Determinants of Advanced Bone Age in Childhood Obesity

Abstract

Background: Childhood obesity is associated with advanced bone age (BA). Previous studies suggest that androgens, oestrogens, sex hormone-binding globulin, and insulin are responsible for this phenomenon, but results are contradictory and might be biased by confounders. We aim to elucidate this matter by applying a multivariate approach. Method: We performed a correlation analysis of BA standard deviation score (SDS) with age- and sex-specific SDS for androgens, oestrogens, and with indicators of insulin secretion derived from oral glucose tolerance testing, in a group of obese children. A multivariate analysis was performed to investigate which parameters were independently predictive of BA SDS. Results: In this cohort (n = 101; mean age 10.9 years; mean BA 11.8 years; mean BMI SDS 3.3), BMI SDS was significantly correlated to BA SDS (r = 0.55, p < 0.001). In a regression analysis in the total cohort (B = 0.27, p < 0.001) as well as in females (B = 0.34, p = 0.042), males (B = 0.31, p = 0.006), and pubertal children (B = 0.32, p = 0.046), dehydroepiandrosterone sulphate (DHEAS) showed a positive, independent association with BA SDS. No association with indicators of insulin secretion was found. Conclusion: BMI SDS is highly correlated to BA SDS in obese children. Increased DHEAS has a central role in advanced BA in obese children.

Factors affecting bone maturation in Chinese girls aged 4-8 years with isolated premature thelarche

“…Similar to the ndings by Kwon et al [23] and others [20,24], our study showed a positive association between serum DHEAS SDS and advanced BA. This relationship is likely due to the higher adrenal androgen levels in children with obesity; these increased levels are believed to be responsible for the advanced BA.…”

“…Similarly, in a study of 66 prepubertal children with obesity and premature adrenarche, an exploratory stepwise regression model showed that weight, oestradiol and DHEAS were the strongest predictors of BA/CA, accounting for 24% of the variance [20]. Another study in 101 obese children generated a backward regression analysis model in which sex, DHEAS SDS, and age explained 27% of the total variance in BA SDS [24]. Therefore, there may be other underlying causes of advanced BA, including genetic causes such as heterozygous mutations in ACAN [28] and extrinsic factors such as exposure to endocrine-disrupting chemicals [29].…”

Factors affecting bone maturation in 423 Chinese girls aged 4-8 years with isolated premature thelarche

“…Similar to the findings by Jung Hyun Kwon et al [23] and others [20,24], our study showed a positive association between DHEAS and advanced BA. This relationship is likely due to the higher adrenal androgen levels in children with obesity; these increased levels are believed to be responsible for the advanced BA.…”

Factors affecting bone maturation in Chinese girls aged 4-8 years with isolated premature thelarche

“…Similar to the ndings by Jung Hyun Kwon et al [23] and others [20,24], our study showed a positive association between DHEAS and advanced BA. This relationship is likely due to the higher adrenal androgen levels in children with obesity; these increased levels are believed to be responsible for the advanced BA.…”