Four-Year Gain in Bone Mineral in Girls With and Without Past Forearm Fractures: A DXA Study

Abstract

We have previously shown that girls with a recent distal forearm fracture have weaker skeletons than girls who have never fractured. This could be a transient or persistent phenomenon. The present study was undertaken to determine whether the bone mineral content (BMC) of girls with previous distal forearm fractures remains lower 4 years postfracture or if catch-up gain has occurred. We report baseline and follow-up dual energy X-ray absorptiometry (DXA) results for 163 girls: 81 girls from the original control group who remained free of fracture (group 1) and 82 girls from the original group with distal forearm fractures (group 2). In data adjusted for bone area, height, weight, and pubertal status, group 2 girls had 3.5-8.5% less BMC at the total body, lumbar spine, ultradistal radius, and hip trochanter than group 1 at baseline, and 2.4 -5.7% less BMC at these sites at follow-up. Even girls from group 2 who did not experience another fracture after baseline (n ‫؍‬ 58) did not display greater BMC at follow-up compared with baseline values at any site, indicating that the decreased BMC at the time of fracture had persisted. In group 2, the relative gain in BMC after adjusting for the initial BMC and current bone area, height, weight, and pubertal stage was less than or similar to, but not greater than that of group 1 (ratio [ 95%

A Pediatric Bone Mass Scan Has Poor Ability to Predict Adult Bone Mass: A 28-Year Prospective Study in 214 Children

“…There are prospective studies that have followed bone mass in the short term perspective during growth [11][12][13][14][19][20][21][22] .…”

“…As girls in the study experienced menarche at a mean age of 12.7 years (range [10][11][12][13][14][15][16][17][18] and boys are known to reach puberty approximately 1.5 year later 25 we stratified children below and above age 10 years. We hence predominantly include children before they reach the fast pre-pubertal growth spurt 25 in the strata of children <10 years.…”

“…Distal forearm bone mineral content (BMC; g), bone mineral density (BMD; g/cm 2 ), and bone width (cm) were measured by single-photon absorptiometry (SPA) in 120 boys with a mean age of 9.9 years (range 3-17) and 94 girls with a mean age of 10.7 years (range [4][5][6][7][8][9][10][11][12][13][14][15][16][17]. The children were included from three published cohort studies between the years 1979-1981: 48 boys and 28 girls with a previous fracture 16 , 31 boys and 25 girls with premature birth 17 and 41 boys and 43 girls from a healthy control cohort within same ages [16][17][18] .…”

“…There are some reports that infer a childhood excess [7][8] or deficit [9][10] in BMD to remain in adulthood and the few prospective studies that have addressed this question infer a partial tracking of BMD during growth [11][12][13][14] But, as these the studies have all been shorter than a decade and terminated before the age of 17, and since peak bone mass is reached later 15 , it seems unlikely that peak bone mass was actually captured in any of these.…”

Prevalent fractures are related to cortical bone geometry in young healthy men at age of peak bone mass

“…(6,32) In prospective cohorts of young girls, low areal bone mass was a risk for incident fracture, and the observed low bone mass was found to persist after puberty. (33,34) Moreover, in girls with childhood fractures, a lower BMC, smaller bone area, and smaller bone width as assessed by DXA were observed after puberty (16 years of age) but also prior to menarche (9 years of age). These findings provide evidence that childhood fractures are associated with low peak bone mass and could be a marker for persistent bone fragility in women.…”