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Peak Bone Mass and Bone Microarchitecture in Adults Born With Low Birth Weight Preterm or at Term: A Cohort Study
Chandima N D Balasuriya1,2, Kari Anne I Evensen3,4,5, Mats P Mosti1
1Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, 7489 Trondheim, Norway.
Insights
Adults born with very low birth weight (VLBW) or small for gestational age (SGA) have lower peak bone mass, increasing osteoporosis risk. VLBW individuals showed the most significant bone deficits and higher fracture risk.
Area of Science:
- Orthopedics
- Endocrinology
- Public Health
Background:
- Peak bone mass (PBM) is crucial for preventing osteoporosis.
- Intrauterine programming may influence skeletal development.
- Low birth weight (LBW) is a potential risk factor for reduced PBM.
Purpose of the Study:
- To assess PBM and trabecular bone score (TBS) in adults born preterm with very low birth weight (VLBW) or small for gestational age (SGA).
- To compare bone health in VLBW and SGA adults with term-born controls.
- To investigate the long-term skeletal consequences of LBW.
Main Methods:
- Follow-up cohort study of 186 men and women aged 25-28 years.
- Participants included 52 preterm VLBW, 59 term-born SGA, and 75 controls.
- Bone mineral density (BMD), bone mineral content (BMC), TBS, and serum bone markers were measured.
Main Results:
- VLBW adults exhibited lower BMC and BMD compared to controls, even after adjustments.
- Adjusted odds ratios for osteopenia/osteoporosis were significantly higher in VLBW (2.4) and SGA (2.0) adults.
- TBS did not differ between groups, but was lower in men than women.
Conclusions:
- LBW groups demonstrated reduced PBM and increased osteopenia/osteoporosis frequency, indicating higher future fracture risk.
- The most substantial bone deficit was observed in VLBW adults.
- Early life factors significantly impact adult bone health and osteoporosis risk.
Context And Objectives:
Peak bone mass (PBM) is regarded as the most important determinant of osteoporosis. Growing evidence suggests a role of intrauterine programming in skeletal development. We examined PBM and trabecular bone score (TBS) in adults born preterm with very low birth weight (VLBW) or small for gestational age (SGA) at term compared with term-born controls.
Design, Setting, Participants, And Outcomes:
This follow-up cohort study included 186 men and women (25 to 28 years); 52 preterm VLBW (≤1500 g), 59 term-born SGA (<10th percentile), and 75 controls (>10th percentile). Main outcome was bone mineral density (BMD) by dual x-ray absorptiometry. Secondary outcomes were bone mineral content (BMC), TBS, and serum bone markers.
Results:
VLBW adults had lower BMC and BMD vs controls, also when adjusted for height, weight, and potential confounders, with the following BMD Z-score differences: femoral neck, 0.6 standard deviation (SD) (P = 0.003); total hip, 0.4 SD (P = 0.01); whole body, 0.5 SD (P = 0.007); and lumbar spine, 0.3 SD (P = 0.213). The SGA group displayed lower spine BMC and whole-body BMD Z-scores, but not after adjustment. Adjusted odds ratios for osteopenia/osteoporosis were 2.4 and 2.0 in VLBW and SGA adults, respectively. TBS did not differ between groups, but it was lower in men than in women. Serum Dickkopf-1 was higher in VLBW subjects vs controls; however, it was not significant after adjustment for multiple comparisons.
Conclusions:
Both low-birth-weight groups displayed lower PBM and higher frequency of osteopenia/osteoporosis, implying increased future fracture risk. The most pronounced bone deficit was seen in VLBW adults.
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