Tracking of bone mass from childhood to puberty: a 7-year follow-up. The CHAMPS study DK
Bone mass in childhood is highly influenced by puberty. At the same age, bone mass was higher for pubertal than pre-pubertal children. A high level of tracking during 7 years from childhood through puberty was shown, indicating that early levels of bone mass may be important for later bone health.
Bone mass development in childhood varies by sex and age, but also by pubertal stage. The objectives of this study were to (1) describe bone mass development in childhood as it relates to pubertal onset and to (2) determine the degree of tracking from childhood to adolescence.
A longitudinal study with 7 years of follow-up was initiated in 2008 to include 831 children (407 boys) aged 8 to 17 years. Participants underwent whole body dual-energy X-ray absorptiometry (DXA) scanning, blood collection to quantify luteinizing hormone levels, and Tanner stage self-assessment three times during the 7-year follow-up. Total body less head bone mineral content, areal bone mineral density, and bone area were used to describe development in bone accrual and to examine tracking over 7 years.
Bone mass in pubertal children is higher than that of pre-pubertal children at the same age. Analysing tracking with quintiles of bone mass Z-scores in 2008 and 2015 showed that more than 80% of participants remained in the same or neighbouring quintile over the study period. Tracking was confirmed by correlation coefficients between Z-scores at baseline and 7-year follow-up (range, 0.80–0.84).
Bone mass is highly influenced by pubertal onset, and pubertal stage should be considered when examining children’s bone health. Because bone mass indices track from childhood into puberty, children with low bone mass may be at risk of developing osteoporosis later in life.
KeywordsBone mass Dual-energy X-ray absorptiometry Longitudinal Puberty Tracking
We thank participants and schools for their participation in the Childhood Health Activity and Motor Performance School study.
The study was supported by The Danish foundation “Tryg-fonden”, the Region of Southern Denmark, Hospital of Southern Jutland, and “Kirsten og Freddy Johansens Fond”.
Compliance with ethical standards
Children and parents have received information both at school meetings and additional written information about the study. The parents signed informed consent forms before examination. Participation was at any time voluntary. Permission to conduct the CHAMPS-study DK was granted by the Regional Scientific Ethical Committee of Southern Denmark (Project ID: S2008-0047, S-20140105) and were in accordance with the ethical standards of the 1964 Helsinki declaration and its later amendments.
Conflicts of interest
- 1.Weaver CM, Gordon CM, Janz KF, Kalkwarf HJ, Lappe JM, Lewis R, O'Karma M, Wallace TC, Zemel BS (2016) The National Osteoporosis Foundation’s position statement on peak bone mass development and lifestyle factors: a systematic review and implementation recommendations. Osteoporos Int 27(4):1281–1386. https://doi.org/10.1007/s00198-015-3440-3 CrossRefPubMedPubMedCentralGoogle Scholar
- 5.McCormack SE, Cousminer DL, Chesi A, Mitchell JA, Roy SM, Kalkwarf HJ, Lappe JM, Gilsanz V, Oberfield SE, Shepherd JA, Winer KK, Kelly A, Grant SFA, Zemel BS (2017) Association between linear growth and bone accrual in a diverse cohort of children and adolescents. JAMA Pediatr 171:e171769. https://doi.org/10.1001/jamapediatrics.2017.1769 CrossRefPubMedPubMedCentralGoogle Scholar
- 6.Zemel BS, Kalkwarf HJ, Gilsanz V, Lappe JM, Oberfield S, Shepherd JA, Frederick MM, Huang X, Lu M, Mahboubi S, Hangartner T, Winer KK (2011) Revised reference curves for bone mineral content and areal bone mineral density according to age and sex for black and non-black children: results of the bone mineral density in childhood study. J Clin Endocrinol Metab 96(10):3160–3169. https://doi.org/10.1210/jc.2011-1111 CrossRefPubMedPubMedCentralGoogle Scholar
- 8.Crabtree NJ, Shaw NJ, Bishop NJ, Adams JE, Mughal MZ, Arundel P, Fewtrell MS, Ahmed SF, Treadgold LA, Hogler W, Bebbington NA, Ward KA (2017) Amalgamated reference data for size-adjusted bone densitometry measurements in 3598 children and young adults—the ALPHABET study. J Bone Miner Res 32(1):172–180. https://doi.org/10.1002/jbmr.2935 CrossRefPubMedGoogle Scholar
- 9.Kang MJ, Hong HS, Chung SJ, Lee YA, Shin CH, Yang SW (2016) Body composition and bone density reference data for Korean children, adolescents, and young adults according to age and sex: results of the 2009-2010 Korean National Health and Nutrition Examination Survey (KNHANES). J Bone Miner Metab 34(4):429–439. https://doi.org/10.1007/s00774-015-0686-y CrossRefPubMedGoogle Scholar
- 11.Jeddi M, Roosta MJ, Dabbaghmanesh MH, Omrani GR, Ayatollahi SM, Bagheri Z, Showraki AR, Bakhshayeshkaram M (2013) Normative data and percentile curves of bone mineral density in healthy Iranian children aged 9-18 years. Arch Osteoporos 8:114. https://doi.org/10.1007/s11657-012-0114-z CrossRefPubMedGoogle Scholar
- 12.Kalkwarf HJ, Gilsanz V, Lappe JM, Oberfield S, Shepherd JA, Hangartner TN, Huang X, Frederick MM, Winer KK, Zemel BS (2010) Tracking of bone mass and density during childhood and adolescence. J Clin Endocrinol Metab 95(4):1690–1698. https://doi.org/10.1210/jc.2009-2319 CrossRefPubMedPubMedCentralGoogle Scholar
- 13.Wren TA, Kalkwarf HJ, Zemel BS, Lappe JM, Oberfield S, Shepherd JA, Winer KK, Gilsanz V (2014) Longitudinal tracking of dual-energy X-ray absorptiometry bone measures over 6 years in children and adolescents: persistence of low bone mass to maturity. J Pediatr 164(6):1280–1285.e1282. https://doi.org/10.1016/j.jpeds.2013.12.040 CrossRefPubMedPubMedCentralGoogle Scholar
- 15.Fujita Y, Iki M, Ikeda Y, Morita A, Matsukura T, Nishino H, Yamagami T, Kagamimori S, Kagawa Y, Yoneshima H (2011) Tracking of appendicular bone mineral density for 6 years including the pubertal growth spurt: Japanese Population-based Osteoporosis Kids Cohort Study. J Bone Miner Metab 29(2):208–216. https://doi.org/10.1007/s00774-010-0213-0 CrossRefPubMedGoogle Scholar
- 18.Tinggaard J, Aksglaede L, Sorensen K, Mouritsen A, Wohlfahrt-Veje C, Hagen CP, Mieritz MG, Jorgensen N, Wolthers OD, Heuck C, Petersen JH, Main KM, Juul A (2014) The 2014 Danish references from birth to 20 years for height, weight and body mass index. Acta Paediatr 103(2):214–224. https://doi.org/10.1111/apa.12468 CrossRefPubMedGoogle Scholar
- 19.Wedderkopp N, Jespersen E, Franz C, Klakk H, Heidemann M, Christiansen C, Moller NC, Leboeuf-Yde C (2012) Study protocol. The Childhood Health, Activity, and Motor Performance School Study Denmark (The CHAMPS-study DK). BMC Pediatr 12:128. https://doi.org/10.1186/1471-2431-12-128 CrossRefPubMedPubMedCentralGoogle Scholar
- 20.Roche Diagnostics GmbH M, Germany (2016) Method sheet, ms_11732234122V19.0, LH (Luteiniserende hormone), 2016-11, V 19.0 DanskGoogle Scholar
- 22.WHO (2010) WHO Anthro for personal computers, version 322, 2011: software for assessing growth and development of the world’s children Geneva: WHO, 2010. http://wwwwhoint/childgrowth/software/en/. Accessed 21 Dec 2016
- 24.Kalkwarf HJ, Zemel BS, Gilsanz V, Lappe JM, Horlick M, Oberfield S, Mahboubi S, Fan B, Frederick MM, Winer K, Shepherd JA (2007) The bone mineral density in childhood study: bone mineral content and density according to age, sex, and race. J Clin Endocrinol Metab 92(6):2087–2099. https://doi.org/10.1210/jc.2006-2553 CrossRefPubMedGoogle Scholar
- 25.Crabtree NJ, Arabi A, Bachrach LK, Fewtrell M, El-Hajj Fuleihan G, Kecskemethy HH, Jaworski M, Gordon CM (2014) Dual-energy X-ray absorptiometry interpretation and reporting in children and adolescents: the revised 2013 ISCD Pediatric Official Positions. J Clin Densitom 17(2):225–242. https://doi.org/10.1016/j.jocd.2014.01.003 CrossRefPubMedGoogle Scholar
- 26.Buttazzoni C, Rosengren BE, Karlsson C, Dencker M, Nilsson JA, Karlsson MK (2015) A pediatric bone mass scan has poor ability to predict peak bone mass: an 11-year prospective study in 121 children. Calcif Tissue Int 96(5):379–388. https://doi.org/10.1007/s00223-015-9965-9 CrossRefPubMedGoogle Scholar
- 27.Nilsen OA, Ahmed LA, Winther A, Christoffersen T, Furberg AS, Grimnes G, Dennison E, Emaus N (2017) Changes and tracking of bone mineral density in late adolescence: the Tromso Study, Fit Futures. Arch Osteoporos 12(1):37. https://doi.org/10.1007/s11657-017-0328-1 CrossRefPubMedPubMedCentralGoogle Scholar
- 28.Cheng S, Volgyi E, Tylavsky FA, Lyytikainen A, Tormakangas T, Xu L, Cheng SM, Kroger H, Alen M, Kujala UM (2009) Trait-specific tracking and determinants of body composition: a 7-year follow-up study of pubertal growth in girls. BMC Med 7:5. https://doi.org/10.1186/1741-7015-7-5 CrossRefPubMedPubMedCentralGoogle Scholar
- 29.Heidemann M, Holst R, Schou AJ, Klakk H, Husby S, Wedderkopp N, Molgaard C (2015) The influence of anthropometry and body composition on children's bone health: the childhood health, activity and motor performance school (the CHAMPS) study, Denmark. Calcif Tissue Int 96(2):97–104. https://doi.org/10.1007/s00223-014-9941-9 CrossRefPubMedGoogle Scholar