Osteoporosis International

, Volume 15, Issue 4, pp 263–273 | Cite as

Attainment of peak bone mass at the lumbar spine, femoral neck and radius in men and women: relative contributions of bone size and volumetric bone mineral density

  • Yvette M. Henry
  • Diana Fatayerji
  • Richard Eastell
Original Article


The age at which peak bone mineral content (peak BMC) is reached remains controversial and the mechanism underlying bone mass “consolidation” is still undefined. The aims of this study were to investigate; (1) the timing of peak BMC by studying bone size and volumetric BMD (vBMD) as separate entities and (2) to determine the relative contributions of bone size and vBMD to bone mass “consolidation”. A total of 132 healthy Caucasian children (63 boys and 69 girls, ages 11–19 years) and 134 healthy Caucasian adults (66 men and 68 women, ages 20–50 years) were studied. BMC was measured by DXA at the AP and lateral lumbar spine (LS) femoral neck (FN) and ultradistal radius (UDR). vBMD and bone volume (size) were estimated. Bone mass “consolidation” was examined between age 16 years to the age peak bone values were attained. During growth, BMC and bone size increased steeply with age and approximately 80–90% of peak values were achieved by late adolescence. vBMD at the spine and UDR (in women) increased gradually, but vBMD at the FN and UDR in men remained almost constant. During “consolidation”, bone size continued to increase with little change in vBMD. Peak vBMD at the lumbar spine was reached at 22 and 29 years in men and women, respectively, but earlier at the FN at 12 years. At the UDR peak vBMD was achieved at age 19 years in women, with little change in men. In conclusion, peak vBMD and bone size are almost fully attained during late adolescence. Although speculative, the lack of change in vBMD during consolidation implies that the continued increase in bone mass may primarily be due to increases in bone size rather than increases in either trabecular volume, cortical thickness or the degree of mineralisation of existing bone matrix (vBMD). Skeletal growth and maturation is heterogeneous, but crucial in understanding how the origins of osteoporosis may begin during childhood and young adulthood.


Bone size Consolidation Gender Growth Volumetric bone density 



We would like to thank all the staff at the Osteoporosis Centre, Sheffield and the volunteers who took part in the study.


  1. 1.
    Seeman E, Hopper JL, Bach LA, Cooper ME et al. (1989) Reduced bone mass in daughters of women with osteoporosis. N Engl J Med 320:554–558PubMedGoogle Scholar
  2. 2.
    Seeman E, Tsalamandris C, Formica C, Hopper JL, McKay J (1994) Reduced femoral neck bone density in the daughters of women with hip fractures: the role of low peak bone density in the pathogenesis of osteoporosis. J Bone Miner Res 9:739–743PubMedGoogle Scholar
  3. 3.
    Tabensky A, Duan Y, Edmonds J, Seeman E (2001) The contribution of reduced peak accrual of bone and age-related bone loss to osteoporosis at the spine and hip: insights from the daughters of women with vertebral or hip fractures. J Bone Miner Res 16:1101–1107PubMedGoogle Scholar
  4. 4.
    Mazess RB, Cameron JR (1974) Bone mineral content in normal US Whites. In: Mazess RB (ed) International Conference on Bone Mineral Measurement. US Department of HEW Publication NIH 75-683, Washington D.C., pp 228–237Google Scholar
  5. 5.
    Szulc P, Marchand F, Duboeuf F, Delmas PD (2000) Cross-sectional assessment of age-related bone loss in men: the MINOS study. Bone 26:123–129CrossRefPubMedGoogle Scholar
  6. 6.
    Recker R, Davies M, Hinders SM, Heaney RP, Stegman MR, Kimmel DB (1992) Bone gain in young adult women. JAMA 268:2403–2408CrossRefPubMedGoogle Scholar
  7. 7.
    Slosman DO, Rizzoli R, Pichard C, Donath A, Bonjour J-P (1994) Longitudinal measurement of regional and whole body bone mass in young healthy adults. Osteoporos Int 4:185–190PubMedGoogle Scholar
  8. 8.
    Slemenda CW, Reister TK, Hui SL, Miller JZ, Christian JC, Johnston CC (1994) Influences on skeletal mineralisation in children and adolescents: evidence for varying effects of sexual maturation and physical activity. J Pediatr 125:201–207PubMedGoogle Scholar
  9. 9.
    Haapasalo H, Kannus P, Sievänen H, Pasanen M et al. (1994) 1996 Development of mass, density, and estimated mechanical characteristics of bones in Caucasian females. J Bone Miner Res 11:1751–1760Google Scholar
  10. 10.
    Matkovic V, Jelic T, Wardlaw GM, Ilich JZ et al. (1999) Timing of peak bone mass in Caucasian females and its implication for the prevention of osteoporosis: inference from a cross-sectional model. J Clin Invest 93:788–808Google Scholar
  11. 11.
    Bass S, Delmas PD, Pearce G, Hendrich E, Tabensky A, Seeman E (1988) The differing tempo of growth in bone size, mass, and density in girls is region-specific. J Clin Invest 104:795–804Google Scholar
  12. 12.
    Gilsanz V, Gibbens DT, Carlson M, Boechat MI, Cann CE, Schulz EE (1991) Peak trabecular vertebral density: a comparison of adolescent and adult females. Calcif Tissue Int 43:260–262Google Scholar
  13. 13.
    Bonjour J-P, Thientz G, Buchs B, Slosman D, Rizzoli R (1992) Critical years and stages of puberty for spinal and femoral bone mass accumulation during adolescence. J Clin Endocrinol Metab 73:555–556Google Scholar
  14. 14.
    Theintz G, Buchs B, Rizzoli R, Slosman D et al. (1995) Longitudinal monitoring of bone mass accumulation in healthy adolescents: evidence for a marked reduction after 16 years of age at the levels of lumbar spine and femoral neck in female subjects. J Clin Endocrinol Metab 75:1060–1065Google Scholar
  15. 15.
    Teegarden D, Proulx WR, Martin BR, Zhao J et al. (1999) Peak bone mass in young women. J Bone Min Res 10:711–715Google Scholar
  16. 16.
    Margery AM, Boulton TJC, Chatterton BE, Schultz C, Nordin BEC, Cockington RA (1991) Bone growth from 11 to 17 years: relation to growth, gender and changes with pubertal status including timing of menarche. Acta Paediatr 88:139–146Google Scholar
  17. 17.
    Katzman DK, Bachrach LK, Carter DR, Marcus R (1996) Clinical and anthropometric correlates of bone mineral acquisition in healthy adolescent girls. J Clin Endocrinol Metab 73:1332–1339Google Scholar
  18. 18.
    Lu PW, Cowell CT, Lloyd-Jones SA, Briody JN, Howman-Giles R (2000) Volumetric bone mineral density in normal subjects, aged 5–27 years. J Clin Endocrinol Metab 81:1586–1590Google Scholar
  19. 19.
    Bradney M, Karlsson MK, Duan Y, Stuckey S, Bass S, Seeman E (1996) Heterogeneity in the growth of the axial and appendicular skeleton in boys: implications for the pathogenesis of bone fragility in men. J Bone Miner Res 15:1871–1878Google Scholar
  20. 20.
    Parsons TJ, Prentice A, Smith EA, Cole TJ, Compston JE (1992) Bone mineral mass consolidation in young British adults. J Bone Miner Res 11:264–274Google Scholar
  21. 21.
    Kroger H, Kotaniemi A, Vainio P, Alhava E (1992) Bone densitometry of the spine and femur in children by dual-energy X-ray absorptiometry. Bone Miner 17:75–85PubMedGoogle Scholar
  22. 22.
    Carter DR, Bouxsein ML, Marcus R (1980) New approaches for interpreting projected bone densitometry data. J Bone Miner Res 7:137–145Google Scholar
  23. 23.
    Tanner JM (1962) Growth at adolescence, 2nd edn. Blackwell Scientific Publications, OxfordGoogle Scholar
  24. 24.
    Duke PM, Litt IF, Gross RT (2002) Adolescents’ self-assessment of sexual maturation. Pediatrics 66:918–920Google Scholar
  25. 25.
    Dangour AD, Schilg S, Hulse JA, Cole TJ (1995) Sitting height and subischial leg length curves for boys and girls from southeast England. Ann Hum Biol 29:290–305CrossRefGoogle Scholar
  26. 26.
    Freeman JV, Cole TJ, Chinn S, Jones PR, White EM, Preece MA (1988) Cross sectional stature and weight reference curves for the UK 1990. Arch Dis Child 73:17–14Google Scholar
  27. 27.
    Gilsanz V, Skaggs DL, Kovanlikaya A, Sayre J et al. (1994) Differential effect of race on the axial and appendicular skeletons of children. J Clin Endocrinol Metab 83:1420–1427Google Scholar
  28. 28.
    Gilsanz V, Boechat MI, Roe TF, Loro ML, Sayre JW, Goodman WG (1999) Gender differences in vertebral body sizes in children and adolescents. Radiology 190:673–677Google Scholar
  29. 29.
    Mora S, Pitukcheewanont P, Kaufman FR, Nelson JC, Gilsanz V (1997) Biochemical markers of bone turnover and the volume and the density of bone in children at different stages of sexual development. J Bone Miner Res 14:1664–1671Google Scholar
  30. 30.
    Boot AM, de Ridder MAJ, Pols HAP, Krenning EP, de Muinck Keizer-Schrama SMPF (1997) Bone mineral density in children and adolescents: relation to puberty, calcium intake, and physical activity. J Clin Endocrinol Metab 82:57–62PubMedGoogle Scholar
  31. 31.
    Kneissel M, Roschger P, Steiner W, Schamall D et al. (2000) Cancellous bone structure in the growing and aging lumbar spine in a historic Nubian population. Calcif Tissue Int 61:95–100CrossRefGoogle Scholar
  32. 32.
    Parfitt AM, Travers R, Rauch F, Glorieux FH (2000) Structural and cellular changes during bone growth in healthy children. Bone 27:487–494CrossRefPubMedGoogle Scholar
  33. 33.
    Byers S, Moore AJ, Byard RW, Fazzalari NL (1997) Quantitative histomorphometric analysis of the human growth plate from birth to adolescence. Bone 27:495–501CrossRefGoogle Scholar
  34. 34.
    Gilsanz V, Kovanlikaya A, Costin G, Roe TF, Sayre J, Kaufman F (1984) Differential effect of gender on the sizes of the bones in the axial and appendicular skeleton. J Clin Endocrinol Metab 82:1603–1607Google Scholar
  35. 35.
    Taylor J, Twomey LT (1986) Sexual dimorphism in human vertebral body shape. J Anat 138:281–286Google Scholar
  36. 36.
    Veldhuizen AG, Baas P, Webb PJ (1999) Observations on the growth of the adolescent spine. J Bone Joint Surg 68B:724–728Google Scholar
  37. 37.
    Duan Y, Parfitt AM, Seeman E (2001) Vertebral bone mass, size, and volumetric density in women with spinal fractures. J Bone Miner Res 14:1796–1802Google Scholar
  38. 38.
    Seeman E, Duan Y, Fong C, Edmonds J (1998) Fracture site-specific deficits in bone size and volumetric density in men with spine or hip fractures. J Bone Miner Res 16:120–127Google Scholar
  39. 39.
    Vega E, Ghiringhelli G, Mautalen C, Valzacchi GR et al. (1995) Bone mineral density and bone size in men with primary osteoporosis and vertebral fractures. Calcif Tissue Int 62:465–469CrossRefGoogle Scholar
  40. 40.
    Gilsanz V, Luiza Loro M, Roe TF, Sayre J et al. (1996) Vertebral size in elderly women with osteoporosis. J Clin Invest 95:2332–2337Google Scholar
  41. 41.
    Hangartner T, Gilsanz V (1996) Evaluation of cortical bone by computed tomography. J Bone Miner Res 11:1518–1525PubMedGoogle Scholar
  42. 42.
    Faulkner RA, Bailey DA, Drinkwater DT, McKay HA, Arnold C, Wilkinson AA (1991) Bone densitometry in Canadian children 8–17 years of age. Calcif Tissue Int 59:344–351CrossRefGoogle Scholar
  43. 43.
    Geusens P, Cantatore F, Nijs J, Proesmans W, Emma F, Dequeker J (1999) Heterogeneity of growth of bone in children at the spine, radius and total skeleton. Growth Dev Aging 55:249–256Google Scholar
  44. 44.
    Hui SL, Zhou L, Evans R Slemenda CW et al. (1992) Rates of growth and loss of bone mineral in the spine and femoral neck in white females. Osteoporos Int 9:200–205CrossRefGoogle Scholar
  45. 45.
    Lloyd T, Rollings N, Andon MB, Demers LM et al. (1992) Determinants of bone density in young women. I. Relationship among pubertal development, total body bone mass, and total body bone density in premenarcheal females. J Clin Endocrinol Metab 75:383–387Google Scholar
  46. 46.
    Beck TJ, Ruff CB, Scott Jr WW, Plato CC, Tobin JD, Quan CA (1998) Sex differences in geometry of the femoral neck with aging: a structural analysis of bone mineral data. Calcif Tissue Int 50:24–29Google Scholar
  47. 47.
    Peacock M, Carey GLM, Ambrosius W, Turner CH, Hui S, Johnston Jr CC (1996) Bone mass and structure at the hip in men and women over the age of 60 years. Osteoporos Int 8:231–239CrossRefGoogle Scholar
  48. 48.
    Zamberlan N, Radetti G, Paganini C, Rossini M et al (1989) Evaluation of cortical thickness and bone density by roentgen microdensitometry in growing males and females. Eur J Pediatr 155:377–382CrossRefGoogle Scholar
  49. 49.
    Garn SM (1970) Changes at the subperiosteal surface. In: The earlier gain and later loss of cortical bone. CC Thomas, Springfield, Ill.Google Scholar
  50. 50.
    Turner RT, Hannon KS, Demers LM, Buchanan J, Bell NH (1999) Differential effects of gonadal function on bone histomorphometry in male and female rats. J Bone Miner Res 4:557–563Google Scholar
  51. 51.
    Zhang XZ, Kalu DN, Erbas B, Hopper JL, Seeman E (1993) The effects of gonadectomy on bone size, mass and volumetric density in growing rats are gender-, site-, and growth hormone-specific. J Bone Miner Res 14:802–809Google Scholar
  52. 52.
    Hietala EL (2001) The effect of ovariectomy on periosteal bone formation and bone resorption in adult rats. Bone Miner 20:57–65Google Scholar
  53. 53.
    Rauch F, Neu C, Manz F, Schoenau E (2001) The development of metaphyseal cortex—implications for distal radius fractures during growth. J Bone Miner Res 16:1547–1555PubMedGoogle Scholar
  54. 54.
    Schoenau E, Neu CM, Rauch F, Manz F (1973) The development of bone strength at the proximal radius during childhood and adolescence. J Clin Endocrinol Metab 86:613–618Google Scholar
  55. 55.
    Israel H (1990) Progressive enlargement of the vertebral body as part of the process of human skeletal aging. Age Aging 2:71–79Google Scholar
  56. 56.
    Mosekilde L, Mosekilde L (1992) Sex difference in age related changes in vertebral body size, density and biomechanical competence in normal individuals. Bone 11:67–73Google Scholar
  57. 57.
    Garn SM, Sullivan TV, Decker SA, Larkin FA, Hawthorne VM (1988) Continuing bone expansion and increasing bone loss over a two-decade period in men and women from a total community sample. Am J Hum Biol 4:57–67Google Scholar
  58. 58.
    Ruff CD, Hayes WC (1999) Sex differences in age-related remodeling of the femur and tibia. J Orthop Res 6:886–896Google Scholar
  59. 59.
    Libanati C, Baylink DJ, Lois-Wenzel E, Srinivasan N, Mohan S (1995) Studies on the potential mediators of skeletal changes occurring during puberty in girls. J Clin Endocrinol Metab 84:2807–2814Google Scholar
  60. 60.
    Garn SM, Rohmann CG, Nolan Jr P (1964) The developmental nature of bone changes during aging. In: Birren JE (ed) Relations of development and aging. Ayer, North Stratford, N.H., pp 44–61Google Scholar
  61. 61.
    Parfitt AM (1983) The physiologic and clinical significance of bone histomorphometric data. In: Recker RR (ed) Bone histomorphometry: techniques and interpretation, CRC Press, Boca Raton, pp 143–223Google Scholar
  62. 62.
    Peel NF, Eastell R (1998) Comparison of rates of bone loss from the spine measured using two manufacturers’ densitometers. J Bone Miner Res 10:1796–1801Google Scholar
  63. 63.
    Tothill P, Avenell A (1994) Anomalies in the measurement of changes in bone mineral density of the spine by dual-energy X-ray absorptiometry. Calcif Tissue Int 63:126–133CrossRefGoogle Scholar
  64. 64.
    Parfitt AM (1996) The two faces of growth: benefits and risks to bone integrity. Osteoporos Int 4:382–398Google Scholar
  65. 65.
    Goulding A, Taylor RW, Gold E, Lewis-Barned NJ (1990) Regional body fat distribution in relation to pubertal stage: a dual-energy X-ray absorptiometry study of New Zealand girls and young women. Am J Clin Nutr 64:546–551Google Scholar
  66. 66.
    Hangartner T, Johnston CC (1990) Influence of fat on bone measurements with dual-energy absorptiometry. Bone Miner 9:71–81PubMedGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2004

Authors and Affiliations

  • Yvette M. Henry
    • 1
  • Diana Fatayerji
    • 1
  • Richard Eastell
    • 1
  1. 1.Bone Metabolism Group, Division of Clinical Science (North)Northern General HospitalSheffieldUK

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