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How Does Bone Quality Differ Between Healthy-weight and Overweight Adolescents and Young Adults?

  • Symposium: Childhood Obesity and Musculoskeletal Problems
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Overweight youth have greater bone mass than their healthy-weight peers but sustain more fractures. However, it is unclear whether and how excess body fat influences bone quality in youth.

Questions/purposes

We determined whether overweight status correlated with three-dimensional aspects of bone quality influencing bone strength in adolescent and young adult females and males.

Methods

We categorized males (n = 103; mean age, 17 years) and females (n = 85; mean age, 18 years) into healthy-weight and overweight groups. We measured lean mass (LM) and fat mass (FM) with dual-energy x-ray absorptiometry (DXA). We used high-resolution peripheral quantitative CT to assess the distal radius (7% site) and distal tibia (8% site). Bone quality measures included total bone mineral density (Tt.BMD), total area (Tt.Ar), trabecular bone volume fraction (BV/TV), trabecular number (Tb.N), separation (Tb.Sp), and thickness (Tb.Th). We used multiple regression to compare bone quality between healthy-weight and overweight adolescents adjusting for age, ethnicity, limb length, LM, and FM.

Results

Overweight males had higher (10%–21%) Tt.BMD, BV/TV, and Tb.N and lower Tb.Sp at the tibia and lower Tt.Ar at the radius than healthy-weight males. No differences were observed between overweight and healthy-weight females. LM attenuated the differences in bone quality between groups in males while FM negatively predicted Tt.BMD, BV/TV, Tb.N, and Tb.Th.

Conclusions

Our data suggest overweight males have enhanced bone quality compared with healthy-weight males; however, when group differences are interpreted in the context of the mechanostat theory, it appears bone quality of overweight adolescents adapts to LM and not to greater FM.

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Acknowledgments

We thank the many members of the Healthy Bones Research team whose ideas and hard work contributed to the design and implementation of the Healthy Bones studies over the years, especially Kerry MacKelvie-O’Brien, PhD, Moira Petit, PhD, Deetria Egeli, BHSc, and Sarah Moore, MSc. We are blessed with skilled and knowledgeable research staff and acknowledge the key contribution of Danmei Liu, PhD, to the medical imaging of bone and to Douglas Race, MA, and his measurement team for acquisition of anthropometry and other data. Without the ongoing and sustained support of schools in Vancouver and Richmond in British Columbia, which are key partners in this research, we would be unable to conduct our studies. Finally, we owe a huge debt of gratitude to the boys and girls (now young men and women) who participated in the Healthy Bones trials over the last decade.

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Authors and Affiliations

  1. Robert H. N. Ho Research Centre, 7/F, 2635 Laurel Street, Vancouver, BC, V5Z 1M9, Canada

    Christa L. Hoy MSc, Heather M. Macdonald PhD & Heather A. McKay PhD

  2. Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada

    Christa L. Hoy MSc, Heather M. Macdonald PhD & Heather A. McKay PhD

  3. Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada

    Christa L. Hoy MSc, Heather M. Macdonald PhD & Heather A. McKay PhD

  4. Child and Family Research Institute, Vancouver, BC, Canada

    Christa L. Hoy MSc & Heather M. Macdonald PhD

  5. Department of Family Practice, University of British Columbia, Vancouver, BC, Canada

    Heather A. McKay PhD

Authors
  1. Christa L. Hoy MSc
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  2. Heather M. Macdonald PhD
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  3. Heather A. McKay PhD
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Corresponding author

Correspondence to Heather A. McKay PhD.

Additional information

The institution of one or more of the authors (CH, HM, HM) has received, during the study period, funding from the Canadian Institutes of Health Research (MOP-84575).

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at the Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.

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Hoy, C.L., Macdonald, H.M. & McKay, H.A. How Does Bone Quality Differ Between Healthy-weight and Overweight Adolescents and Young Adults?. Clin Orthop Relat Res 471, 1214–1225 (2013). https://doi.org/10.1007/s11999-012-2576-0

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  • DOI: https://doi.org/10.1007/s11999-012-2576-0

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