Effects of Sex, Race, and Puberty on Cortical Bone and the Functional Muscle Bone Unit in Children, Adolescents, and Young Adults

Leonard, Mary B.; Elmi, Angelo; Mostoufi‐Moab, Sogol; Shults, Justine; Burnham, Jon M.; Thayu, Meena; Kibe, Lucy W.; Wetzsteon, Rachel J.; Zemel, Babette S.

doi:10.1210/jc.2009-1913

Cited by 137 publications

(145 citation statements)

References 30 publications

(34 reference statements)

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“…Race, sex, and pubertal differences in pQCT measures of cortical bone and muscle area were recently reported in the CHOP reference participants. 1 A subset of 302 reference participants at CHOP enrolled in an ancillary longitudinal study with an additional visit at 12 months, as previously described. 40 The study protocol was approved by the Institutional Review Boards at CHOP and CCHMC.…”

Section: Study Participantsmentioning

confidence: 99%

“…pQCT results were compared with reference data generated in more than 700 concurrent healthy participants. 1,[19][20][21] The hypotheses were that glucocorticoid exposure and resolution of secondary hyperparathyroidism after renal transplantation would be associated with declines in trabecular BMD and increases in cortical BMD. 12,22 We also hypothesized that increases in muscle area after renal transplantation would be associated with increases in cortical dimensions.…”

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confidence: 99%

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Bone Density and Cortical Structure after Pediatric Renal Transplantation

Terpstra

Kalkwarf²,

Shults³

et al. 2012

Journal of the American Society of Nephrology

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The impact of renal transplantation on trabecular and cortical bone mineral density (BMD) and cortical structure is unknown. We obtained quantitative computed tomography scans of the tibia in pediatric renal transplant recipients at transplantation and 3, 6, and 12 months; 58 recipients completed at least two visits. We used more than 700 reference participants to generate Z-scores for trabecular BMD, cortical BMD, section modulus (a summary measure of cortical dimensions and strength), and muscle and fat area. At baseline, compared with reference participants, renal transplant recipients had significantly lower mean section modulus and muscle area; trabecular BMD was significantly greater than reference participants only in transplant recipients younger than 13 years. After transplantation, trabecular BMD decreased significantly in association with greater glucocorticoid exposure. Cortical BMD increased significantly in association with greater glucocorticoid exposure and greater decreases in parathyroid hormone levels. Muscle and fat area both increased significantly, but section modulus did not improve. At 12 months, transplantation associated with significantly lower section modulus and greater fat area compared with reference participants. Muscle area and cortical BMD did not differ significantly between transplant recipients and reference participants. Trabecular BMD was no longer significantly elevated in younger recipients and was low in older recipients. Pediatric renal transplant associated with persistent deficits in section modulus, despite recovery of muscle, and low trabecular BMD in older recipients. Future studies should determine the implications of these data on fracture risk and identify strategies to improve bone density and structure. During childhood and adolescence, skeletal development is characterized by increases in trabecular and cortical bone mineral density (BMD) and cortical dimensions. 1 Children with CKD have numerous risk factors for impaired bone acquisition, including growth failure, delayed puberty, malnutrition, acidosis, vitamin D deficiency, muscle deficits, and secondary hyperparathyroidism. Successful renal transplantation corrects many of the underlying abnormalities contributing to bone deficits in childhood CKD. However, immunosuppressive therapies and persistent hyperparathyroidism may impair recovery of bone structure and strength. The risk of fracture among adult renal transplant recipients increases in the months after transplantation and then gradually declines. 2 The

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Section: Study Participantsmentioning

confidence: 99%

mentioning

confidence: 99%

Bone Density and Cortical Structure after Pediatric Renal Transplantation

Terpstra

Kalkwarf²,

Shults³

et al. 2012

Journal of the American Society of Nephrology

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“…10 African Americans have greater maturation-specific trabecular density and cortical structural strength. 11 Indeed, we recently examined adult bone loci in a multi-ethnic pediatric setting. 12 Using polygenic risk scores, we demonstrated that adult variants are predictive of BMD early in childhood and adolescence; further, we showed that, within the study cohorts and across populations worldwide, the frequency of those alleles associated with increased BMD is systematically …”

Section: Introductionmentioning

confidence: 99%

Genetics of pediatric bone strength

et al. 2016

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Osteoporosis is one of the most common chronic forms of disability in postmenopausal women and represents a major health burden around the world. Bone fragility is affected by bone mineral density (BMD), and, one of the most important factors in preventing osteoporosis is optimizing peak bone mass, which is achieved during growth in childhood and adolescence. BMD is a complex trait resulting from environmental and genetic factors. Genome-wide association studies have discovered robust genetic signals influencing BMD in adults, and similar studies have also been conducted to investigate the genetics of BMD in the pediatric setting. These latter studies have revealed that many adult osteoporosis-related loci also regulate BMD during growth. These investigations have the potential to profoundly impact public health and will allow for the eventual development of effective interventions for the prevention of osteoporosis.

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“…Femur cross-sectional area, but not cortical area, was also greater in these children, even when taking into consideration the significantly longer femurs in blacks vs. whites. Finally, Leonard et al [136] showed that all tibia cortical bone measures, corrected for tibia length, including BMC, BMD, periosteal and endosteal circumferences, and section modulus, were greater in blacks vs. whites [137]. Unlike the Gilsanz et al [136] study, the differences in vertebral cancellous BMD were less apparent by Tanner stage 5 in this study [137].…”

Section: Skeletal Accretionmentioning

confidence: 43%

“…Finally, Leonard et al [136] showed that all tibia cortical bone measures, corrected for tibia length, including BMC, BMD, periosteal and endosteal circumferences, and section modulus, were greater in blacks vs. whites [137]. Unlike the Gilsanz et al [136] study, the differences in vertebral cancellous BMD were less apparent by Tanner stage 5 in this study [137]. Wetzsteon et al [138] showed in younger adolescents (9e12 years of age) that both blacks and Hispanics have greater radius and tibia vBMD, cortical area and bone strength than whites, after correcting for age, sex as well as bone and muscle size.…”

Section: Skeletal Accretionmentioning

confidence: 99%