Objective: We wished to clarify whether the osteopenia reported in adult men with a history of constitutional delay of growth and puberty (CDGP) could be due to the delayed puberty or an independent predisposition to osteoporosis in this condition. Design: Short prepubertal children with CDGP and children with familial short stature (FSS) were matched for height and other auxological variables. The FSS children served as a control group. Methods: We measured spinal (L1-L4) bone mineral content (BMC) and bone mineral density (BMD) by dual energy X-ray absorptiometry (Hologic QDR 1000/w) in 56 children aged 5-11 years. All children had height below the 10th percentile for chronological age (CA), and bone age (BA) less than 10 years, 29 of them with clinical diagnosis of possible CDGP and 27 of them with FSS. The BMD standard deviation scores (SDS) relative to the values for normal height children were obtained. Results: The mean (Ϯ S.D.) spinal BMD was significantly lower in the children with CDGP than in the FSS group (0.534 Ϯ 0.059 vs 0.623 Ϯ 0.060 g/cm 2 , P < 0.001). Both groups had negative mean lumbar BMD SDS, but in the CDGP group it was significantly lower than in the FSS group as well when the SDS was based on the CA (¹1.41 Ϯ 0.61 vs ¹0.38 Ϯ 0.51, P < 0.001) and when it was related to BA (¹0.78 Ϯ 0.64 vs ¹0.17 Ϯ 0.52, P < 0.01). BMC was significantly lower in the CDGP than in the FSS group, when multiple regression analysis was performed by using scanned bone area, body weight and height, sex and BA as independent variables (P ¼ 0.0005). Conclusion:The finding of decreased mineralization in prepubertal children with CDGP before the age of puberty suggests that they may have an inherent predisposition to osteopenia.
Several studies have analyzed the correlation between axial bone mineral density (BMD) measured by dual X-ray absorptiometry (DXA) and growth parameters. However, little is known about the growth-related changes in appendicular BMD measured by this technique. We used DXA to measure BMD in the lumbar spine (L1-L4) and distal radius in 121 normal growing children (69 boys, 52 girls), aged 3 to 18 yr. Both lumbar and radius BMD showed a steady increase with age and a steeper increment during puberty. There was a good correlation between spinal and radial BMD (r = 0.83; p < 0.001) and both were highly correlated with growth parameters; their respective correlation coefficients did not differ significantly for chronological age (r = 0.70 vs 0.80), weight (r = 0.77 vs 0.76), height (r = 0.73 vs 0.79), body surface (r = 0.78 vs 0.80), body mass index (r = 0.54 vs 0.49) and bone age (r = 0.77 vs 0.79). By multiple regression analysis the best predictors for spinal BMD were bone age, pubertal stage and weight, while for radial BMD the best predictors were chronological age and weight. We have shown that the measurement of BMD by DXA at distal radius, an easily accessible bone, has a correlation with growth parameters as good as lumbar spine BMD measurements in children.
We have previously reported that children with constitutionally delayed growth (CDG) have significantly lower spinal bone mineralization than children with familial short stature (FSS). The aim of the present study was to evaluate whether the decreased bone mineralization in children with CDG also affects the radius, which has a lower bone turnover than the spine. To avoid the possibility of size-related artifacts in the assessment of bone mineral data, data were corrected for bone and body size. Radial bone mineral content (RBMC) and radial bone mineral density (RBMD) were measured by dual energy X-ray absorptiometry (Hologic QDR 1000/w) in 56 short prepubertal children aged 5-11 years. All children had height below the 10th percentile for chronological age (CA), and bone age (BA) less than 10 years, 29 of them with clinical diagnosis of CDG and 27 of them with FSS. The mean (+/- SD) RBMD was significantly lower in the children with CDG than in the FSS group (0.361 +/- 0.035 vs 0.385 +/- 0.033 g/cm2, p<0.05). RBMC was significantly lower in CDG than in FSS, when multiple regression analysis was performed by using radial scanned bone area (RSBA), body weight and height, sex and BA as independent variables (p = 0.03). These data indicate that the decreased bone mineralization in children with CDG also affects peripheral bone, and that this finding is not due to bone or body size artifacts.
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