Size-corrected BMD decreases during peak linear growth: Implications for fracture incidence during adolescence

Faulkner, Robert A., Davison, K. Shawn, Bailey, Donald A., Mirwald, Robert L. and Baxter-Jones, Adam D. G. (2006) Size-corrected BMD decreases during peak linear growth: Implications for fracture incidence during adolescence. Journal of Bone And Mineral Research, 21 12: 1864-1870. doi:10.1359/JBMR.060907

Author Faulkner, Robert A.
Davison, K. Shawn
Bailey, Donald A.
Mirwald, Robert L.
Baxter-Jones, Adam D. G.
Title Size-corrected BMD decreases during peak linear growth: Implications for fracture incidence during adolescence
Journal name Journal of Bone And Mineral Research   Check publisher's open access policy
ISSN 0884-0431
Publication date 2006-12-01
Sub-type Article (original research)
DOI 10.1359/JBMR.060907
Open Access Status Not Open Access
Volume 21
Issue 12
Start page 1864
End page 1870
Total pages 7
Editor J. A. Eisman
Place of publication Washington, D. C., U. S. A.
Publisher American Society for Bone and Mineral Research
Language eng
Subject C1
730204 Child health
321017 Orthopaedics
321019 Paediatrics
730114 Skeletal system and disorders (incl. arthritis)
Abstract Peak adolescent fracture incidence at the distal end of the radius coincides with a decline in size-corrected BMD in both boys and girls. Peak gains in bone area preceded peak gains in BMC in a longitudinal sample of boys and girls, supporting the theory that the dissociation between skeletal expansion and skeletal mineralization results in a period of relative bone weakness. Introduction: The high incidence of fracture in adolescence may be related to a period of relative skeletal fragility resulting from dissociation between bone expansion and bone mineralization during the growing years. The aim of this study was to examine the relationship between changes in size-corrected BMD (BMDsc) and peak distal radius fracture incidence in boys and girls. Materials and Methods: Subjects were 41 boys and 46 girls measured annually (DXA; Hologic 2000) over the adolescent growth period and again in young adulthood. Ages of peak height velocity (PHV), peak BMC velocity (PBMCV), and peak bone area (BA) velocity (PBAV) were determined for each child. To control for maturational differences, subjects were aligned on PHV. BMDsc was calculated by first regressing the natural logarithms of BMC and BA. The power coefficient (pc) values from this analysis were used as follows: BMDsc = BMC/BA(pc). Results: BMDsc decreased significantly before the age of PHV and then increased until 4 years after PHV. The peak rates in radial fractures (reported from previous work) in both boys and girls coincided with the age of negative velocity in BMDsc; the age of peak BA velocity (PBAV) preceded the age of peak BMC velocity (PBMCV) by 0.5 years in both boys and girls. Conclusions: There is a clear dissociation between PBMCV and PBAV in boys and girls. BMDsc declines before age of PHV before rebounding after PHV. The timing of these events coincides directly with reported fracture rates of the distal end of the radius. Thus, the results support the theory that there is a period of relative skeletal weakness during the adolescent growth period caused, in part, by a draw on cortical bone to meet the mineral demands of the expanding skeleton resulting in a temporary increased fracture risk.
Keyword Children
Bmd Size Correction
Endocrinology & Metabolism
X-ray Absorptiometry
Bone-mineral Density
Lumbar Spine
Q-Index Code C1

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Created: Wed, 15 Aug 2007, 19:47:29 EST