Reduced Spinal Bone Mineral Density in Adolescents of an Ultra-Orthodox Jewish Community in Brooklyn

Abstract

ABSTRACT. Objectives. Bone mass increases throughout childhood, with maximal bone mass accrual rate occurring in early to mid-puberty and slowing in late puberty. Prevention of osteoporosis and its morbidities depends primarily on the establishment of adequate peak bone mass. Physical activity, calcium intake, and vitamin D stores (from sunlight conversion of precursors of vitamin D and to a lesser degree from dietary intake) are vital determinants of bone mineral density (BMD). BMD is further controlled by genetic and environmental factors that are poorly understood.Observance of ultra-Orthodox Jewish customs may have a negative effect on the factors that promote bone health, and there have been anecdotal reports of higher fracture rates in this population. The ultra-Orthodox Jewish lifestyle encourages scholarly activity in preference to physical activity. Additionally, modest dress codes and inner-city dwelling reduce sunlight exposure. Orthodox Jews do not consume milk products for 6 hours after meat ingestion, leading to potentially fewer opportunities to consume calcium. Foods from the milk group are some of the best sources of dietary calcium.Our aims are to examine BMD in a group of healthy ultra-Orthodox Jewish adolescents in an urban community and to attempt to correlate it to physical activity and dietary factors.Design and Methods. We recruited 50 healthy, ultraOrthodox Jews, ages 15 to 19 years (30 males and 20 females). None were taking corticosteroids or had evidence of malabsorption. All girls were postmenarchal and nulliparous. Pubic hair Tanner stage for boys and breast Tanner stage for girls were determined. Weight and height standard deviation scores were calculated. Calcium, phosphorus, protein, vitamin D, and calorie intake were assessed using a comprehensive food questionnaire referring to what has been eaten over the last year. Hours per week of weight-bearing exercise and walking were determined. Lumbar spine (L) BMD was assessed by dual energy radiograph absorptiometry. The pediatric software supplied by Lunar Radiation Corporation, which contains gender-and age-specific norms, provided a z score for the lumbar BMD for each participant. L2 to L4 bone mineral apparent density (BMAD) was calculated from L2 to L4 BMD.Results. BMD of L2 to L4 was significantly decreased compared with age/sex-matched normative data: mean z score was ؊1.25 ؎ 1.25 (n ‫؍‬ 50). The mean L2 to L4 BMD z score ؎ standard deviation was ؊1.71 ؎ 1.18 for boys and ؊0.58 ؎ 1.04 for girls. Eight boys (27%) had L2 to L4 BMD z scores <؊2.5, which defines osteoporosis in adulthood. Twenty-seven adolescents (54%), 16 boys and 11 girls, had Tanner stage V. Two participants (4%) had delayed development of Tanner stage V. Mean consumption of calcium by participants under 19 years old was 908 ؎ 506 mg/day (n ‫؍‬ 46), which is lower than the adequate intake of 1300 mg/day for this age. The consumption of phosphorus was 1329 ؎ 606 mg/day, and the consumption of vitamin D was 286 ؎ 173 IU/day (n ‫؍‬ 50).The mean serum 25(OH)D level...

High risk of osteoporosis in male patients with eating disorders

“…Although weight bearing exercise is known to help avert osteoporosis in the general population, there seems to be a varying relationship in anorexia nervosa. Several studies have reported that physical activity [25][26][27] increases bone density, while in other studies of patients with anorexia nervosa, exercise showed no protective capacity regarding BMD. 28,29 Our inability to find a relationship does not necessarily exclude the importance of this variable in influencing BMD; it may reflect that weight-bearing exercise is only protective if menstruation and the endocrinologic milieu has also been preserved.…”

Association of bone microarchitecture with parathyroid hormone concentration and calcium intake in men: the STRAMBO study

“…In young and middle-aged men, 25OHD was weakly correlated positively with BMD at the lumbar spine and the hip (13). The relationship between the PTH level and the BMD in young and middle-aged adults was weak or non-significant (15,29,30). Thus, current PTH secretion does not seem to be a significant determinant of bone mass and microarchitecture in young adult men, although these men may be in the phase of slow bone loss (31).…”

Child injuries in Bergen, Norway

“…Establishment of an adequate peak bone mass is important to avoid osteoporosis and its subsequent comorbidities in later life. 166 Landin and Nilsson found that children with fractures due to low energy trauma had a lower bone density in their cortical forearm bones than children without fractures. This difference was not evident in children with fractures due to high-energy trauma.…”

“…193 A study of ultra-orthodox Jewish adolescents with very little physical activity, measured in walking hours, found that the lumbal BMD was significantly decreased, especially in boys. 166 The relationship between bone mineral density and child fractures have been analysed with different results 32,90 and is further discussed in the chapter on fracture.…”