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Prenatal and childhood influences on osteoporosis
1MRC Environmental Epidemiology Unit, Southampton General Hospital, Southampton, SO16 6YD, UK.
Insights
Maximizing peak bone mass in childhood and adolescence through diet and physical activity is crucial for preventing osteoporosis and fractures later in life. Early life factors, including maternal health, also significantly impact bone strength throughout adulthood.
Area of Science:
- Bone biology and osteoporosis research.
- Pediatric and adolescent skeletal development.
- Public health and preventive medicine.
Background:
- Osteoporosis is a significant cause of fractures and mortality, particularly in older adults.
- While preventing age-related bone loss is important, peak bone mass achieved during youth is a key determinant of lifelong bone strength.
- Factors influencing bone mass accumulation include genetics, lifestyle, and early life exposures.
Purpose of the Study:
- To review the factors influencing peak bone mass acquisition during childhood and adolescence.
- To highlight the role of early life programming, including intrauterine and infancy periods, on adult bone health.
- To emphasize preventive strategies for osteoporosis targeting bone mineral acquisition.
Main Methods:
- Review of cross-sectional and longitudinal studies on skeletal growth patterns.
- Analysis of factors affecting bone mineral accrual, including diet, physical activity, and endocrine status.
- Examination of epidemiological data linking birth weight, childhood growth, and adult bone mass.
Main Results:
- Boys generally have higher bone mineral content than girls, with peak bone density increasing during puberty.
- Peak height velocity and peak bone mineral accrual are dissociated.
- Heredity, gender, diet, physical activity, endocrine status, and maternal factors (smoking, diet, activity) influence bone mass.
- Low birth weight and poor childhood growth are associated with increased hip fracture risk in adulthood.
Conclusions:
- Optimizing bone mineral acquisition during childhood and adolescence is vital for fracture prevention in later life.
- Encouraging physical activity and adequate calcium intake are key modifiable factors.
- Maternal nutrition and optimizing intrauterine growth are important preventive strategies for future generations' bone health.
Abstract:
Osteoporosis is a major cause of morbidity and mortality through its association with age-related fractures. Although most effort in fracture prevention has been directed at retarding the rate of age-related bone loss, and reducing the frequency and severity of trauma among elderly people, evidence is growing that peak bone mass is an important contributor to bone strength during later life. The normal patterns of skeletal growth have been well characterized in cross-sectional and longitudinal studies. It has been confirmed that boys have higher bone mineral content, but not volumetric bone density, than girls. Furthermore, in both genders there is a dissociation between the peak velocities for height gain and bone mineral accrual. Puberty is the period during which volumetric density appears to increase in both axial and appendicular sites. Many factors influence the accumulation of bone mineral during childhood and adolescence, including heredity, gender, diet, physical activity, endocrine status and sporadic risk factors such as cigarette smoking. Measures for maximizing bone mineral acquisition, particularly through encouraging physical activity and adequate dietary calcium intake, are likely to affect the risk of fracture in later generations. In addition to these modifiable factors during childhood, evidence has also accrued that the risk of fracture might be programmed during intrauterine life. Epidemiological studies have demonstrated a relationship between birthweight, weight in infancy and adult bone mass. This appears to be mediated through modulation of the set-point for basal activity of pituitary-dependent endocrine systems such as the hypothalamic - pitutiary - adrenal (HPA) and growth hormone/insulin-like growth factor I (GH/IGF-I) axes. Maternal smoking, diet and physical activity levels appear to modulate bone mineral acquisition during intrauterine life; furthermore, both low birth size and poor childhood growth are directly linked to the later risk of hip fracture. The optimization of maternal nutrition and intrauterine growth should also be included within preventive strategies against osteoporotic fracture, albeit for future generations.