We determined serum leptin, soluble leptin receptor, adiponectin, bone alkaline phosphatase (BALP), C-terminal telopeptide of type I collagen (CTX-I), osteocalcin (OC), carboxylated-OC (Gla-OC), undercarboxylated-OC (Glu-OC), sclerostin, body composition, and bone mineral density (BMD) in 40 obese prepubertal children before and after therapy. The control group, matched for sex and age, consisted of 40 non-obese children. RESULTS We found that values of the total body less head-bone mineral content (TBLH-BMC) and TBLH-BMD were significantly increased, but TBLH-BMD Z-score was decreased by 25% (p = 0.002) in obese children with weight loss after therapy. We observed increases of CTX-I to OC ratio (p = 0.009), and Gla-OC concentrations (p = 0.049). Changes in TBLH-BMD Z-score in patients were positively correlated with changes in BMI Z-score (p = 0.001), percentage of fat mass (p = 0.004), and BALP activity (p = 0.01). Changes in BALP activity were negatively correlated (p < 0.001) with changes in adiponectin concentrations, while changes in sclerostin levels were positively correlated (p = 0.001) with leptin changes. CONCLUSIONS We suggest that alterations in adipokines metabolism were associated with a lower rate of bone mineral accrual as a result of decreased bone formation rather than increased bone resorption. The lower rate of bone mass accrual in weight losing children may be an effect of reduced BALP levels related to increase in adiponectin levels.
Collapse
Affiliation(s)
- Joanna Gajewska
- a Screening Department , Institute of Mother and Child , Warsaw , Poland
| | | | - Witold Klemarczyk
- b Department of Nutrition , Institute of Mother and Child , Warsaw , Poland
| | | | - Halina Weker
- b Department of Nutrition , Institute of Mother and Child , Warsaw , Poland
| | - Katarzyna Szamotulska
- c Department of Epidemiology and Biostatistics , Institute of Mother and Child , Warsaw , Poland
| |
Collapse
|
21
|
Vandewalle S, Van Caenegem E, Craen M, Taes Y, Kaufman JM, T'Sjoen G. Growth, sexual and bone development in a boy with bilateral anorchia under testosterone treatment guided by the development of his monozygotic twin. J Pediatr Endocrinol Metab 2018; 31:361-367. [PMID: 29353265 DOI: 10.1515/jpem-2017-0126] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 12/01/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND Sex steroids are essential for sexual maturation, linear growth and bone development. However, there is no consensus on the optimal timing, dosage and dosage interval of testosterone therapy to induce pubertal development and achieve a normal adult height and bone mass in children with hypogonadism. CASE PRESENTATION A monozygotic monochorial male twin pair, of which one boy was diagnosed with anorchia at birth due to testicular regression syndrome was followed from the age of 3 until the age of 18 years. Low dose testosterone substitution (testosterone esters 25 mg/2 weeks) was initiated in the affected twin based on the start of pubertal development in the healthy twin and then gradually increased accordingly. Both boys were followed until age 18 and were compared as regards to linear growth, sexual maturation, bone maturation and bone development. Before puberty induction both boys had a similar weight and height. During puberty, a slightly faster weight and height gain was observed in the affected twin. Both boys ended up however, with a similar and normal (near) adult height and weight and experienced a normal development of secondary sex characteristics. At the age of 17 and 18 years, bone mineral density, body composition and volumetric bone parameters at the forearm and calf were evaluated in both boys. The affected boy had a higher lean mass and muscle cross-sectional area. The bone mineral density at the lumbar spine and whole body was similar. Trabecular and cortical volumetric bone parameters were comparable. At one cortical site (proximal radius), however, the affected twin had a smaller periosteal and endosteal circumference with a thicker cortex. CONCLUSIONS In conclusion, a low dose testosterone substitution in bilateral anorchia led to a normal onset of pubertal development and (near) adult height. Furthermore, there was no difference in bone mineral density at the age of 17 and 18 years.
Collapse
Affiliation(s)
- Sara Vandewalle
- Department of Endocrinology, Ghent University Hospital, De Pintelaan 185 6K12IE, 9000 Ghent, Belgium, Phone: +32 9 332 34 13, Fax: +32 9 332 38 17
- Unit for Osteoporosis and Metabolic Bone Diseases, Ghent University Hospital, Ghent, Belgium
| | - Eva Van Caenegem
- Unit for Osteoporosis and Metabolic Bone Diseases, Ghent University Hospital, Ghent, Belgium
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - Margarita Craen
- Department of Pediatric Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - Youri Taes
- Unit for Osteoporosis and Metabolic Bone Diseases, Ghent University Hospital, Ghent, Belgium
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - Jean-Marc Kaufman
- Unit for Osteoporosis and Metabolic Bone Diseases, Ghent University Hospital, Ghent, Belgium
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - Guy T'Sjoen
- Unit for Osteoporosis and Metabolic Bone Diseases, Ghent University Hospital, Ghent, Belgium
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| |
Collapse
|
22
|
Kelley JC, Stettler-Davis N, Leonard MB, Hill D, Wrotniak BH, Shults J, Stallings VA, Berkowitz R, Xanthopoulos MS, Prout-Parks E, Klieger SB, Zemel BS. Effects of a Randomized Weight Loss Intervention Trial in Obese Adolescents on Tibia and Radius Bone Geometry and Volumetric Density. J Bone Miner Res 2018; 33:42-53. [PMID: 28884881 PMCID: PMC8527854 DOI: 10.1002/jbmr.3288] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 08/31/2017] [Accepted: 09/06/2017] [Indexed: 01/06/2023]
Abstract
Obese adolescents have increased fracture risk, but effects of alterations in adiposity on bone accrual and strength in obese adolescents are not understood. We evaluated 12-month changes in trabecular and cortical volumetric bone mineral density (vBMD) and cortical geometry in obese adolescents undergoing a randomized weight management program, and investigated the effect of body composition changes on bone outcomes. Peripheral quantitative computed tomography (pQCT) of the radius and tibia, and whole-body dual-energy X-ray absorptiometry (DXA) scans were obtained at baseline, 6 months, and 12 months in 91 obese adolescents randomized to standard care versus behavioral intervention for weight loss. Longitudinal models assessed effects of body composition changes on bone outcomes, adjusted for age, bone length, and African-American ancestry, and stratified by sex. Secondary analyses included adjustment for physical activity, maturation, vitamin D, and inflammatory biomarkers. Baseline body mass index (BMI) was similar between intervention groups. Twelve-month change in BMI in the standard care group was 1.0 kg/m2 versus -0.4 kg/m2 in the behavioral intervention group (p < 0.01). Intervention groups were similar in bone outcomes, so they were combined for subsequent analyses. For the tibia, BMI change was not associated with change in vBMD or structure. Greater baseline lean body mass index (LBMI) associated with higher cortical vBMD in males, trabecular vBMD in females, and polar section modulus (pZ) and periosteal circumference (Peri-C) in both sexes. In females, change in LBMI positively associated with gains in pZ and Peri-C. Baseline visceral adipose tissue (VFAT) was inversely associated with pZ in males and cortical vBMD in females. Change in VFAT did not affect bone outcomes. For the radius, BMI and LBMI changes positively associated with pZ in males. Thus, in obese adolescents, weight loss intervention with modest changes in BMI was not detrimental to radius or tibia bone strength, and changes in lean, but not adiposity, measures were beneficial to bone development. © 2017 American Society for Bone and Mineral Research.
Collapse
Affiliation(s)
- Jennifer C Kelley
- Division of Endocrinology and Diabetes, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | | | - Mary B Leonard
- Department of Pediatrics, Stanford University, Palo Alto, CA, USA
| | - Douglas Hill
- Department of Pediatrics, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Pediatric Advanced Care Team, The Children's Hospital of Philadephia, Philadelphia, PA, USA
| | - Brian H Wrotniak
- Department of Physical Therapy, D'Youville College, Buffalo, NY, USA
| | - Justine Shults
- Department of Pediatrics, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Division of Biostatistics and Data Management, The Children's Hospital of Philadephia, Philadelphia, PA, USA
| | - Virginia A Stallings
- Department of Pediatrics, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Division of Gastroenterology, Hepatology, and Nutrition, The Children's Hospital of Philadephia, Philadelphia, PA, USA
| | - Robert Berkowitz
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Melissa S Xanthopoulos
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Elizabeth Prout-Parks
- Department of Pediatrics, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Division of Gastroenterology, Hepatology, and Nutrition, The Children's Hospital of Philadephia, Philadelphia, PA, USA
| | - Sarah B Klieger
- Biostatistical and Data Management Core, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Babette S Zemel
- Department of Pediatrics, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Division of Gastroenterology, Hepatology, and Nutrition, The Children's Hospital of Philadephia, Philadelphia, PA, USA
| |
Collapse
|
23
|
Okbay Güneş A, Alikaşifoğlu M, Şen Demirdöğen E, Erginöz E, Demir T, Kucur M, Ercan O. The Relationship of Disordered Eating Attitudes with Stress Level, Bone Turnover Markers, and Bone Mineral Density in Obese Adolescents. J Clin Res Pediatr Endocrinol 2017; 9:237-245. [PMID: 28196789 PMCID: PMC5596805 DOI: 10.4274/jcrpe.3794] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To investigate the effect of stress caused by disordered eating attitudes on bone health in obese adolescents. METHODS A cross-sectional study comprising 80 obese adolescents was performed from November 2013 to September 2014. Twenty-four-hour urinary free cortisol levels were measured as a biological marker of stress. Bone turnover was evaluated using bone-specific alkaline phosphatase, serum osteocalcin, and urinary N-telopeptide concentrations. Bone mineral density was measured using dual-energy X-ray absorptiometry. The Eating Disorder Examination Questionnaire, Dutch Eating Behavior Questionnaire, Children's Depression Inventory, and the State-Trait Anxiety Inventory for Children were used to assess eating disorders, depression, and anxiety. Psychiatric examinations were performed for binge eating disorders. RESULTS In the Pearson's correlation test, a positive correlation was found between the 24-hour urinary cortisol level and Dutch Eating Behavior Questionnaire total and restrained eating subscale scores (p<0.05 for both). In linear regression analyses, the Dutch Eating Behavior Questionnaire total and restrained eating subscale scores were found to be significant contributors for urinary cortisol level (β=1.008, p=0.035; β=2.296, p=0.014, respectively). The femoral neck areal bone mineral density was found to be significantly higher in subjects who had binge eating disorder compared with those without binge eating disorder (p=0.049). CONCLUSION Despite the lack of apparent effects on bone turnover and bone mineral density in our obese adolescents at the time of the study, our results suggest that disordered eating attitudes, and especially restrained eating attitudes, might be a source of stress. Therefore, studies in this area should continue.
Collapse
Affiliation(s)
- Aslı Okbay Güneş
- İstanbul University Cerrahpaşa Faculty of Medicine, Department of Pediatrics, İstanbul, Turkey
| | - Müjgan Alikaşifoğlu
- İstanbul University Cerrahpaşa Faculty of Medicine, Department of Pediatrics, Division of Adolescent Medicine, İstanbul, Turkey
,* Address for Correspondence: İstanbul University Cerrahpaşa Faculty of Medicine, Department of Pediatrics, Division of Adolescent Medicine, İstanbul, Turkey E-mail:
| | - Ezgi Şen Demirdöğen
- İstanbul University Cerrahpaşa Faculty of Medicine, Department of Child and Adolescent Psychiatry, İstanbul, Turkey
| | - Ethem Erginöz
- İstanbul University Cerrahpaşa Faculty of Medicine, Department of Public Health, İstanbul, Turkey
| | - Türkay Demir
- İstanbul University Cerrahpaşa Faculty of Medicine, Department of Child and Adolescent Psychiatry, İstanbul, Turkey
| | - Mine Kucur
- İstanbul University Cerrahpaşa Faculty of Medicine, Department of Biochemistry, İstanbul, Turkey
| | - Oya Ercan
- İstanbul University Cerrahpaşa Faculty of Medicine, Department of Pediatrics, Division of Adolescent Medicine and Endocrinology, İstanbul, Turkey
| |
Collapse
|
24
|
de Groot CJ, van den Berg A, Ballieux BE, Kroon HM, Rings EH, Wit JM, van den Akker EL. Determinants of Advanced Bone Age in Childhood Obesity
. Horm Res Paediatr 2017; 87:254-263. [PMID: 28365712 PMCID: PMC5637288 DOI: 10.1159/000467393] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 03/01/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Childhood obesity is associated with advanced bone age (BA). Previous studies suggest that androgens, oestrogens, sex hormone-binding globulin, and insulin are responsible for this phenomenon, but results are contradictory and might be biased by confounders. We aim to elucidate this matter by applying a multivariate approach. METHOD We performed a correlation analysis of BA standard deviation score (SDS) with age- and sex-specific SDS for androgens, oestrogens, and with indicators of insulin secretion derived from oral glucose tolerance testing, in a group of obese children. A multivariate analysis was performed to investigate which parameters were independently predictive of BA SDS. RESULTS In this cohort (n = 101; mean age 10.9 years; mean BA 11.8 years; mean BMI SDS 3.3), BMI SDS was significantly correlated to BA SDS (r = 0.55, p < 0.001). In a regression analysis in the total cohort (B = 0.27, p < 0.001) as well as in females (B = 0.34, p = 0.042), males (B = 0.31, p = 0.006), and pubertal children (B = 0.32, p = 0.046), dehydroepiandrosterone sulphate (DHEAS) showed a positive, independent association with BA SDS. No association with indicators of insulin secretion was found. CONCLUSION BMI SDS is highly correlated to BA SDS in obese children. Increased DHEAS has a central role in advanced BA in obese children.
.
Collapse
Affiliation(s)
- Cornelis J. de Groot
- Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, the Netherlands,*Cornelis J. de Groot, Willem-Alexander Children's Hospital, Leiden University Medical Center, Albinusdreef 2, PO Box 9600, NL–2300 RC Leiden (Netherlands), E-Mail
| | - Adriaan van den Berg
- Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, the Netherlands
| | - Bart E.P.B. Ballieux
- Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Herman M. Kroon
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Edmond H.H.M. Rings
- Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, the Netherlands,Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Jan M. Wit
- Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, the Netherlands
| | | |
Collapse
|
25
|
Abstract
The prevalence of obesity in children has reached epidemic proportions. Concern about bone health in obese children, in part, derives from the potentially increased fracture risk associated with obesity. Additional risk factors that affect bone mineral accretion, may also contribute to obesity, such as low physical activity and nutritional factors. Consequences of obesity, such as inflammation, insulin resistance, and non-alcoholic fatty liver disease, may also affect bone mineral acquisition, especially during the adolescent years when rapid increases in bone contribute to attaining peak bone mass. Further, numerous pediatric health conditions are associated with excess adiposity, altered body composition, or endocrine disturbances that can affect bone accretion. Thus, there is a multitude of reasons for considering clinical assessment of bone health in an obese child. Multiple diagnostic challenges affect the measurement of bone density and its interpretation. These include greater precision error, difficulty in positioning, and the effects of increased lean and fat tissue on bone health outcomes. Future research is required to address these issues to improve bone health assessment in obese children.
Collapse
Affiliation(s)
- Jennifer C Kelley
- Division of Endocrinology and Diabetes, Monroe Carell, Jr Children's Hospital at Vanderbilt, Vanderbilt University School of Medicine, Nashville, TN, 37232, USA
| | - Nicola Crabtree
- Department of Endocrinology and Diabetes, Birmingham Children's Hospital, Birmingham, UK
| | - Babette S Zemel
- Division of Gastroenterology, Hepatology and Nutrition, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, Room 1560, Philadelphia, PA, 19104, USA.
| |
Collapse
|
26
|
Sioen I, Lust E, De Henauw S, Moreno LA, Jiménez-Pavón D. Associations Between Body Composition and Bone Health in Children and Adolescents: A Systematic Review. Calcif Tissue Int 2016; 99:557-577. [PMID: 27484027 DOI: 10.1007/s00223-016-0183-x] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 07/22/2016] [Indexed: 12/18/2022]
Abstract
More clarification on the associations between children's and adolescents' lean and fat mass (LM and FM) on the one hand and their bone health on the other hand is needed, given the rising prevalence of overweight and obesity in this population. This systematic literature review aimed to describe the current evidence on these associations. Data sources were Medline/PubMed, EMBASE, CINAHL and The Cochrane Library (up to November 2014). Search items included LM, FM, children and adolescents (0-18 years), bone health measured with dual-energy X-ray absorptiometry and peripheral quantitative computed tomography (pQCT) and search items concerning study design: observational and longitudinal studies. The study populations were healthy children and adolescents including obese children. Children with other diseases and clinical series of study subjects were excluded. Based on the studies included in this review (n = 19), there is a consensus that the contribution of LM to the variance of the different bone parameters is larger than the contribution of FM and that an increase in LM is associated with an increase in bone parameters. Most of the studies indicated that the increase in bone parameters seen in overweight and obese children and adolescents is due to an increase in LM and not to greater FM. The results on the association between body fat and bone parameters were contradictory and depended on children's age and sex. Still more data from studies with a longitudinal study design using (high resolution) pQCT and a representative sample are needed to get further insight in the associations between body fat and bone parameters in children, specifically concerning differences in sex, skeletal site and fat depots.
Collapse
Affiliation(s)
- I Sioen
- Department of Public Health, Ghent University, UZ 4K3, De Pintelaan 185, 9000, Ghent, Belgium.
- Research Foundation Flanders, Brussels, Belgium.
| | - E Lust
- Department of Public Health, Ghent University, UZ 4K3, De Pintelaan 185, 9000, Ghent, Belgium
| | - S De Henauw
- Department of Public Health, Ghent University, UZ 4K3, De Pintelaan 185, 9000, Ghent, Belgium
| | - L A Moreno
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, Facultad de Ciencias de la Salud, Instituto Agroalimentario de Aragón (IA2), Instituto de Investigación Sanitaria Aragón (IIS Aragón), Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Universidad de Zaragoza, Saragossa, Spain
| | - D Jiménez-Pavón
- GALENO Research Group, Department of Physical Education, University of Cádiz, Puerto Real, Cádiz, Spain
| |
Collapse
|
27
|
Abstract
Until recently, much of the research exploring the role of nutrition on bone mass accrual has focused on single nutrients. Although randomised controlled trials have provided key information about the effects of calcium and vitamin D on bone, they also have limitations, e.g. generalisation, implementation of the results and long-term consequences. Human subjects do not eat single nutrients, but foods, and describing healthy food patterns for optimising bone mineral accrual is warranted. Recent advances in research suggest that the effects of whole diet are larger than those of single nutrients on bone health. Research should focus on younger age groups to identify the life-course determinants of osteoporosis during prenatal, infancy, childhood and adolescence that would help to maximise peak bone mass. Food patterns that describe the variability, quality and choices of individuals give broader insight and may provide new strategies for preventing osteoporosis.
Collapse
|
28
|
Avila ML, Pullenayegum E, Williams S, Shammas A, Stimec J, Sochett E, Marr K, Brandão LR. Timing of low bone mineral density and predictors of bone mineral density trajectory in children on long-term warfarin: a longitudinal study. Osteoporos Int 2016; 27:1547-1557. [PMID: 26572757 DOI: 10.1007/s00198-015-3411-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 11/05/2015] [Indexed: 01/06/2023]
Abstract
UNLABELLED We studied bone mineral density (BMD) of children exposed to long-term warfarin. BMD Z-scores ≤ -2.0 were estimated to occur in less than one fifth of the patients after 10 years of warfarin exposure, and BMI and growth hormone deficiency predicted BMD changes over time. These predictors can help identify high-risk patients. INTRODUCTION Children with chronic diseases are at increased risk of developing thrombosis, which may require long-term warfarin therapy. Warfarin could further jeopardize the bone health of a population already at risk for bone fragility. Our objective was to investigate the occurrence and timing of low bone mineral density (BMD) and the predictors that influence BMD trajectory in children receiving warfarin for >1 year. METHODS We analyzed the results of an institutional protocol that includes dual-energy X-ray absorptiometry, with or without spinal X-rays and laboratory biomarkers, as required. RESULTS Low BMD (age, sex, race, and height-for-age-Z-score adjusted BMD Z-score ≤ -2.0) was detected in 13 % (9/70) of the patients at some point during their follow-up; these patients were more likely to have complex underlying medical conditions and low body mass index (BMI) percentile. BMD Z-scores remained within normal range in 87 % of children. Survival analysis showed that the estimated 10-year abnormal BMD-free rate for the entire group was 81 % (95 % confidence interval [CI] 69 to 93 %). Trajectory analysis revealed that BMI percentiles at baseline and growth hormone deficiency (GHD) were associated with lower BMD Z-scores at the first assessment, whereas baseline BMI percentile was the only predictor of BMD Z-score over time. CONCLUSIONS Our findings identified BMI and GHD as risk factors influencing BMD in children exposed to long-term warfarin, creating an opportunity for early detection and intervention in these patients.
Collapse
Affiliation(s)
- M L Avila
- Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, M5G-1X8, ON, Canada
| | - E Pullenayegum
- Child Health Evaluative Sciences, The Hospital for Sick Children, University of Toronto, Toronto, M5G-1X8, ON, Canada
| | - S Williams
- Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, M5G-1X8, ON, Canada
| | - A Shammas
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, M5G-1X8, ON, Canada
| | - J Stimec
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, M5G-1X8, ON, Canada
| | - E Sochett
- Division of Endocrinology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, M5G-1X8, ON, Canada
| | - K Marr
- Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, M5G-1X8, ON, Canada
| | - L R Brandão
- Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, M5G-1X8, ON, Canada.
| |
Collapse
|
29
|
Pacholczak R, Klimek-Piotrowska W, Kuszmiersz P. Associations of anthropometric measures on breast cancer risk in pre- and postmenopausal women--a case-control study. J Physiol Anthropol 2016; 35:7. [PMID: 26951106 DOI: 10.1186/s40101-016-0090-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 02/26/2016] [Indexed: 01/01/2023] Open
Abstract
Background The type of silhouette and quantity of fat tissue are correlated with hormonal imbalance which plays a substantial role in breast carcinogenesis. The goal of the study was to investigate the association between various anthropometric characteristics and breast cancer risk. Methods Detailed anthropometric assessment was conducted on 487 women of whom 193 had diagnosed breast cancer and were consecutive patients in the Oncology Center, Cracow, Poland between 2002 and 2004. Measurements were divided into four categories: overall body size (body mass index [BMI], waist circumference [WC], waist-hip ratio [WHR]), regional body sizes (skinfold thicknesses, circumferences), thickness of the skeleton (widths, chest diameters), and body proportions. Additionally, results were analyzed in regard to menopausal status. Differences between groups were assessed using Student’s t test and Mann-Whitney’s test. Models of logistic regression for selected data were built to estimate the odds ratio. Results were considered statistically significant when the P value was less than 0.05. Results The BMI in both groups was negatively associated with the risk of cancer. Among premenopausal women, WHR increased the risk of breast cancer (WHR > 0.83, OR, 2.72; 95 % CI, 1.01–7.27). Anthropometric indices of hip-to-shoulder ratio in postmenopausal (≥84.2 mm, OR, 0.02; 95 % CI, 0.01–0.11) and trunk-to-height ratio in both premenopausal women (≥32.76, OR, 0.09; 95 % CI, 0.03–0.28) and postmenopausal women (≥32.76, OR, 0.13; 95 % CI, 0.05–0.33) were strongly related to a decreased risk of breast cancer. Thicknesses of the triceps and subscapular skinfolds increased the risk of breast cancer. Conclusions Women with breast cancer present with an obese type of silhouette with a specific concentration of fat tissue in the central and upper parts of the body.
Collapse
|
30
|
Potikanond S, Rattanachote P, Pintana H, Suntornsaratoon P, Charoenphandhu N, Chattipakorn N, Chattipakorn S. Obesity does not aggravate osteoporosis or osteoblastic insulin resistance in orchiectomized rats. J Endocrinol 2016; 228:85-95. [PMID: 26675491 DOI: 10.1530/joe-15-0333] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/13/2015] [Indexed: 01/03/2023]
Abstract
The present study aimed to test the hypothesis that testosterone deprivation impairs osteoblastic insulin signaling, decreases osteoblast survival, reduces bone density, and that obesity aggravates those deleterious effects in testosterone-deprived rats. Twenty four male Wistar rats underwent either a bilateral orchiectomy (O, n=12) or a sham operation (S, n=12). Then the rats in each group were further divided into two subgroups fed with either a normal diet (ND) or a high-fat diet (HF) for 12 weeks. At the end of the protocol, blood samples were collected to determine metabolic parameters and osteocalcin ratios. The tibiae were collected to determine bone mass using microcomputed tomography and for osteoblast isolation. The results showed that rats fed with HF (sham-operated HF-fed rats (HFS) and ORX HF-fed rats (HFO)) developed peripheral insulin resistance and had decreased trabecular bone density. In ND-fed rats, only the ORX ND-fed rats (NDO) group had decreased trabecular bone density. In addition, osteoblastic insulin resistance, as indicated by a decrease in tyrosine phosphorylation of the insulin receptor and Akt, were observed in all groups except the sham-operated ND-fed rats (NDS) rats. Those groups, again with the exception of the NDS rats, also had decreased osteoblastic survival. No differences in the levels of osteoblastic insulin resistance and osteoblastic survival were found among the NDO, HFS, and HFO groups. These findings suggest that either testosterone deprivation or obesity alone can impair osteoblastic insulin signaling and decrease osteoblastic survival leading to the development of osteoporosis. However, obesity does not aggravate those deleterious effects in the bone of testosterone-deprived rats.
Collapse
Affiliation(s)
- Saranyapin Potikanond
- Department of PharmacologyFaculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Pinyada Rattanachote
- Neurophysiology Unit, Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Hiranya Pintana
- Center of Calcium and Bone Research (COCAB)Faculty of Science, Mahidol University, Bangkok, Thailand
| | | | - Narattaphol Charoenphandhu
- Cardiac Electrophysiology Unit Department of Physiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nipon Chattipakorn
- Center of Excellence in Cardiac Electrophysiology ResearchChiang Mai University, Chiang Mai, Thailand
| | - Siriporn Chattipakorn
- Department of Oral Biology and Diagnostic SciencesFaculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand
| |
Collapse
|
31
|
Abstract
PURPOSE OF REVIEW The purpose of this review is to summarize the recent clinical findings surrounding the muscle-bone relationships in children, while considering muscle adiposity, endocrine factors, and lifestyle influences (i.e., diet and exercise) involved in pediatric musculoskeletal development. RECENT FINDINGS Positive relationships between cortical bone geometry and muscle mass, size and function have been reported. Prospective studies in particular have helped clarify some of the inconsistent relationships between muscle and cortical bone volumetric density. Muscle fat is associated with impaired glucose handling and muscular functionality, which may in turn have a downstream effect on cortical bone growth during adolescence. Lifestyle factors such as healthful diets and higher impact physical activities can promote optimal skeletal development by improving the muscular phenotype and endocrine profile. SUMMARY Muscle and bone are two intricately-related tissue types; however, factors such as sex, maturation, study design, and outcome measures studied can modify this relationship. Further research is warranted to understand the impact of muscle adiposity on cardiometabolic health, muscle function and, subsequently, pediatric musculoskeletal development and fracture risk. Following age-specific diet and physical activity recommendations should be a major focus in obtaining optimal muscle and bone development throughout maturation.
Collapse
Affiliation(s)
- Joseph M Kindler
- aDepartment of Foods and Nutrition, College of Family and Consumer Sciences, University of Georgia, Athens bDepartment of Cellular Biology and Anatomy, Medical College of Georgia, Georgia Regents University, Augusta, Georgia, USA
| | | | | |
Collapse
|
32
|
Chaplais E, Thivel D, Greene D, Dutheil F, Duche P, Naughton G, Courteix D. Bone-adiposity cross-talk: implications for pediatric obesity. A narrative review of literature. J Bone Miner Metab 2015; 33:592-602. [PMID: 25796628 DOI: 10.1007/s00774-015-0654-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Accepted: 01/12/2015] [Indexed: 01/01/2023]
Abstract
The rising prevalence of overweight and obesity among pediatric populations has become a major global concern. The objective of this review is to demonstrate potential interactions between the products released by fat tissue and the hormonal production of bone tissue in obese children and adolescents. Advancing the understanding of the complex interactions between adipocyte and osteocyte activities may contribute to the mechanistic understanding of the body's responses to weight loss during adolescence. This knowledge could also reveal any side effects encountered with these interventions. Currently, the concept of bone-adiposity crosstalk has not been fully elucidated, and the mechanisms remain controversial. Understanding the local interactions between the released products by fat tissue and hormones produced in bone tissue requires further investigations.
Collapse
Affiliation(s)
- Elodie Chaplais
- Laboratory of the Metabolic Adaptations to Exercise under Physiological and Pathological Conditions (AME2P), EA 3533, Clermont University, Blaise Pascal University, Clermont-Ferrand, France.
- School of Exercise Science, Australian Catholic University, Strathfield campus, Locked Bag 2002, Strathfield, NSW, 2135, Australia.
| | - David Thivel
- Laboratory of the Metabolic Adaptations to Exercise under Physiological and Pathological Conditions (AME2P), EA 3533, Clermont University, Blaise Pascal University, Clermont-Ferrand, France
- CRNH-Auvergne, Clermont-Ferrand, France
| | - David Greene
- School of Exercise Science, Australian Catholic University, Strathfield campus, Locked Bag 2002, Strathfield, NSW, 2135, Australia
| | - Frederic Dutheil
- Laboratory of the Metabolic Adaptations to Exercise under Physiological and Pathological Conditions (AME2P), EA 3533, Clermont University, Blaise Pascal University, Clermont-Ferrand, France
- School of Exercise Science, Australian Catholic University, Strathfield campus, Locked Bag 2002, Strathfield, NSW, 2135, Australia
- Occupational Medicine, University Hospital CHU G. Montpied, 63000, Clermont-Ferrand, France
| | - Pascale Duche
- Laboratory of the Metabolic Adaptations to Exercise under Physiological and Pathological Conditions (AME2P), EA 3533, Clermont University, Blaise Pascal University, Clermont-Ferrand, France
- CRNH-Auvergne, Clermont-Ferrand, France
| | - Geraldine Naughton
- School of Exercise Science, Australian Catholic University, Strathfield campus, Locked Bag 2002, Strathfield, NSW, 2135, Australia
- School of Exercise Science, Australian Catholic University, Melbourne campus, Fitzroy MDC, Locked Bag 4115, Fitzroy, VIC, 3065, Australia
| | - Daniel Courteix
- Laboratory of the Metabolic Adaptations to Exercise under Physiological and Pathological Conditions (AME2P), EA 3533, Clermont University, Blaise Pascal University, Clermont-Ferrand, France
- School of Exercise Science, Australian Catholic University, Strathfield campus, Locked Bag 2002, Strathfield, NSW, 2135, Australia
- CRNH-Auvergne, Clermont-Ferrand, France
| |
Collapse
|
33
|
Moon RJ, Lim A, Farmer M, Segaran A, Clarke NMP, Dennison EM, Harvey NC, Cooper C, Davies JH. Differences in childhood adiposity influence upper limb fracture site. Bone 2015; 79:88-93. [PMID: 26027507 PMCID: PMC4521307 DOI: 10.1016/j.bone.2015.05.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 05/08/2015] [Accepted: 05/21/2015] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Although it has been suggested that overweight and obese children have an increased risk of fracture, recent studies in post-menopausal women have shown that the relationship between obesity and fracture risk varies by fracture site. We therefore assessed whether adiposity and overweight/obesity prevalence differed by upper limb fracture site in children. METHODS Height, weight, BMI, triceps and subscapular skinfold thickness (SFT) were measured in children aged 3-18 years with an acute upper limb fracture. Data was compared across three fracture sites (hand, forearm and upper arm/shoulder [UA]), and to published reference data. RESULTS 401 children (67.1% male, median age 11.71 years, range 3.54-17.27 years) participated. 34.2%, 50.6% and 15.2% had fractures of the hand, forearm and UA, respectively. Children with forearm fractures had higher weight, BMI, subscapular SFT and fat percentage z-scores than those with UA fractures (p<0.05 for all). SFT and fat percentage z-scores were also higher in children with forearm fractures compared to hand fractures, but children with hand and UA fractures did not differ. Overweight and obesity prevalence was higher in children with forearm fractures (37.6%) than those with UA fractures (19.0%, p=0.009). This prevalence was also higher than the published United Kingdom population prevalence (27.9%, p=0.003), whereas that of children with either UA (p=0.13) or hand fractures (29.1%, p=0.76) did not differ. These differences in anthropometry and overweight/obesity prevalence by fracture site were evident in boys, but not present in girls. CONCLUSION Measurements of adiposity and the prevalence of overweight/obesity differ by fracture site in children, and in particular boys, with upper limb fractures.
Collapse
Affiliation(s)
- Rebecca J Moon
- Paediatric Endocrinology, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK; MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK.
| | - Adelynn Lim
- Paediatric Endocrinology, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK
| | - Megan Farmer
- Paediatric Endocrinology, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK
| | - Avinash Segaran
- Paediatric Endocrinology, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK
| | - Nicholas M P Clarke
- Paediatric Orthopaedics, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK
| | - Elaine M Dennison
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK; NIHR Musculoskeletal Research Unit, University of Oxford, Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7HE, UK
| | - Justin H Davies
- Paediatric Endocrinology, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK
| |
Collapse
|
34
|
Viljakainen HT, Valta H, Lipsanen-Nyman M, Saukkonen T, Kajantie E, Andersson S, Mäkitie O. Bone Characteristics and Their Determinants in Adolescents and Young Adults with Early-Onset Severe Obesity. Calcif Tissue Int 2015; 97:364-75. [PMID: 26139232 DOI: 10.1007/s00223-015-0031-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 06/23/2015] [Indexed: 12/26/2022]
Abstract
Childhood obesity is associated with compromised bone health. We studied bone characteristics and their determinants in obese young adults. The study included 68 subjects with early-onset severe obesity and 73 normal-weight controls. Data on physical activity (PA), diet and smoking were collected. Bone characteristics were measured using peripheral QCT. The obese and control subjects were similar in age (mean 19.6 ± 2.6 years) and height but BMIs differed (39.7 and 22.6 kg/m(2)). A clustering of unhealthy lifestyles was marked: Obese subjects reported less supervised PA in childhood, adolescence and currently (p < 0.03) and were more likely to smoke (p = 0.005), and had a lower healthy eating index (HEI) (p = 0.007) but similar alcohol consumption compared with controls. In obese women, all crude bone characteristics were higher than in controls; in men, the differences were smaller. Associations of lifestyle factors with bone characteristics were tested using partial correlations. Independently of BMI, supervised PA in adolescence and alcohol consumption were related positively to bone characteristics in both groups. HEI associated positively with bone characteristics only in controls, while smoking was a positive determinant of bone characteristics only in obese subjects. The multivariate model showed that the contribution of lifestyle factors to bone characteristics was minimal compared with BMI. Early-onset obesity is accompanied by poor dietary quality, sedentary lifestyle, and more frequent smoking, but the overall contribution of these lifestyle factors to bone strength is limited. Bone strength is more likely to be compromised in men and in unloaded bone sites in subjects with early-onset severe obesity. The impact of obesity-related endocrine changes on bone characteristics need to be evaluated in future studies.
Collapse
Affiliation(s)
- H T Viljakainen
- Children's Hospital, Helsinki University Central Hospital, University of Helsinki, Biomedicum Helsinki 2, P.O.Box 705, 00029, Helsinki, Finland.
| | - H Valta
- Children's Hospital, Helsinki University Central Hospital, University of Helsinki, Biomedicum Helsinki 2, P.O.Box 705, 00029, Helsinki, Finland
| | - M Lipsanen-Nyman
- Children's Hospital, Helsinki University Central Hospital, University of Helsinki, Biomedicum Helsinki 2, P.O.Box 705, 00029, Helsinki, Finland
| | - T Saukkonen
- Children's Hospital, Helsinki University Central Hospital, University of Helsinki, Biomedicum Helsinki 2, P.O.Box 705, 00029, Helsinki, Finland
- Novo Nordisk Pharma Oy, Espoo, Finland
| | - E Kajantie
- Children's Hospital, Helsinki University Central Hospital, University of Helsinki, Biomedicum Helsinki 2, P.O.Box 705, 00029, Helsinki, Finland
- Diabetes Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland
- Department of Obstetrics and Gynecology, MRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - S Andersson
- Children's Hospital, Helsinki University Central Hospital, University of Helsinki, Biomedicum Helsinki 2, P.O.Box 705, 00029, Helsinki, Finland
| | - O Mäkitie
- Children's Hospital, Helsinki University Central Hospital, University of Helsinki, Biomedicum Helsinki 2, P.O.Box 705, 00029, Helsinki, Finland
- Folkhälsan Research Center, Helsinki, Finland
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
35
|
Freychet C, Bacchetta J. Troubles du comportement alimentaire : pensons à l’ostéoprotection ! Arch Pediatr 2015; 22:571-3. [DOI: 10.1016/j.arcped.2015.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 03/20/2015] [Indexed: 10/23/2022]
|
36
|
Roggen I, Roelants M, Sioen I, Vandewalle S, De Henauw S, Goemaere S, Kaufman JM, De Schepper J. Pediatric reference values for tibial trabecular bone mineral density and bone geometry parameters using peripheral quantitative computed tomography. Calcif Tissue Int 2015; 96:527-33. [PMID: 25837845 DOI: 10.1007/s00223-015-9988-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 03/21/2015] [Indexed: 10/23/2022]
Abstract
The purpose of this study was to establish reference data, in relation to age and body height, for tibial trabecular and cortical volumetric bone mineral density, bone mineral content, and cross-sectional bone geometry in healthy children and adolescents using peripheral quantitative computed tomography (pQCT). Over a 2-year period, 432 (207 male and 225 female) healthy children, with an age range of 5 to 19 years, from 6 different geographic areas in Belgium were recruited. Multislice pQCT scanning (XCT2000(®), Stratec Medizintechnik, Pforzheim, Germany) was performed at the distal metaphysis (at the 4% site) and the distal diaphysis (14 and 38% sites) of the tibia of the dominant leg. Gender-specific centile curves in relation to age and body height were generated with the LMS method for total and trabecular volumetric bone mineral density (at 4% site), bone mineral content, total bone cross-sectional area, periosteal circumference (all at 4, 14, and 38% site), cortical volumetric bone mineral density, endosteal circumference, and cortical thickness (at the 14 and the 38% site). These centile curves can be used for the interpretation of pQCT results at the 4, 14, and 38% site of the tibia in European children and adolescents, at least when a similar methodology is used.
Collapse
Affiliation(s)
- Inge Roggen
- Department of Pediatrics, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | | | | | | | | | | | | | | |
Collapse
|
37
|
Gajewska J, Klemarczyk W, Ambroszkiewicz J, Szamotulska K, Chełchowska M, Weker H. Associations between IGF-I, IGF-binding proteins and bone turnover markers in prepubertal obese children. J Pediatr Endocrinol Metab 2015; 28:563-9. [PMID: 25719298 DOI: 10.1515/jpem-2014-0326] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 12/17/2014] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess the relationships between components of the growth hormone axis, body composition, and bone markers in obese children. METHODS We determined the levels of bone alkaline phosphatase (BALP), C-terminal telopeptide of type I collagen (CTX-I), insulin-like growth factor-I (IGF-I), and IGF-binding proteins (IGFBPs) by immunoenzymatic methods, and body composition by dual-energy X-ray absorptiometry in 45 obese and 20 non-obese children. RESULTS IGF-I and functional IGFBP-3 levels, IGF-I/total IGFBP-3, and functional IGFBP-3/total IGFBP-3 molar ratios were significantly higher in obese patients than in controls. Multivariate regression analysis in obese patients showed significant associations of BALP with IGF-I (p=0.047) and percent of body fat mass (p=0.002). CONCLUSION The relationship of IGF-I and functional IGFBP-3 to BALP may support the concept of IGF-I influence on accelerated bone formation process in obesity. Moreover, IGF-I and percentage of body fat mass may be significant predictors of BALP in obese during the prepubertal period.
Collapse
|
38
|
Leonard MB, Zemel BS, Wrotniak BH, Klieger SB, Shults J, Stallings VA, Stettler N. Tibia and radius bone geometry and volumetric density in obese compared to non-obese adolescents. Bone 2015; 73:69-76. [PMID: 25497572 PMCID: PMC4540475 DOI: 10.1016/j.bone.2014.12.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 10/27/2014] [Accepted: 12/03/2014] [Indexed: 11/23/2022]
Abstract
Childhood obesity is associated with biologic and behavioral characteristics that may impact bone mineral density (BMD) and structure. The objective was to determine the association between obesity and bone outcomes, independent of sexual and skeletal maturity, muscle area and strength, physical activity, calcium intake, biomarkers of inflammation, and vitamin D status. Tibia and radius peripheral quantitative CT scans were obtained in 91 obese (BMI>97th percentile) and 51 non-obese adolescents (BMI>5th and <85th percentiles). Results were converted to sex- and race-specific Z-scores relative to age. Cortical structure, muscle area and muscle strength (by dynamometry) Z-scores were further adjusted for bone length. Obese participants had greater height Z-scores (p<0.001), and advanced skeletal maturity (p<0.0001), compared with non-obese participants. Tibia cortical section modulus and calf muscle area Z-scores were greater in obese participants (1.07 and 1.63, respectively, both p<0.0001). Tibia and radius trabecular and cortical volumetric BMD did not differ significantly between groups. Calf muscle area and strength Z-scores, advanced skeletal maturity, and physical activity (by accelerometry) were positively associated with tibia cortical section modulus Z-scores (all p<0.01). Adjustment for muscle area Z-score attenuated differences in tibia section modulus Z-scores between obese and non-obese participants from 1.07 to 0.28. After multivariate adjustment for greater calf muscle area and strength Z-scores, advanced maturity, and less moderate to vigorous physical activity, tibia section modulus Z-scores were 0.32 (95% CI -0.18, 0.43, p=0.06) greater in obese, vs. non-obese participants. Radius cortical section modulus Z-scores were 0.45 greater (p=0.08) in obese vs. non-obese participants; this difference was attenuated to 0.14 with adjustment for advanced maturity. These findings suggest that greater tibia cortical section modulus in obese adolescents is attributable to advanced skeletal maturation and greater muscle area and strength, while less moderate to vigorous physical activities offset the positive effects of these covariates. The impact of obesity on cortical structure was greater at weight bearing sites.
Collapse
Affiliation(s)
- Mary B Leonard
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, USA.
| | - Babette S Zemel
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Brian H Wrotniak
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Physical Therapy, D'Youville College, Buffalo, NY, USA
| | - Sarah B Klieger
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Justine Shults
- Department of Physical Therapy, D'Youville College, Buffalo, NY, USA
| | - Virginia A Stallings
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | |
Collapse
|
39
|
Dimitri P, Jacques RM, Paggiosi M, King D, Walsh J, Taylor ZA, Frangi AF, Bishop N, Eastell R. Leptin may play a role in bone microstructural alterations in obese children. J Clin Endocrinol Metab 2015; 100:594-602. [PMID: 25412414 PMCID: PMC4318898 DOI: 10.1210/jc.2014-3199] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Bone mass is low and fracture risk is higher in obese children. Hormonal changes in relation to skeletal microstructure and biomechanics have not been studied in obese children. OBJECTIVE The objective of the study was to ascertain the relationships of obesity-related changes in hormones with skeletal microstructure and biomechanics. DESIGN High resolution peripheral quantitative computed tomography (HR-pQCT) was used to compare three-dimensional cortical and trabecular microstructure and biomechanics at load-bearing and nonload bearing sites in obese and lean children. The relationship between leptin, adiponectin, testosterone, estrogen, osteocalcin and sclerostin and skeletal microstructure was also determined. SETTING The study was conducted at a tertiary pediatric endocrine unit in the United Kingdom. PARTICIPANTS Obese and lean children were matched by gender and pubertal stage. RESULTS Radial cortical porosity (mean difference -0.01 [95% CI: -0.02, -0.004], P = .003) and cortical pore diameter (mean difference -0.005 mm [95% CI: -0.009, -0.001], P = .011) were lower in obese children. Tibial trabecular thickness was lower (mean difference -0.009 mm [95% CI: -0.014, -0.004], P = .003), and trabecular number was higher (mean difference 0.23 mm(-1) [95% CI: 0.08, 0.38], P = .004) in obese children. At the radius, fat mass percentage negatively correlated with cortical porosity (r = -0.57, P < .001) and pore diameter (r = -0.38, P = .02) and negatively correlated with trabecular thickness (r = -0.62, P < .001) and trabecular von Mises stress (r = -0.39, P = .019) at the tibia. No difference was observed in the other biomechanical parameters of the radius and tibia. Leptin was higher in obese children (805.3 ± 440.6 pg/ml vs 98.1 ± 75.4 pg/ml, P < .001) and was inversely related to radial cortical porosity (r = 0.60, 95% CI: [-0.80, -0.30], P < .001), radial cortical pore diameter (r = 0.51, 95% CI [-0.75, -0.16], P = .002), tibial trabecular thickness (r = 0.55, 95% CI: [-0.78, -0.21], P = .001) and tibial trabecular von Mises stress (r = -0.39, 95% CI: -0.65, 0.04, P = .02). CONCLUSION Childhood obesity alters radial and tibial microstructure. Leptin may direct these changes. Despite this, the biomechanical properties of the radius and tibia do not adapt sufficiently in obese children to withstand the increased loading potential from a fall. This may explain the higher incidence of fracture in obese children.
Collapse
Affiliation(s)
- P Dimitri
- Department of Paediatric Endocrinology (P.D., D.K.), Sheffield Children's NHS Foundation Trust, Sheffield, S10 2TH, United Kingdom; School of Health and Related Research (R.M.J.), The Mellanby Centre for Bone Research (M.P., J.W., N.B., R.E.), Academic Unit of Bone Metabolism, and Centre for Computational Imaging and Simulation Technologies in Biomedicine, Department of Mechanical Engineering (Z.A.T., A.F.F.), University of Sheffield, Sheffield, S10 2TN, United Kingdom
| | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Abstract
Osteoporosis, a musculoskeletal disease characterized by decreased bone mineral density (BMD) and an increased risk of fragility fractures, is now recognized as an important public health problem in men. Osteoporotic fractures, particularly of the hip, result in significant morbidity and mortality in men and lead to considerable societal costs. Many national and international organizations now address screening and treatment for men in their osteoporosis clinical guidelines. However, male osteoporosis remains largely underdiagnosed and undertreated. The objective of this paper is to provide an overview of recent findings in male osteoporosis, including pathophysiology, epidemiology, and incidence and burden of fracture, and discuss current knowledge about the evaluation and treatment of osteoporosis in males. In particular, clinical practice guidelines, fracture risk assessment, and evidence of treatment effectiveness in men are addressed.
Collapse
Affiliation(s)
- Tina Willson
- University of Utah College of Pharmacy, Salt Lake City, UT, USA
- Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA
| | - Scott D Nelson
- University of Utah College of Pharmacy, Salt Lake City, UT, USA
- Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA
| | | | - Richard E Nelson
- Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Joanne LaFleur
- University of Utah College of Pharmacy, Salt Lake City, UT, USA
- Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA
| |
Collapse
|
41
|
Abstract
Before the characterization of human and animal models of estrogen deficiency, estrogen action was confined in the context of the female bone. These interesting models uncovered a wide spectrum of unexpected estrogen actions on bone in males, allowing the formulation of an estrogen-centric theory useful to explain how sex steroids act on bone in men. Most of the principal physiological events that take place in the developing and mature male bone are now considered to be under the control of estrogen. Estrogen determines the acceleration of bone elongation at puberty, epiphyseal closure, harmonic skeletal proportions, the achievement of peak bone mass, and the maintenance of bone mass. Furthermore, it seems to crosstalk with androgen even in the determination of bone size, a more androgen-dependent phenomenon. At puberty, epiphyseal closure and growth arrest occur when a critical number of estrogens is reached. The same mechanism based on a critical threshold of serum estradiol seems to operate in men during adulthood for bone mass maintenance via the modulation of bone formation and resorption in men. This threshold should be better identified in-between the ranges of 15 and 25 pg/mL. Future basic and clinical research will optimize strategies for the management of bone diseases related to estrogen deficiency in men.
Collapse
Affiliation(s)
- Vincenzo Rochira
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via P. Giardini 1355, 41126 Modena, Italy
- Azienda USL di Modena, Nuovo Ospedale Civile Sant'Agostino Estense (NOCSAE), Via P. Giardini 1355, 41126 Modena, Italy
- *Vincenzo Rochira:
| | - Elda Kara
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via P. Giardini 1355, 41126 Modena, Italy
| | - Cesare Carani
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via P. Giardini 1355, 41126 Modena, Italy
| |
Collapse
|
42
|
Zhang J, Jin Y, Xu S, Zheng J, Zhang Q, Chen J, Huang Y, Shao H, Yang D, Ying Q. Associations of fat mass and fat distribution with bone mineral density in Chinese obese population. J Clin Densitom 2015; 18:44-9. [PMID: 24815308 DOI: 10.1016/j.jocd.2014.03.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 03/26/2014] [Indexed: 12/12/2022]
Abstract
The purpose of the study was to investigate the associations of fat mass (FM) and fat distribution with bone mineral density (BMD) in Chinese obese population. Three hundred and forty-seven Chinese obese females and 339 males aged 20-39 years were analyzed. Lean mass (LM), FM, percent body fat (%BF), android FM, gynoid FM, and total and regional BMD were measured using dual-energy X-ray absorptiometry. Fat distribution was assessed by android-to-gynoid FM ratio (AOI). As a result, increased central body fat had an inverse association with total and leg BMD in females but not in males. Increased FM and %BF were positively associated with arm, trunk, and pelvic BMD in Chinese obese females. Increased FM was positively associated with total, rib, and trunk BMD in Chinese obese males. The results remained almost unchanged after adjusting for LM, and LM was significantly positively associated with spine BMD in female group. FM was positively associated with trunk BMD in male group after adjusting for LM. AOI was inversely associated with total and leg BMD, and %BF was positively associated with arm, trunk, and pelvic BMD when replacing FM with %BF in female group. The results remained almost unchanged after adjusting for LM. There is no significant association in male group when replacing FM with %BF. In conclusion, our findings demonstrate that there are different associations of FM and fat distribution with BMD, and AOI has a negative association with BMD.
Collapse
Affiliation(s)
- Jun Zhang
- Department of Orthopedics, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China
| | - Yongming Jin
- Department of Orthopedics, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China
| | - Shaonan Xu
- Department of Orthopedics, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China
| | - Jiayin Zheng
- Department of Probability and Statistics, School of Mathematical Sciences, Peking University, Beijing, China
| | - Qi Zhang
- Department of Surgery, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China
| | - Jinping Chen
- Department of Orthopedics, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China
| | - Yazeng Huang
- Department of Orthopedics, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China
| | - Haiyu Shao
- Department of Orthopedics, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China
| | - Di Yang
- Department of Orthopedics, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China
| | - Qifeng Ying
- Department of Dual Energy X-ray Absorptiometry (DEXA), Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China.
| |
Collapse
|
43
|
Farr JN, Amin S, LeBrasseur NK, Atkinson EJ, Achenbach SJ, McCready LK, Joseph Melton L, Khosla S. Body composition during childhood and adolescence: relations to bone strength and microstructure. J Clin Endocrinol Metab 2014; 99:4641-8. [PMID: 25243571 PMCID: PMC4255129 DOI: 10.1210/jc.2014-1113] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
CONTEXT Numerous studies have examined the association of body composition with bone development in children and adolescents, but none have used micro-finite element (μFE) analysis of high-resolution peripheral quantitative computed tomography images to assess bone strength. OBJECTIVE This study sought to examine the relations of appendicular lean mass (ALM) and total body fat mass (TBFM) to bone strength (failure load) at the distal radius and tibia. DESIGN, PARTICIPANTS, AND SETTING This was a cross-sectional study of 198 healthy 8- to <15-year-old boys (n = 109) and girls (n = 89) performed in a Clinical Research Unit. RESULTS After adjusting for bone age, height, fracture history, ALM, and TBFM, multiple linear regression analyses in boys and girls, separately, showed robust positive associations between ALM and failure loads at both the distal radius (boys: β = 0.92, P < .001; girls: β = 0.66, P = .001) and tibia (boys: β = 0.96, P < .001; girls: β = 0.66, P < .001). By contrast, in both boys and girls the relationship between TBFM and failure load at the distal radius was virtually nonexistent (boys: β = -0.07; P = .284; girls: β = -0.03; P = .729). At the distal tibia, positive, albeit weak, associations were observed between TBFM and failure load in both boys (β = 0.09, P = .075) and girls (β = 0.17, P = .033). CONCLUSIONS Our data highlight the importance of lean mass for optimizing bone strength during growth, and suggest that fat mass may have differential relations to bone strength at weight-bearing vs non-weight-bearing sites in children and adolescents. These observations suggest that the strength of the distal radius does not commensurately increase with excess gains in adiposity during growth, which may result in a mismatch between bone strength and the load experienced by the distal forearm during a fall. These findings may explain, in part, why obese children are over-represented among distal forearm fracture cases.
Collapse
Affiliation(s)
- Joshua N Farr
- Division of Endocrinology, Department of Medicine (J.N.F., L.K.M., S.K.); Division of Epidemiology, Department of Health Sciences Research (S.A., L.J.M.); Division of Rheumatology, Department of Medicine (S.A.); Department of Physical Medicine and Rehabilitation (N.K.L); and Division of Biomedical Statistics and Informatics, Department of Health Sciences Research (E.J.A., S.J.A.); Mayo Clinic College of Medicine, Rochester, Minnesota, 55905
| | | | | | | | | | | | | | | |
Collapse
|
44
|
Vandewalle S, Taes Y, Fiers T, Toye K, Van Caenegem E, Kaufman JM, De Schepper J. Relation of adrenal-derived steroids with bone maturation, mineral density and geometry in healthy prepubertal and early pubertal boys. Bone 2014; 69:39-46. [PMID: 25220426 DOI: 10.1016/j.bone.2014.09.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 09/01/2014] [Accepted: 09/02/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND Little is known about the effects of adrenal steroids on skeletal maturation and bone mass acquisition in healthy prepubertal boys. OBJECTIVE To study whether adrenal-derived steroids within the physiological range are associated with skeletal maturation, areal and volumetric bone mineral density (aBMD and vBMD) and bone geometry in healthy prepubertal and early pubertal boys. METHODS 98 healthy prepubertal and early pubertal boys (aged 6-14 y) were studied cross-sectionally. Androstenedione (A) and estrone (E1) were determined by liquid chromatography tandem mass spectrometry and DHEAS was determined by immunoassay. Whole body and lumbar spine aBMD and bone area were determined by dual-energy X-ray absorptiometry. Trabecular (distal site) and cortical (proximal site) vBMD and bone geometry were assessed at the non-dominant forearm and leg using peripheral QCT. Skeletal age was determined by X-ray of the left hand. RESULTS Adrenal-derived steroids (DHEAS, A and E1) are positively associated with bone age in prepubertal and early pubertal children, independently of age. There are no associations between the adrenal-derived steroids and the studied parameters of bone size (lumbar spine and whole body bone area, trabecular or cortical area at the radius or tibia, periosteal circumference and cortical thickness at the radius or tibia) or BMD (aBMD or vBMD). CONCLUSION In healthy prepubertal and early pubertal boys, serum adrenal-derived steroid levels, are associated with skeletal maturation, independently of age, but not with bone size or (v)BMD. Our data suggest that adrenal derived steroids are not implicated in the accretion of bone mass before puberty in boys.
Collapse
Affiliation(s)
- S Vandewalle
- Department of Endocrinology, Ghent University Hospital, Belgium; Unit for Osteoporosis and Metabolic Bone Diseases, Ghent University Hospital, Belgium; Department of Pediatric Endocrinology, Ghent University Hospital, Belgium.
| | - Y Taes
- Department of Endocrinology, Ghent University Hospital, Belgium; Unit for Osteoporosis and Metabolic Bone Diseases, Ghent University Hospital, Belgium
| | - T Fiers
- Department of Hormonology, Ghent University Hospital, Belgium
| | - K Toye
- Department of Endocrinology, Ghent University Hospital, Belgium; Unit for Osteoporosis and Metabolic Bone Diseases, Ghent University Hospital, Belgium
| | - E Van Caenegem
- Department of Endocrinology, Ghent University Hospital, Belgium; Unit for Osteoporosis and Metabolic Bone Diseases, Ghent University Hospital, Belgium
| | - J-M Kaufman
- Department of Endocrinology, Ghent University Hospital, Belgium; Unit for Osteoporosis and Metabolic Bone Diseases, Ghent University Hospital, Belgium
| | - J De Schepper
- Department of Endocrinology, Ghent University Hospital, Belgium; Department of Pediatric Endocrinology, Ghent University Hospital, Belgium; Department of Pediatric Endocrinology, Brussels University Hospital, Belgium
| |
Collapse
|
45
|
Vaitkeviciute D, Lätt E, Mäestu J, Jürimäe T, Saar M, Purge P, Maasalu K, Jürimäe J. Physical activity and bone mineral accrual in boys with different body mass parameters during puberty: a longitudinal study. PLoS One 2014; 9:e107759. [PMID: 25279833 PMCID: PMC4184811 DOI: 10.1371/journal.pone.0107759] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 08/14/2014] [Indexed: 11/27/2022] Open
Abstract
The aim of our longitudinal study was to investigate the relationships between physical activity and bone mass in boys with different body mass status during the years surrounding pubertal growth spurt. Two hundred and six boys entering puberty took part in this study. The subjects were divided into underweight (BMI < 15.35), normal weight (BMI ≥ 15.35-21.22), overweight (BMI ≥ 21.22-26.02) and obese (BMI > 26.02) groups at baseline according to age related categories. Whole-body DXA scans were performed at baseline, after 12 and 24 months to assess body composition (lean body mass, fat mass), and total body (TB), lumbar spine (LS) and femoral neck (FN) bone mineral density (BMD) parameters. Physical activity was measured by 7-day accelerometry. For longitudinal analysis, multilevel fixed effects regression models were constructed. Biological age, height and lean body mass had an effect for explanation of TB BMD, FN BMD and LS BMD. Moderate to vigorous physical activity (MVPA), vigorous physical activity (VPA) and sedentary time (SED) had the significant effect only on FN BMD. Being an underweight boy at the baseline indicated greater chance (p<0.01) to have lower TB BMD in the future (2 years at follow up) development, compared to normal weight (estimates = -0.038), overweight (estimates = -0.061) and obese boys (estimates = -0.106).
Collapse
Affiliation(s)
- Donvina Vaitkeviciute
- Institute of Sport Pedagogy and Coaching Sciences, Faculty of Exercise and Sport Sciences, Centre of Behavioral, Social and Health Sciences, University of Tartu, Tartu, Estonia
| | - Evelin Lätt
- Institute of Sport Pedagogy and Coaching Sciences, Faculty of Exercise and Sport Sciences, Centre of Behavioral, Social and Health Sciences, University of Tartu, Tartu, Estonia
| | - Jarek Mäestu
- Institute of Sport Pedagogy and Coaching Sciences, Faculty of Exercise and Sport Sciences, Centre of Behavioral, Social and Health Sciences, University of Tartu, Tartu, Estonia
| | - Toivo Jürimäe
- Institute of Sport Pedagogy and Coaching Sciences, Faculty of Exercise and Sport Sciences, Centre of Behavioral, Social and Health Sciences, University of Tartu, Tartu, Estonia
| | - Meeli Saar
- Institute of Sport Pedagogy and Coaching Sciences, Faculty of Exercise and Sport Sciences, Centre of Behavioral, Social and Health Sciences, University of Tartu, Tartu, Estonia
| | - Priit Purge
- Institute of Sport Pedagogy and Coaching Sciences, Faculty of Exercise and Sport Sciences, Centre of Behavioral, Social and Health Sciences, University of Tartu, Tartu, Estonia
| | - Katre Maasalu
- Department of Traumatology and Orthopedics, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - Jaak Jürimäe
- Institute of Sport Pedagogy and Coaching Sciences, Faculty of Exercise and Sport Sciences, Centre of Behavioral, Social and Health Sciences, University of Tartu, Tartu, Estonia
| |
Collapse
|
46
|
Abstract
PURPOSE OF REVIEW Despite evidence that energy deficit produces multiple physiological and metabolic benefits, clinicians are often reluctant to prescribe weight loss in older individuals or those with low bone mineral density (BMD), fearing BMD will be decreased. Confusion exists concerning the effects that weight loss has on bone health. RECENT FINDINGS Bone density is more closely associated with lean mass than total body mass and fat mass. Although rapid or large weight loss is often associated with loss of bone density, slower or smaller weight loss is much less apt to adversely affect BMD, especially when it is accompanied with high intensity resistance and/or impact loading training. Maintenance of calcium and vitamin D intake seems to positively affect BMD during weight loss. Although dual energy X-ray absorptiometry is normally used to evaluate bone density, it may overestimate BMD loss following massive weight loss. Volumetric quantitative computed tomography may be more accurate for tracking bone density changes following large weight loss. SUMMARY Moderate weight loss does not necessarily compromise bone health, especially when exercise training is involved. Training strategies that include heavy resistance training and high impact loading that occur with jump training may be especially productive in maintaining, or even increasing bone density with weight loss.
Collapse
Affiliation(s)
- Gary R Hunter
- Division of Kinesiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | | |
Collapse
|
47
|
Abstract
Skeletal health is modulated by a variety of factors, including genetic makeup, hormonal axes, and environment. Across all ages, extremes of body weight may exert a deleterious effect on bone accretion and increase fracture risk. The incidence of both anorexia nervosa and obesity, each involving extreme alterations in body composition, is rising among youth, and secondary osteoporosis is increasingly being diagnosed among affected children and adolescents. Compared with the elderly, the definition of osteoporosis that stems from any underlying condition differs for the pediatric population and special precautions are required with regard to treatment of young patients. Early recognition and management of both underweight and overweight youth and the accompanying consequences on bone and mineral metabolism are essential for preservation of skeletal health, although prevention of bone loss and optimization of bone mineral accrual remain the most important protective measures.
Collapse
Affiliation(s)
- Shara R Bialo
- Division of Pediatric Endocrinology, Hasbro Children's Hospital/Alpert Medical School of Brown University, 593 Eddy Street, MPSII, Providence, RI, 02903, USA,
| | | |
Collapse
|
48
|
Vandewalle S, Taes Y, Fiers T, Toye K, Van Caenegem E, Roggen I, De Schepper J, Kaufman JM. Associations of sex steroids with bone maturation, bone mineral density, bone geometry, and body composition: a cross-sectional study in healthy male adolescents. J Clin Endocrinol Metab 2014; 99:E1272-82. [PMID: 24670081 DOI: 10.1210/jc.2013-3887] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Although both testosterone (T) and estradiol (E2) are considered essential in the regulation of the male skeleton, there are few data concerning the relative contribution of T and E2 on bone mineral density (BMD), bone geometry, and bone maturation in healthy boys. OBJECTIVE The objective of the study was to analyze the relationship between T and E2 and BMD, bone geometry, skeletal maturation, and body composition. METHODS This is a cross-sectional study in 199 healthy boys (aged 6-19 y). T and E2 were determined by liquid chromatography tandem mass spectrometry. Whole-body and lumbar areal bone mineral density (aBMD) and bone area, lean mass, and fat mass were determined by dual-energy X-ray absorptiometry. Trabecular (distal site) and cortical (proximal site) volumetric BMD (vBMD) and bone geometry were assessed at the nondominant forearm and leg using peripheral quantitative computed tomography. Skeletal age was determined by an X-ray of the left hand. RESULTS T was positively associated with lean mass (P < .001), lumbar and whole-body bone area (P < .001), trabecular and cortical area (P < .01), and periosteal circumference (P < .01) at the radius. E2 was positively associated with lumbar and whole-body aBMD (P < .001), trabecular vBMD at the radius and tibia (P < .01), and cortical thickness at the radius (P < .05). E2 was an independent negative predictor of the endosteal circumference (P < .01). Moreover, E2 was positively associated with bone age advancement (P < .001). CONCLUSION Circulating E2 is positively associated with bone maturation and aBMD and vBMD and negatively with endosteal circumference in healthy boys, whereas T is a determinant of lean mass and bone size. These findings underscore the important role of E2 in skeletal development in boys.
Collapse
Affiliation(s)
- S Vandewalle
- Departments of Endocrinology (S.V., Y.T., K.T., E.V.C., J.D.S., J.-M.K.), Pediatric Endocrinology (S.V., J.D.S.), and Hormonology (T.F.) and Unit for Osteoporosis and Metabolic Bone Diseases (S.V., Y.T., K.T., E.V.C., J.-M.K.), Ghent University Hospital, 9000 Ghent, Belgium; and Department of Pediatric Endocrinology (I.R., J.D.S.), Brussel University Hospital, 1090 Brussels, Belgium
| | | | | | | | | | | | | | | |
Collapse
|