Early Identification of Children Predisposed to Low Peak Bone Mass and Osteoporosis Later in Life¹

Abstract

The amount of bone that is gained during adolescence is the main contributor to peak bone mass, which, in turn, is a major determinant of osteoporosis and fracture risk in the elderly. We examined whether computed tomography measurements for the density and the volume of bone in the axial and the appendicular skeletons could be tracked through puberty in 40 healthy white children (20 girls and 20 boys). Longitudinal measurements of the cross-sectional area and cancellous bone density of the vertebral bodies and the cross-sectional and cortical bone areas of the femurs at the beginning of puberty accounted for 62-92% of the variations seen at sexual maturity; on average, 3 yr later. When baseline values for these bone traits were divided into quartiles, a linear relation across Tanner stages of sexual development was observed for each quartile in both girls and boys. The regression lines differed among quartiles for each trait, paralleled each other, and did not overlap. Thus, we are now in a position to identify those children who are genetically prone to develop low values for peak bone mass and toward whom osteoporosis prevention trials should be geared. (J Clin Endocrinol Metab 85: 3908 -3918, 2000) R ECENT DATA suggest that the genetic susceptibility to osteoporosis may be detectable in early childhood (1). Studies have shown a familial resemblance for bone mineral mass between prepubertal girls and their mothers and that genes linked to osteoporosis and/or fractures in adulthood are associated with low bone mass in prepubertal children (1-3). In addition, peak bone mass, a major determinant of the risk for osteoporosis and fractures in the elderly, is virtually achieved at the end of sexual development in the lumbar spine and the femur (4 -6). By the age of 16 yr, most children have completed sexual maturity, and studies have shown that bone mass values in girls by this age are equal or greater to that of their premenopausal mothers (7,8).Puberty is the time of life when the greatest acquisition of bone occurs (6, 9). Regardless of gender, bone mass more than doubles during puberty (10). In this study, we used computed tomography (CT) to longitudinally measure the densities of cancellous and cortical bone and the crosssectional dimensions of bone in the axial and appendicular skeletons of children at each Tanner stage of sexual development from early puberty to sexual maturity. Our aims were to examine whether measures for quantitative phenotypic traits, which contribute to bone mass and bone strength, at sexual maturity can be predicted from values in early puberty and to assess the constancy of a child's expected measures relative to population percentiles. This knowledge may aid in the early identification of those children who are at risk for osteoporosis and fragility fractures later in life. Subjects and Methods Study populationThe study subjects were healthy white children who were recruited from schools of Los Angeles County. The investigational protocol was approved by the institutional...

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