Pubertal Timing Predicts Previous Fractures and BMD in Young Adult Men: The GOOD Study

Abstract

The importance of pubertal timing for adult BMD in males was studied through association of pubertal timing with young adult bone phenotype. Pubertal timing was found to predict both cortical and trabecular volumetric BMD and previous fractures in young adult men. Thus, late puberty is a risk factor for low BMD and previous fractures in young adult men.Introduction: Peak bone mass (PBM), achieved during puberty, is a determinant of the risk for osteoporosis and future fractures. The role of variations within the normal range in pubertal timing for fractures during pubertal development and for adult bone mass in men is unknown. Materials and Methods:The aim of this study was to investigate the importance of pubertal timing for adult BMD and for fractures before achievement of PBM in men. The population-based Gothenburg Osteoporosis and Obesity Determinants (GOOD) study is a well-characterized cohort of young adult Swedish males 18-20 years of age. Detailed growth charts from birth to 18-20 years of age were retrieved for 642 men participating in the GOOD study. Age at peak height velocity (PHV) was estimated and used as an assessment of pubertal timing. The skeletal phenotype was analyzed at young adult age using DXA and pQCT and previous fractures were assessed by questionnaires. Results: Age at PHV was a negative independent predictor of both adult cortical and trabecular volumetric BMD and of total body and radius areal BMD. Moreover, age at PHV was associated with previous fractures in a logistic regression analysis. The OR for cortical osteopenia was 2.49 (95% CI, 1.91-3.24; p < 0.001) and for previous upper limb fractures was 1.35 (95% CI, 1.04-1.75; p < 0.05) per year increment in age at PHV. Conclusions: Age at PHV is a negative independent predictor of BMD and a positive predictor of previous fractures in young adult men. Longitudinal studies to determine if pubertal timing also predicts BMD and fractures in elderly men are required.

Catch up in bone acquisition in young adult men with late normal puberty

“…Pubertal timing affects BMD accrual during adolescence, (12)(13)(14)22) and has been reported to be associated with BMD in adulthood and old age in women in several, but not all, studies. (1,(5)(6)(7)(23)(24)(25)(26) This relationship has been mainly studied in women, partly because menarcheal age is a rather reliable and easily assessed measure of pubertal timing.…”

“…(12) Boot and colleagues (22) observed in a study of 500 children and adolescents (4-20 years of age) that an earlier age at menarche was associated with higher BMD at the lumbar spine and total body in a substudy including girls who had experienced menarche (n ¼ 143). The relationship between pubertal onset in boys and BMD was not investigated in that study.…”

“…(15,16) For 641 subjects, a representative subset of the complete GOOD material, detailed growth and weight charts from birth until 19 years of age were obtained in order to calculate peak height velocity, as described. (12) Five years later, they were contacted by letter and telephone and invited to participate in the 5-year follow-up study, as described. (17) Out of the 641 subjects with available peak height velocity (PHV) data, 501 men, 24.1 AE 0.6 years of age, completed the measurements at the follow-up and were included in the present study.…”

“…We have earlier reported, in the Gothenburg Osteoporosis and Obesity (GOOD) study of 19-year-old males in Sweden, that late but normal puberty was associated with lower BMD and previous fracture in a cross-sectional study. (12) Gilsanz and colleagues (13) recently reported that areal BMD (aBMD) at all sites was inversely related to the timing of puberty in teenagers of both genders, in a healthy cohort with variations in puberty within the normal range. In contrast, Jackowski and colleagues (14) reported no significant differences in bone mineral content (BMC) in early, middle, and late maturing men in late adolescence.…”

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

“…(41) An increased arm span and longer limb length could be indicators for a late puberty, which is indeed a risk factor for low bone mass and fractures. (41,42) In this regard, sex steroids and especially estradiol again could play a role in pubertal timing, limb growth, and bone expansion. Based on the observations in girls with late puberty, showing that a deficit in aBMD could be observed prior to menarche, Chevalley and colleagues proposed an alternative hypothesis.…”