Children who avoid drinking cow’s milk are at increased risk for prepubertal bone fractures

Goulding, Ailsa; Rockell, Jennifer; Black, Ruth E.; Grant, Andrea M.; Jones, Ianthe E.; Williams, Sheila

doi:10.1016/j.jada.2003.11.008

Cited by 202 publications

(122 citation statements)

References 35 publications

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“…[1][2][3][4] are data that support an increased incidence of fractures in children who are overweight. [10][11][12]14,15 This may be explained in part by recent observations that longitudinal calcium intake is negatively correlated with body fat percentage and BMI in children. 14,22,23 Overweight children also have lower bone mass and bone area (as measured by dual-energy x-ray absorptiometry) relative to their body weight than do children with healthy body weight, which may predispose overweight children to fractures.…”

Section: Figurementioning

confidence: 99%

“…These approaches include (1) measurement of calcium balance with various levels of calcium intake with or without use of calcium stable isotopes methodology, 32,33,45 (2) measurement of bone mineral content by dual-energy x-ray absorptiometry or other radiographic techniques in groups of children before and after calcium supplementation, 46,47 and (3) epidemiologic studies of the association of fracture incidence in children with bone mineral content or relating bone mass and/or fracture risk in adults to childhood calcium intake. [10][11][12][13][14][15]48,49 None of these approaches are useful in the office setting.…”

Section: Determining Adequate Calcium Intake In Children and Adolescentsmentioning

confidence: 99%

“…These same investigators have also found an increased number of childhood fractures in children who avoided drinking milk. 14,15 Additional prospective studies on the relationship between calcium intake and fractures are needed before the magnitude of increased fracture risk at different calcium intake levels can be fully assessed. However, currently available evidence suggests that low calcium intakes may be an important risk factor for fractures.…”

mentioning

confidence: 99%

“…However, currently available evidence suggests that low calcium intakes may be an important risk factor for fractures. [10][11][12][13][14][15] In addition to the calcium and vitamin D content of the general diet, other dietary factors are important to maximize retention of dietary calcium. Dietary substances that may decrease retention include alcohol, caffeine, oxalates, phytates (eg, in soy), and protein.…”

mentioning

confidence: 99%

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Optimizing Bone Health and Calcium Intakes of Infants, Children, and Adolescents

Greer¹,

Krebs²

2006

Pediatrics

283

180

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Most older children and adolescents in the United States currently do not achieve the recommended intake of calcium. Maintaining adequate calcium intake during childhood and adolescence is necessary for the development of peak bone mass, which may be important in reducing the risk of fractures and osteoporosis later in life. Optimal calcium intake is especially relevant during adolescence, when most bone mineral accretion occurs. Because of the influence of the family's diet on the diet of children and adolescents, adequate calcium intake by all members of the family is important. Assessment of calcium intake can be performed in the physician's office. A well-rounded diet including low-fat dairy products, fruits, and vegetables and appropriate physical activity are important for achieving good bone health. Establishing these practices in childhood is important so that they will be followed throughout the life span. OVERVIEW AND BACKGROUNDNational survey data consistently show that most US children older than 8 years fail to achieve the recommended intake of calcium [1][2][3][4] (Fig 1). Maintaining adequate calcium intake during childhood and adolescence is necessary for the attainment of peak bone mass, which may be important in reducing the risk of fractures and osteoporosis later in life. 3,4 Approximately 99% of total body calcium is found in the skeleton, with only small amounts found in the plasma and extravascular fluid. The primary need for dietary calcium is for bone mineral deposition. Hypocalcemia and calcium-deficiency rickets are uncommon in healthy infants, children, and adolescents. Overall calcium homeostasis is maintained by the actions of calcium-regulating hormones, which most notably include parathyroid hormone, calcitonin, and 1,25-dihydroxyvitamin D. Calcium is absorbed in the intestine by both passive and active processes, the active process being more important in situations in which dietary calcium intakes are suboptimal. The ability to respond to low calcium intakes is limited, however, and active absorption does not compensate for low intake. The active process requires vitamin D, which emphasizes the fact that good bone health requires satisfactory intakes of both calcium and vitamin D. The current recommended adequate vitamin D intake for all infants (including those who are breastfeeding), children, and adolescents is 200 IU per day (5.0 g per day). 4,5 Optimizing calcium intake is particularly important during adolescence. Peak calcium-accretion rate is attained at an average of 12.5 years of age in girls and All clinical reports from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffirmed, revised, or retired at or before that time.The guidance in this report does not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate.

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Section: Figurementioning

confidence: 99%

Section: Determining Adequate Calcium Intake In Children and Adolescentsmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Optimizing Bone Health and Calcium Intakes of Infants, Children, and Adolescents

Greer¹,

Krebs²

2006

Pediatrics

283

180

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“…[7][8][9][10] Similarly, studies of predominantly healthy white children with forearm fractures demonstrate an association with lower BMD relative to peers without forearm fractures. [11][12][13][14][15][16] Other factors associated with forearm fracture risk in white children include low dietary calcium intake, 17 low dietary milk intake, 17 and high BMI. 12,13 Although low 25-hydroxyvitamin D levels are associated with lower BMD [18][19][20][21] and increased risk of osteoporotic fractures in adults, 22,23 the association of 25-hydroxyvitamin D status with forearm fracture risk in children has not been previously reported.…”

mentioning

confidence: 99%

Bone Mineral Density and Vitamin D Status Among African American Children With Forearm Fractures

2012

PEDIATRICS

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WHAT'S KNOWN ON THIS SUBJECT: Forearm fractures are unique injuries which are associated with lower bone mineral density in adults and white children. The relationships among bone mineral density, 25-hydroxyvitamin D status, and risk for forearm fracture have not been investigated in African American children. WHAT THIS STUDY ADDS:Our data support an association between both lower bone mineral density and vitamin D deficiency and increased odds of forearm fracture in African American children. Promotion of bone health is indicated in this population.abstract OBJECTIVE: To determine whether African American children with forearm fractures have decreased bone mineral density and an increased prevalence of vitamin D deficiency (serum 25-hydroxyvitamin D level #20 ng/mL) compared with fracture-free control patients. METHODS:This case-control study in African American children, aged 5 to 9 years, included case patients with forearm fracture and control patients without fracture. Evaluation included measurement of bone mineral density and serum 25-hydroxyvitamin D level. Univariable and multivariable analyses were used to test for associations between fracture status and 2 measures of bone health (bone mineral density and 25-hydroxyvitamin D level) while controlling for other potential confounders. RESULTS:The final sample included 76 case and 74 control patients. There were no significant differences between case and control patients in age, gender, parental education level, enrollment season, outdoor play time, height, or mean dietary calcium nutrient density. Cases were more likely than control patients to be overweight (49.3% vs 31.4%, P = .03). Compared with control patients, case patients had lower whole body z scores for bone mineral density (0.62 6 0.96 vs 0.98 6 1.09; adjusted odds ratio 0.38 [0.20-0.72]) and were more likely to be vitamin D deficient (47.1% vs 40.8%; adjusted odds ratio 3.46 [1.09-10.94]). CONCLUSIONS:These data support an association of lower bone mineral density and vitamin D deficiency with increased odds of forearm fracture among African American children. Because suboptimal childhood bone health also negatively impacts adult bone health, interventions to increase bone mineral density and correct vitamin D deficiency are indicated in this population to provide short-term and long-term benefits. Pediatrics 2012;130:e553-e560

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Milk, Dairy Fat, Dietary Calcium, and Weight Gain

Berkey

Rockett²,

Willett³

et al. 2005

Arch Pediatr Adolesc Med

252

202

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Children who avoid drinking cow’s milk are at increased risk for prepubertal bone fractures

Cited by 202 publications

References 35 publications

Optimizing Bone Health and Calcium Intakes of Infants, Children, and Adolescents

Optimizing Bone Health and Calcium Intakes of Infants, Children, and Adolescents

Bone Mineral Density and Vitamin D Status Among African American Children With Forearm Fractures

Milk, Dairy Fat, Dietary Calcium, and Weight Gain

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