Original Full Length ArticleLongitudinal changes in lean mass predict pQCT measures of tibial geometry and mineralisation at 6–7 years
Introduction
Bone mineral accrual and bone geometry are important determinants of long term osteoporosis and fracture risk. Mathematical modelling has suggested that a 10% increase in peak bone mass will delay the onset of osteoporosis by 13 years [1]. Thus, understanding factors that influence bone mineral accrual during childhood may inform novel approaches to fracture prevention. It is well recognised that genotype, physical activity, nutrition and chronic disease in childhood and adolescence all contribute to bone development. These factors may have a direct influence on bone, or act indirectly through effects on linear growth and body composition. Indeed, we have previously demonstrated that growth in height in early childhood is associated with skeletal size, mineralisation [2], [3] and geometry [4]. Furthermore, these associations appear to persist into adulthood: in a UK cohort, pre-pubertal height gain velocity was positively associated with bone cross-sectional area and strength–strain index of the radius, assessed by peripheral quantitative computed tomography (pQCT) at 60–64 years [5]. How such relationships between bone development and overall growth relate to changes in body compartments (lean and fat mass) remains to be elucidated. Cross-sectional studies that have assessed associations between fat mass (FM) and bone mineral content (BMC) or areal bone mineral density (aBMD) measured by DXA have found conflicting results: positive [6], [7], [8], [9], [10], negative [8], [11] and non-significant [9] relationships have been reported, whilst some suggest that the relationships differ by sex [8], [9], [12] and stage of pubertal development [8], [13]. Associations described between FM and bone geometry assessed by pQCT in children have also been inconsistent [13], [14], [15], [16]. Similar to the findings of the cross-sectional studies, many of the observed associations between longitudinal changes in body composition and bone development varied by sex, age and pubertal status [13], suggesting that the timing, rate and extent of changes in body composition might be important for bone mineral accrual and geometric development. In this study, we therefore aimed to evaluate relationships between changes in body composition in infancy and early childhood, and bone geometry and volumetric BMD (vBMD) assessed by pQCT in a cohort of pre-pubertal children participating in the Southampton Women's Survey (SWS).
Section snippets
The Southampton Women's Survey
Details of the Southampton Women's Survey (SWS) have been published previously [17], but briefly, the SWS is a study of 12583, initially non-pregnant, women aged 20–34 years, resident in the city of Southampton, UK. Assessments of lifestyle, sociodemographic factors and anthropometry were performed at study entry (April 1998–December 2002), and women who subsequently became pregnant were followed in detail throughout their pregnancy.
The SWS was conducted according to the guidelines laid down in
Results
A total of 227 children had DXA at birth and 6–7 years in addition to pQCT of the tibia at 6–7 years, but 27 were not included in the analysis due to movement artefact on the 6–7 year DXA scan. Six (3.0%) scans at the 4% tibia and 41 (20.5%) at the 38% tibia had to be excluded from the analysis due to movement artefact. The children with and without scans at the 4% and 38% sites did not differ in sex, age, height, weight, LM or FM at 6–7 years (p > 0.05 for all).
Children included in this analysis
Discussion
To our knowledge, this is the first study to describe relationships between longitudinal changes in body composition from birth and bone development assessed by pQCT in pre-pubertal children. Our findings suggest that in infancy and early childhood, gains in lean mass are positively associated with tibial bone size and trabecular vBMD at 6–7 years of age. Conversely, gains in fat mass, after adjustment for gain in LM, was not significantly associated with tibial geometry. There were no
Disclosures
KMG has acted as a consultant to Abbott Nutrition and Nestle Nutrition and has received reimbursement for speaking at an Abbott Nutrition Conference on Pregnancy Nutrition and Later Health Outcomes, at a Nestle Nutrition Institute Workshop and at a workshop funded by the International Life Sciences Institute (ILSI Europe). He is part of an academic consortium that has received research funding from Abbott Nutrition, Nestec and Danone.
Acknowledgements
We thank the mothers who gave us their time and a team of dedicated research nurses and ancillary staff for their assistance. This work was supported by grants from the Medical Research Council, British Heart Foundation, Arthritis Research UK, National Osteoporosis Society, International Osteoporosis Foundation, Cohen Trust, NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, and NIHR Musculoskeletal Biomedical
References (29)
- et al.
Adiposity and TV viewing are related to less bone accrual in young children
J Pediatr
(2009) - et al.
Tracking of bone mass from childhood to adolescence and factors that predict deviation from tracking
Bone
(2009) - et al.
Increased fat mass is associated with increased bone size but reduced volumetric density in pre pubertal children
Bone
(2012) - et al.
Relationship of total body fat mass to weight-bearing bone volumetric density, geometry, and strength in young girls
Bone
(2010) - et al.
Dual effect of adipose tissue on bone health during growth
Bone
(2011) - et al.
Growth in early life predicts bone strength in late adulthood: the Hertfordshire Cohort Study
Bone
(2007) - et al.
Multiplicity in randomised trials I: endpoints and treatments
Lancet
(2005) - et al.
The ‘muscle-bone unit’ during the pubertal growth spurt
Bone
(2004) - et al.
A theoretical analysis of the relative influences of peak BMD, age-related bone loss and menopause on the development of osteoporosis
Osteoporos Int
(2003) - et al.
Intrauterine growth and postnatal skeletal development: findings from the Southampton Women's Survey
Paediatr Perinat Epidemiol
(2012)
Different indices of fetal growth predict bone size and volumetric density at 4 years of age
J Bone Miner Res
Fetal and infant growth predict hip geometry at 6 y old: findings from the Southampton Women's Survey
Pediatr Res
Growth from birth to adulthood and bone phenotype in early old age: a British birth cohort study
J Bone Miner Res
Association between lean and fat mass and indicators of bone health in prepubertal Caucasian children
Horm Res Paediatr
Cited by (18)
Sarcopenia, osteoporosis and frailty
2023, Metabolism: Clinical and ExperimentalBiomechanics of immature human cortical bone: A systematic review
2022, Journal of the Mechanical Behavior of Biomedical MaterialsCitation Excerpt :Berteau et al. (2014) and Vinz (1976) report density values of 0.00185 g/cm3 in children 5-16 years and 1.85 g/cm3 in children 0–8.5 years, respectively. The apparent densities reported from pQCT data were in general agreement across the surveyed studies (Ward et al., 2005; Moyer-Mileur et al., 2008; Wang et al., 2005; Chivers et al., 2019; Duff et al., 2017; Laudermilk et al., 2012; Macdonald et al., 2006; Meiring et al., 2013; Moon et al., 2015; Vandewalle et al., 2013; Dowthwaite and Scerpella, 2011; Farr et al., 2010; Kuhn et al., 1989; Laddu et al., 2013). The range in apparent densities determined with pQCT may be associated with physiological age or body mass variation rather than chronological age.
Growth from birth to adolescence and bone mineral density in young adults: The 1993 Pelotas birth cohort
2020, BoneCitation Excerpt :The foundation of bone strength is laid in utero, and subsequent growth in infancy, childhood, and adolescence is essential for the acquisition of adult peak bone mass [8]. The increased overall exposure to weight during growth, in dose and/or duration, may positively influence bone health as a consequence of greater and/or longer exposure to loading, especially from the lean component [9]. Many studies have consistently demonstrated a positive correlation between birth weight and bone mass [8,10–15], supporting the intrauterine programming hypothesis.
Weight Trajectories from Birth and Bone Mineralization at 7 Years of Age
2017, Journal of PediatricsCitation Excerpt :Nevertheless, the results of this study should be interpreted taking into account specific limitations and methodologic options. Bone parameters were assessed by DXA which, despite being well validated and the most commonly used technique to assess bone density in children,22 does not provide a measure of true volumetric density.13 Additional limitations of DXA include the systematic overestimation of BMD as bone size increases and the partial artefactual increase of aBMD with weight, due to effect of fat on radiograph absorption.
- 1
SWS Study Group: P. Taylor, M. Hanson.