Association between Body Composition and Bone Mineral Density in Children and Adolescents: A Systematic Review and Meta-Analysis

Abstract

Background: Bone mass acquisition during growth is a major determinant of the risk of developing osteoporosis later in life. Body composition is an anthropometric determinant of bone mineral density (BMD) and significantly influences its development during childhood and adolescence. Objective: This study aimed to systematically examine the association between body composition and bone mineral density in children and adolescents. Methods: Observational studies addressing this association were identified from PubMed (MEDLINE), Embase, Scopus and the Cochrane Library (up to January 2021). The study populations consisted of healthy children and adolescents. The DerSimonian and Laird method was used to compute pooled estimates of effect size and the respective 95% confidence intervals for upper limbs, femoral neck (FN), lumbar spine (LS) and total body, respectively. Subgroup analyses were further performed based on age, sex and ethnicity. Results: Thirty-one published studies were eligible for inclusion in this systematic review and meta-analysis, including three longitudinal studies. The combined population from all the studies amounted to 21,393 (11,205 males and 10,188 females). The pooled estimates of the correlation coefficients for lean mass (LM) and BMD ranged from 0.53 to 0.74 (p < 0.050), and the pooled regression coefficients ranged from 0.23 to 0.79 for FN, LS and total body (p < 0.050). For fat mass (FM), the pooled correlation coefficients ranged from 0.10 to 0.50 (p < 0.050) and the pooled regression coefficient was only significant for FN BMD with a weak strength (pooled β = 0.07, p < 0.050). The pooled regression coefficients for body fat percentage (BF%) were between −0.54 and −0.04 (p < 0.050). The subgroup analysis revealed a stronger association in Asians than in Caucasians for LM and in males compared to females for BF% (p < 0.050). Conclusions: This systematic review and meta-analysis supports a positive association between LM and BMD. BF% appears to have a deleterious effect on bone acquisition in children and adolescents.

The inverse relationship between fatness and bone mineral content is mediated by the adolescent appendicular skeletal muscle mass index: The Cogni-Action Project

“…In this regard, our main finding contributes to this research area by showing the significant but partial mediation role of a muscle mass indicator adjusted for height on the relationship between fatness and BMC. In children and adolescents, ASMI, and strength are strongly associated ( 58 ), and both have been associated with bone health in the transition from childhood to adulthood ( 48 , 59 ). Thereby, physical activity plays a fundamental role in promoting healthy muscle mass in this population.…”

Association between creatine phosphokinase level within normal range and bone mineral density in adolescents

“…[2] The amount of bone a person acquires during growth is a major factor that determines the symptoms and risk factors for OP later in life. [3] The skeletal system develops rapidly during adolescence, with bone mass approaching 90% of peak adult bone mass by the end of puberty. [4] Therefore, accumulating more bone mass and obtaining higher peak bone mass during adolescence is crucial for the prevention of OP in the elderly.…”

Relationship between body composition and bone mass in normal-weight and overweight adolescents

“…In adolescents, body composition, a parameter combining fat mass (FM) and lean mass (LM), has been associated with bone mineral density (BMD) ( Jeddi et al, 2015 ; Sioen et al, 2016 ; Han, Kim & Kim, 2021 ), a measurement of the mineral mass of bone per unit area, expressed in g/cm2 ( International Atomic Energy Agency, 2010 ). LM shows a clear association with bone health, explained by the mechanical loading transferred to the skeleton ( Deng et al, 2021 ). The effect of FM on bone health, however, is controversial, with reports of positive and negative associations in studies with adolescents ( Deng et al, 2021 ) and adults ( Hamrick, 2011 ).…”

“…LM shows a clear association with bone health, explained by the mechanical loading transferred to the skeleton ( Deng et al, 2021 ). The effect of FM on bone health, however, is controversial, with reports of positive and negative associations in studies with adolescents ( Deng et al, 2021 ) and adults ( Hamrick, 2011 ). On the one hand, the mechanical loading of extra mass may be favorable to bone development, but on the other hand, high levels of fat mass can lead to inflammation and oxidative stress, culminating in negative effects ( Hamrick, 2011 ; Shapses, Pop & Wang, 2017 ).…”