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Calcium acquisition rates do not support age-appropriate gains in total body bone mineral content in prepuberty and late puberty in girls with cystic fibrosis

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Abstract

Few longitudinal data are available characterizing bone development in adolescents with cystic fibrosis (CF) although this is a critical time for bone mineralization. Dual energy X-ray absorptiometry (DXA) scans were obtained at 1- to 4-year intervals in 18 prepubertal and pubertal girls (age 7–18 years) with CF to determine calcium (Ca) accretion rates and changes (Δ) in total body bone mineral content (TBBMC) and lumbar spine bone mineral density (LS BMD) Z-scores. Daily Ca acquisition rates were calculated assuming TBBMC was composed of 32.2% Ca. Bone Ca accretion averaged 82 mg/day (2.05 mmol/day) [(range:–38 to +197 mg/day (–0.95 to 4.9 mmol/day)] on ∼1,200 mg/day (30 mmol/day) Ca intakes. Estimated mean peak Ca accretion was 160 mg/day (4 mmol/day) at age 13 years; losses of bone Ca occurred in late puberty. Gains in insulin-like growth factor 1 (IGF-1) predicted Ca accretion (p<0.06). Body mass index (BMI) Z-score predicted LS BMD and TBBMC Z-score cross-sectionally but did not predict ΔTBBMC Z-score. Changes in TBBMC Z-score paralleled Ca accretion rates with age. Bone Ca accretion in girls with CF fell below rates in healthy girls during prepuberty and late puberty despite Ca intakes approaching recommendations. IGF-1 and BMI Z-scores may identify children with CF at risk of compromised bone accretion, and more data are required to elucidate roles of lung function and glucocorticoid use in compromised bone health.

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Acknowledgements

We would like to thank the study participants and their families as well as the nursing staff of the Johns Hopkins Pediatric Research Unit. Kerry J. Schulze was responsible for study management, laboratory and data analysis, and manuscript preparation; Carrie Cutchins was responsible for data collection during the follow-up study; Beryl J. Rosenstein was the codirector or the CF Clinic at Johns Hopkins and as such offered assistance in recruiting patients; Emily L. Germain-Lee was responsible for the review of medical charts and provided medical exams during the baseline study; Kimberly O’Brien was the principal investigator of the study, provided scientific and managerial oversight, and assisted in data interpretation and manuscript preparation.

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Authors and Affiliations

  1. Center for Human Nutrition, Johns Hopkins University School of Medicine, Department of Pediatrics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA

    Kerry J. Schulze, Carrie Cutchins, Beryl J. Rosenstein, Emily L. Germain-Lee & Kimberly O. O’Brien

  2. Johns Hopkins Bloomberg School of Public Health, Center for Human Nutrition, Room W2041, 615 Wolfe Street, Baltimore, MD, 21205-2179, USA

    Kerry J. Schulze & Kimberly O. O’Brien

  3. Johns Hopkins Bloomberg School of Public Health, Department of International Health, 615 N. Wolfe Street, Baltimore, MD, 21205-2179, USA

    Carrie Cutchins

  4. Department of Pediatric Pulmonary Medicine, The Johns Hopkins University School of Medicine, Park Building 315, 600 N. Wolfe Street, Baltimore, MD, 21287, USA

    Beryl J. Rosenstein

  5. Pediatric Endocrinology, Johns Hopkins University School of Medicine, Park Building 211, 600 N. Wolfe Street, Baltimore, MD, 21287, USA

    Emily L. Germain-Lee

Authors
  1. Kerry J. Schulze
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  2. Carrie Cutchins
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  3. Beryl J. Rosenstein
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  4. Emily L. Germain-Lee
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  5. Kimberly O. O’Brien
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Corresponding author

Correspondence to Kimberly O. O’Brien.

Additional information

Supported by the Cystic Fibrosis Foundation and the National Center for Research Resources (NCRR)/General Clinical Research Center, RR00052, Johns Hopkins Hospital

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Schulze, K.J., Cutchins, C., Rosenstein, B.J. et al. Calcium acquisition rates do not support age-appropriate gains in total body bone mineral content in prepuberty and late puberty in girls with cystic fibrosis. Osteoporos Int 17, 731–740 (2006). https://doi.org/10.1007/s00198-005-0041-6

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  • DOI: https://doi.org/10.1007/s00198-005-0041-6

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