Effect of a calcium and exercise intervention on the bone mineral status of 16–18-y-old adolescent girls

Stear, S J; Prentice, Ann; Jones, Sarah; Cole, Tim

doi:10.1093/ajcn/77.4.985

Cited by 145 publications

(103 citation statements)

References 27 publications

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“…Some studies found a positive effect of exercise on bone mineral content or aBMD but only when they limited their analyses to compliant participants [49,54]. Additionally, children who do not routinely load their skeletons seem to be more responsive to an exercise program as supported by findings from two of the trials [36,52].…”

Section: Discussionmentioning

confidence: 99%

“…On review of these trials an additional seven trials were identified and added to those being reviewed [8,29,38,42,43,49,55] (Table 1). Of these trials, 14 were excluded because of duplication of study populations (Table 1), and one did not present measures of variance for changes in bone outcomes [8].…”

Section: Search Strategy and Criteriamentioning

confidence: 99%

“…Some trials provided estimates of bone change within different subgroups (eg, prepubertal versus pubertal, males versus females) [25,28,31,36,39,48,49,54]. Results from each of these subgroups were used in this review.…”

Section: Search Strategy and Criteriamentioning

confidence: 99%

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Does Exercise Influence Pediatric Bone? A Systematic Review

Specker

Thiex

Sudhagoni

2015

Clinical Orthopaedics &Amp; Related Research

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Background Periods of growth are thought to be the best time to increase bone mineral content, bone area, and areal bone mineral density (aBMD) through increased loading owing to high rates of bone modeling and remodeling. However, questions remain regarding whether a benefit of exercise is seen at all bone sites, is dependent on pubertal status or sex of the child, or whether other factors such as diet modify the response to exercise. Questions/purposes We asked: (1) Does bone-loading exercise in childhood consistently increase bone mineral content, bone area, or aBMD? (2) Do effects of exercise differ depending on pubertal status or sex? (3) Does calcium intake modify the bone response to exercise? Methods A literature search identified 22 unique trials for inclusion in this meta-analysis of the effect of exercise on bone changes by bone site, pubertal status, and sex. Sample sizes ranged from 16 to 410 subjects 3 to 18 years old with length of intervention ranging from 3 to 36 months. Fifteen of 22 trials were randomized (child randomized in nine, classroom/school randomized in six) and seven were observational trials. Ten trials were Level 2 and 11 were Level 3 based on the Oxford Centre for Evidence-Based Medicine criteria. Random effects models tested the difference (intervention mean effect-control mean effect) in percent change in bone mineral content, bone area, and aBMD. Meta-regression was used to identify sources of heterogeneity and funnel plots were used to assess publication bias. Results Children assigned to exercise had greater mean percent changes in bone mineral content and aBMD than children assigned to the control groups. Mean differences (95% CI) in bone mineral content percent change between intervention and control groups at total body (0.8; 95% CI, 0.3-1.3; p = 0.003), femoral neck (1.5; 95% CI, 0.5-2.5; p = 0.003), and spine (1.7; 95% CI, 0.4-3.1; p = 0.01) were significant with no differences in bone area (all p [ 0.05). There were greater percent changes in aBMD in intervention than control groups at the femoral neck (0.6; 95% CI, 0.2-1.1; p = 0.006) and spine (1.2; 95% CI, 0.6-1.8; p \ 0.001). Benefit of exercise was limited to children who were prepubertal (bone mineral content: total body [0.9; 95% CI, 0.2-1.7; p = 0.01], femoral neck [1.8; 95% CI, 0.0-3.5; p = 0.047], spine [3.7; 95% CI, 0.8-6.6; p = 0.01], and aBMD: femoral neck [0.6; 95% CI, À0.1-1.2; p = 0.07], spine [1.5; 95% CI, 0.7-2.3; p \ 0.001]), with no differences among children who were pubertal (all p [ 0.05). Changes in aBMD did not differ by sex (all p [ 0.05), although the number of studies providing malespecific results was small (six of 22 eligible studies included boys). There was significant heterogeneity in bone

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Section: Discussionmentioning

confidence: 99%

Section: Search Strategy and Criteriamentioning

confidence: 99%

See 1 more Smart Citation

Does Exercise Influence Pediatric Bone? A Systematic Review

Specker

Thiex

Sudhagoni

2015

Clinical Orthopaedics &Amp; Related Research

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“…Dietary requirements for calcium (Ca) and phosphorus (P) are increased and almost 50% of total bone mineral is deposited at 9-18 y in females and 10-20 y in males (Matkovic, 1991). Several Ca supplementation studies have been conducted in children and adolescents, which have shown that Ca supplementation is associated with increases in bone mineral content, which may be attributable to a reduction in bone turnover rate mediated by reduced parathyroid hormone (PTH) secretion (Johnston et al, 1992;Lloyd et al, 1993;Cadogan et al, 1997;Slemenda et al, 1997;Dibba et al, 2000;Wastney et al, 2000;Ginty et al 2002a, b;Prentice et al, 2002;Stear et al, 2003). In adults, other nutrients have been postulated to have direct and/or indirect effects on Ca and bone metabolism and bone mineral status, including magnesium (Mg) (Sojka & Weaver, 1995;Tucker et al, 1999;New et al, 2000), vitamin D (Holick, 1996), and potassium (K) (Sojka & Weaver, 1995;Tucker et al, 1999;New et al, 2000).…”

Section: Introductionmentioning

confidence: 99%

Effects of usual nutrient intake and vitamin D status on markers of bone turnover in Swiss adolescents

et al. 2004

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Objective: To evaluate the effects of nutrient intake and vitamin D status on markers of type I collagen formation and degradation in adolescent boys and girls. Design: Cross-sectional study. Setting: Canton of Vaud, West Switzerland. Subjects: A total of 92 boys and 104 girls, aged 11-16 y. Data were collected on height, weight, pubertal status (self-assessment of Tanner stage), nutrient intake (3-day dietary record) and fasting serum concentration of 25-hydroxyvitamin D (25OHD), and markers of collagen formation (P1NP) and degradation (serum C-terminal telopeptides: S-CTX). Results: Tanner stage was a significant determinant of P1NP in boys and girls and S-CTX in girls. Of the nutrients examined, only the ratio of calcium to phosphorus (Ca/P) was positively associated with P1NP in boys, after adjustment for pubertal status. 25OHD decreased significantly at each Tanner stage in boys. Overall, 15% of boys and 17% of girls were identified as being vitamin D insufficient (serum 25OHD o30 nmol/l), with the highest proportion of insufficiency at Tanner stage 4-5 (29%) in boys and at Tanner stage 3 (24%) in girls. A significant association was not found between 25OHD and either bone turnover marker, nor was 25OHD insufficiency associated with higher concentrations of the bone turnover markers. Conclusions: The marked effects of puberty on bone metabolism may have obscured any possible effects of diet and vitamin D status on markers of bone metabolism. The mechanistic basis for the positive association between dietary Ca/P ratio and P1NP in boys is not clear and may be attributable to a higher Ca intake per se, a critical balance between Ca and P intake or higher dairy product consumption. A higher incidence of vitamin D insufficiency in older adolescents may reflect a more sedentary lifestyle or increased utilisation of 25OHD, and suggests that further research is needed to define their requirements.

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“…In general, studies support the view that moderate weightbearing activity has a more positive effect on bone mass than do non-weight-bearing activities, which impose minimal physical strain on bone (Cromer & Harel, 2000). Several studies have shown that both exercise and calcium interventions have an overall beneficial impact on bone acquisition during childhood and adolescence (Stear et al, 2003). According to Anderson (2001), physical activities during the critical growing years make important contributions to the accrual of bone mass, perhaps independently of calcium intake.…”

Section: Osteoporosis 424mentioning

confidence: 75%