Associations Between Body Composition and Bone Health in Children and Adolescents: A Systematic Review

More clarification on the associations between children's and adolescents' lean and fat mass (LM and FM) on the one hand and their bone health on the other hand is needed, given the rising prevalence of overweight and obesity in this population. This systematic literature review aimed to describe the current evidence on these associations. Data sources were Medline/PubMed, EMBASE, CINAHL and The Cochrane Library (up to November 2014). Search items included LM, FM, children and adolescents (0-18 years), bone health measured with dual-energy X-ray absorptiometry and peripheral quantitative computed tomography (pQCT) and search items concerning study design: observational and longitudinal studies. The study populations were healthy children and adolescents including obese children. Children with other diseases and clinical series of study subjects were excluded. Based on the studies included in this review (n = 19), there is a consensus that the contribution of LM to the variance of the different bone parameters is larger than the contribution of FM and that an increase in LM is associated with an increase in bone parameters. Most of the studies indicated that the increase in bone parameters seen in overweight and obese children and adolescents is due to an increase in LM and not to greater FM. The results on the association between body fat and bone parameters were contradictory and depended on children's age and sex. Still more data from studies with a longitudinal study design using (high resolution) pQCT and a representative sample are needed to get further insight in the associations between body fat and bone parameters in children, specifically concerning differences in sex, skeletal site and fat depots.