Association Between Linear Growth and Bone Accrual in a Diverse Cohort of Children and Adolescents,JAMA Pediatrics

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Association Between Linear Growth and Bone Accrual in a Diverse Cohort of Children and Adolescents
JAMA Pediatrics ( IF 24.7 ) Pub Date : 2017-09-05 , DOI: 10.1001/jamapediatrics.2017.1769
Shana E. McCormack ₁ , Diana L. Cousminer ₂ , Alessandra Chesi ₂ , Jonathan A. Mitchell ₃ , Sani M. Roy ₄ , Heidi J. Kalkwarf ₅ , Joan M. Lappe ₆ , Vicente Gilsanz ₇ , Sharon E. Oberfield ₈ , John A. Shepherd ₉ , Karen K. Winer ₁₀ , Andrea Kelly ₁ , Struan F. A. Grant ₁₁ , Babette S. Zemel ₃

Affiliation

Division of Endocrinology and Diabetes, Department of Pediatrics, The Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia
Division of Human Genetics, Department of Pediatrics, The Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia
Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, The Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia
Division of Endocrinology, Department of Pediatrics, Cook Children’s Medical Center, Fort Worth, Texas
Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
College of Nursing, Creighton University, Omaha, Nebraska7Osteoporosis Research Center, School of Medicine, Creighton University, Omaha, Nebraska
Department of Radiology, Children’s Hospital Los Angeles, Keck School of Medicine of USC, University of Southern California, Los Angeles9Department of Pediatrics, Children’s Hospital Los Angeles, Keck School of Medicine of USC, University of Southern California, Los Angeles
Division of Pediatric Endocrinology, Diabetes and Metabolism, Department of Pediatrics, Columbia University, New York, New York
Department of Radiology and Biomedical Imaging, University of California, San Francisco
Pediatric Growth and Nutrition Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health, Bethesda, Maryland
Division of Endocrinology and Diabetes, Department of Pediatrics, The Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia2Division of Human Genetics, Department of Pediatrics, The Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia

Importance Prevention of osteoporosis in adulthood begins with optimizing bone health in early life. The longitudinal association between growth and bone accretion during childhood is not fully understood. Objectives To assess the acquisition of whole-body (WB) and skeletal site–specific bone mineral content (BMC) relative to linear growth in a healthy, diverse, longitudinal cohort of children, adolescents, and young adults and to test for differences related to sex and African American race. Design, Setting, and Participants This investigation was a mixed longitudinal study with annual assessments for up to 7 years at 5 US clinical centers. Participants were healthy children, adolescents, and young adults. The study dates were July 2002 through March 2010. The dates of the analysis were June through December 2016. Main Outcomes and Measures Anthropometrics, BMC, and body composition via dual-energy x-ray absorptiometry. The superimposition by translation and rotation (SITAR) analysis method was used to define the mean trajectories for height, WB lean soft tissue, appendicular lean soft tissue, and WB and skeletal site–specific BMC acquisition and to measure the age and magnitude of peak velocity for each parameter. The SITAR modeling was performed separately by sex and self-reported race. Results Among 2014 healthy children, adolescents, and young adults (1022 [50.7%] female and 479 [23.8%] African American) aged 5 to 19 years at study entry, the mean age of peak height velocity was 13.1 years (95% CI, 13.0-13.2 years) in African American boys vs 13.4 years (95% CI, 13.3-13.4 years) in non-African American boys (difference, −0.3 years; 95% CI, −0.4 to −0.1 years) and 11.0 years (95% CI, 10.8-11.1 years) in African American girls vs 11.6 years (95% CI, 11.5-11.6 years) in non-African American girls (difference, −0.6 years; 95% CI, −0.7 to −0.5 years). Age of peak acquisition of WB BMC was 14.0 years (95% CI, 13.8-14.1 years) in African American boys vs 14.0 years (95% CI, 13.9-14.1 years) in non-African American boys (difference, −0.0 years; 95% CI, −0.2 to 0.2 years) and 12.1 years (95% CI, 12.0-12.3 years) in African American girls vs 12.4 years (95% CI, 12.3-12.5 years) in non-African American girls (difference, −0.3 years; 95% CI, −0.4 to −0.1 years). At age 7 years, children had acquired 69.5% to 74.5% of maximal observed height but only 29.6% to 38.1% of maximal observed WB BMC. Adolescents gained 32.7% to 35.8% of maximal observed WB BMC during the 2 years before and 2 years after peak height velocity. Another 6.9% to 10.7% of maximal observed WB BMC occurred after linear growth had ceased. In the group at highest risk for fracture, non-African American boys, peak fracture incidence occurred approximately 1 year before peak height velocity. Conclusions and Relevance In this longitudinal study, height gains substantially outpaced gains in BMC during childhood, which could contribute to fracture risk. A significant proportion of bone is accrued after adult height is achieved. Therefore, late adolescence represents a potentially underrecognized window of opportunity to optimize bone mass.

中文翻译：

不同儿童和青少年队列中线性生长与骨增量之间的关联

重要性成年期骨质疏松症的预防始于优化生命早期的骨骼健康。儿童时期生长和骨骼增生之间的纵向关联尚未完全了解。目的评估相对于健康、多样化、纵向队列的儿童、青少年和年轻成人中线性生长的全身 (WB) 和骨骼部位特定骨矿物质含量 (BMC) 的获取情况，并测试与性和非裔美国人种族。设计、设置和参与者这项调查是一项混合纵向研究，在 5 个美国临床中心进行了长达 7 年的年度评估。参与者是健康的儿童、青少年和年轻人。研究日期为 2002 年 7 月至 2010 年 3 月。分析日期为 6 月至 2016 年 12 月。主要结果和措施通过双能 X 射线吸收测定法测量人体测量学、BMC 和身体成分。平移和旋转叠加 (SITAR) 分析方法用于定义身高、WB 瘦软组织、附肢瘦软组织以及 WB 和骨骼部位特定 BMC 采集的平均轨迹，并测量峰值速度的年龄和幅度对于每个参数。SITAR 建模按性别和自我报告的种族分开进行。结果在研究开始时 2014 年 5 至 19 岁的健康儿童、青少年和年轻成人（1022 [50.7%] 名女性和 479 [23.8%] 非裔美国人）中，身高速度峰值的平均年龄为 13.1 岁（95% CI , 13.0-13.2 岁) 与非非洲裔美国男孩的 13.4 岁 (95% CI, 13.3-13.4 岁) (差异, -0.3 岁; 95% CI, -0.4 到 -0)。1 岁）和 11.0 岁（95% CI，10.8-11.1 岁）对比非非洲裔美国女孩的 11.6 岁（95% CI，11.5-11.6 岁）（差异，-0.6 岁；95% CI， -0.7 至 -0.5 年）。非裔美国男孩获得 WB BMC 的峰值年龄为 14.0 岁（95% CI，13.8-14.1 岁），而非非洲裔美国男孩为 14.0 岁（95% CI，13.9-14.1 岁）（差异，-0.0 岁；非洲裔美国女孩的 95% CI，-0.2 至 0.2 岁）和 12.1 岁（95% CI，12.0-12.3 岁）与非非洲裔美国女孩的 12.4 岁（95% CI，12.3-12.5 岁）（差异，- 0.3 年；95% CI，-0.4 至 -0.1 年）。在 7 岁时，儿童获得了最大观察身高的 69.5% 至 74.5%，但仅达到最大观察 WB BMC 的 29.6% 至 38.1%。青少年增加了 32.7% 至 35。在峰值高度速度之前 2 年和之后 2 年期间观察到的最大 WB BMC 的 8%。在线性生长停止后，另外 6.9% 到 10.7% 的最大观察到的 WB BMC 发生。在骨折风险最高的组中，非非洲裔美国男孩，骨折发生率峰值发生在身高速度峰值前大约 1 年。结论和相关性在这项纵向研究中，儿童时期身高的增长大大超过 BMC 的增长，这可能导致骨折风险。达到成年身高后，骨骼的很大一部分会累积。因此，青春期晚期代表了一个潜在的未被充分认识的优化骨量的机会窗口。峰值骨折发生率发生在峰值高度速度前大约 1 年。结论和相关性在这项纵向研究中，儿童时期身高的增长大大超过 BMC 的增长，这可能导致骨折风险。达到成年身高后，骨骼的很大一部分会累积。因此，青春期晚期代表了一个潜在的未被充分认识的优化骨量的机会窗口。峰值骨折发生率发生在峰值高度速度前大约 1 年。结论和相关性在这项纵向研究中，儿童时期身高的增长大大超过 BMC 的增长，这可能导致骨折风险。达到成年身高后，骨骼的很大一部分会累积。因此，青春期晚期代表了一个潜在的未被充分认识的优化骨量的机会窗口。

更新日期：2017-09-05

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