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Original Investigation
July 3, 2017

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

Author Affiliations
  • 1Division of Endocrinology and Diabetes, Department of Pediatrics, The Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia
  • 2Division of Human Genetics, Department of Pediatrics, The Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia
  • 3Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, The Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia
  • 4Division of Endocrinology, Department of Pediatrics, Cook Children’s Medical Center, Fort Worth, Texas
  • 5Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
  • 6College of Nursing, Creighton University, Omaha, Nebraska
  • 7Osteoporosis Research Center, School of Medicine, Creighton University, Omaha, Nebraska
  • 8Department of Radiology, Children’s Hospital Los Angeles, Keck School of Medicine of USC, University of Southern California, Los Angeles
  • 9Department of Pediatrics, Children’s Hospital Los Angeles, Keck School of Medicine of USC, University of Southern California, Los Angeles
  • 10Division of Pediatric Endocrinology, Diabetes and Metabolism, Department of Pediatrics, Columbia University, New York, New York
  • 11Department of Radiology and Biomedical Imaging, University of California, San Francisco
  • 12Pediatric Growth and Nutrition Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health, Bethesda, Maryland
JAMA Pediatr. Published online July 3, 2017. doi:10.1001/jamapediatrics.2017.1769
Key Points

Question  How does the association between linear growth and bone accrual during childhood and adolescence affect bone health?

Findings  In this mixed longitudinal study of 2014 healthy children, adolescents, and young adults using an innovative approach to model growth in a diverse cohort, we found that, 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 whole-body bone mineral content. Also, adolescents gained 32.7% to 35.8% of maximal observed whole-body bone mineral content during the 4 years around peak height velocity and another 6.9% to 10.7% of maximal observed whole-body bone mineral content in late adolescence, even after linear growth had ceased.

Meaning  The important physiological lag between gains in bone and gains in height may contribute to the increased risk for fracture in childhood and indicates that late adolescence represents a potentially underrecognized opportunity for clinical and public health interventions to maximize peak bone mass.

Abstract

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.

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