Bone Mineral Density in Postmenarchal Adolescent Girls in the United States: Associated Biopsychosocial Variables and Bone Turnover Markers

Zeev Harel, Melanie Gold, Barbara Cromer, Ann Bruner, Margaret Stager, Laura Bachrach, Kevin Wolter, Carol Reid, Paige Hertweck, Anita Nelson, Dorothy Nelson, Susan M. Coupey, Christine Johnson, Ronald Burkman, Henry Bone

Research output: Contribution to journalArticle

42 Citations (Scopus)

Abstract

Purpose: During adolescence, bone formation prevails over resorption, resulting in accumulation of 40% of peak bone mass throughout this time period. Although multiple studies have explored bone mass accrual during the early stages of puberty, less is known about factors that may influence bone accrual during later years of adolescence. In the present cross-sectional study we examined relationships among bone mineral density (BMD) and demographic factors, behavioral variables, and bone metabolism markers in postmenarchal adolescent girls. Methods: The population was comprised of 389 healthy postmenarchal adolescent girls aged 11-18 years, who were recruited into a prospective study of the effect of depot medroxyprogesterone acetate (DMPA) on bone health in adolescents. At the baseline visit, investigators collected demographic, reproductive health, and lifestyle data, and performed a complete physical examination. Body mass index (BMI) was calculated. Before study initiation, BMD at the lumbar spine, total hip, and femoral neck was measured by dual-energy X-ray absorptiometry (DXA), and markers of bone metabolism (serum bone-specific alkaline phosphatase [BAP], serum osteocalcin, and urinary N-telopeptide [uNTX]) were measured. The baseline data from this study were analyzed to evaluate possible correlates of BMD in postmenarchal adolescent girls. Potential associations between BMD values and other parameters were assessed by analysis of variance and Pearson's correlation coefficient. Results: Participants enrolled in the study had a mean (± SD) chronological age of 14.9 ±1.7 years (range 11-18), mean gynecologic age of 39.9 ±23.0 months (range 1-120) postmenarche, and mean BMI of 23.5 ±4.6 kg/m2 (range 16.0-42.2). Racial/ethnic distribution was 46% African American, 35% Caucasian, and 19% other races; 9% had previously been pregnant. Positive correlations were observed between lumbar spine BMD and chronological age (r = .301, p < .0001), gynecologic age (r = .349, p < .0001), and BMI (r = .371, p < .0001). Total hip and femoral neck BMD values were significantly higher (p < .05 and p < .05, respectively) in African American participants compared with non-African American participants. Previous history of pregnancy was significantly associated with a lower BMD at the lumbar spine (p < .0001) and the total hip (p < .01) when compared with the BMD of adolescents who had never been pregnant. Cigarette smoking and alcohol use were not associated with significant differences in BMD. Negative correlations were observed between gynecologic age and the levels of BAP (r = -.564, p < .0001), osteocalcin (r = -.349, p < .0001), and uNTX (r = -.281, p < .0001), and between lumbar spine BMD and BAP (r = -.363, p < .0001), osteocalcin (r = -.129, p < .05), and uNTX (r = -.202, p < .001) levels. Conclusions: Our data demonstrate that chronological age, gynecologic age, race/ethnicity, BMI, and previous history of pregnancy are markedly associated with BMD in postmenarchal adolescent girls. Bone accretion in the postmenarchal years continues in the face of a slowdown in bone turnover during this time period.

Original languageEnglish (US)
Pages (from-to)44-53
Number of pages10
JournalJournal of Adolescent Health
Volume40
Issue number1
DOIs
StatePublished - Jan 2007

Fingerprint

Bone Remodeling
Bone Density
Bone and Bones
Osteocalcin
Spine
Body Mass Index
Alkaline Phosphatase
Hip
Reproductive History
Femur Neck
African Americans
Demography
Medroxyprogesterone Acetate
Reproductive Health
Photon Absorptiometry
Puberty
Serum
Osteogenesis
Physical Examination
Life Style

Keywords

  • Adolescent
  • Bone density
  • Bone markers
  • Female

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Bone Mineral Density in Postmenarchal Adolescent Girls in the United States : Associated Biopsychosocial Variables and Bone Turnover Markers. / Harel, Zeev; Gold, Melanie; Cromer, Barbara; Bruner, Ann; Stager, Margaret; Bachrach, Laura; Wolter, Kevin; Reid, Carol; Hertweck, Paige; Nelson, Anita; Nelson, Dorothy; Coupey, Susan M.; Johnson, Christine; Burkman, Ronald; Bone, Henry.

In: Journal of Adolescent Health, Vol. 40, No. 1, 01.2007, p. 44-53.

Research output: Contribution to journalArticle

Harel, Z, Gold, M, Cromer, B, Bruner, A, Stager, M, Bachrach, L, Wolter, K, Reid, C, Hertweck, P, Nelson, A, Nelson, D, Coupey, SM, Johnson, C, Burkman, R & Bone, H 2007, 'Bone Mineral Density in Postmenarchal Adolescent Girls in the United States: Associated Biopsychosocial Variables and Bone Turnover Markers', Journal of Adolescent Health, vol. 40, no. 1, pp. 44-53. https://doi.org/10.1016/j.jadohealth.2006.08.013
Harel, Zeev ; Gold, Melanie ; Cromer, Barbara ; Bruner, Ann ; Stager, Margaret ; Bachrach, Laura ; Wolter, Kevin ; Reid, Carol ; Hertweck, Paige ; Nelson, Anita ; Nelson, Dorothy ; Coupey, Susan M. ; Johnson, Christine ; Burkman, Ronald ; Bone, Henry. / Bone Mineral Density in Postmenarchal Adolescent Girls in the United States : Associated Biopsychosocial Variables and Bone Turnover Markers. In: Journal of Adolescent Health. 2007 ; Vol. 40, No. 1. pp. 44-53.
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T1 - Bone Mineral Density in Postmenarchal Adolescent Girls in the United States

T2 - Associated Biopsychosocial Variables and Bone Turnover Markers

AU - Harel, Zeev

AU - Gold, Melanie

AU - Cromer, Barbara

AU - Bruner, Ann

AU - Stager, Margaret

AU - Bachrach, Laura

AU - Wolter, Kevin

AU - Reid, Carol

AU - Hertweck, Paige

AU - Nelson, Anita

AU - Nelson, Dorothy

AU - Coupey, Susan M.

AU - Johnson, Christine

AU - Burkman, Ronald

AU - Bone, Henry

PY - 2007/1

Y1 - 2007/1

N2 - Purpose: During adolescence, bone formation prevails over resorption, resulting in accumulation of 40% of peak bone mass throughout this time period. Although multiple studies have explored bone mass accrual during the early stages of puberty, less is known about factors that may influence bone accrual during later years of adolescence. In the present cross-sectional study we examined relationships among bone mineral density (BMD) and demographic factors, behavioral variables, and bone metabolism markers in postmenarchal adolescent girls. Methods: The population was comprised of 389 healthy postmenarchal adolescent girls aged 11-18 years, who were recruited into a prospective study of the effect of depot medroxyprogesterone acetate (DMPA) on bone health in adolescents. At the baseline visit, investigators collected demographic, reproductive health, and lifestyle data, and performed a complete physical examination. Body mass index (BMI) was calculated. Before study initiation, BMD at the lumbar spine, total hip, and femoral neck was measured by dual-energy X-ray absorptiometry (DXA), and markers of bone metabolism (serum bone-specific alkaline phosphatase [BAP], serum osteocalcin, and urinary N-telopeptide [uNTX]) were measured. The baseline data from this study were analyzed to evaluate possible correlates of BMD in postmenarchal adolescent girls. Potential associations between BMD values and other parameters were assessed by analysis of variance and Pearson's correlation coefficient. Results: Participants enrolled in the study had a mean (± SD) chronological age of 14.9 ±1.7 years (range 11-18), mean gynecologic age of 39.9 ±23.0 months (range 1-120) postmenarche, and mean BMI of 23.5 ±4.6 kg/m2 (range 16.0-42.2). Racial/ethnic distribution was 46% African American, 35% Caucasian, and 19% other races; 9% had previously been pregnant. Positive correlations were observed between lumbar spine BMD and chronological age (r = .301, p < .0001), gynecologic age (r = .349, p < .0001), and BMI (r = .371, p < .0001). Total hip and femoral neck BMD values were significantly higher (p < .05 and p < .05, respectively) in African American participants compared with non-African American participants. Previous history of pregnancy was significantly associated with a lower BMD at the lumbar spine (p < .0001) and the total hip (p < .01) when compared with the BMD of adolescents who had never been pregnant. Cigarette smoking and alcohol use were not associated with significant differences in BMD. Negative correlations were observed between gynecologic age and the levels of BAP (r = -.564, p < .0001), osteocalcin (r = -.349, p < .0001), and uNTX (r = -.281, p < .0001), and between lumbar spine BMD and BAP (r = -.363, p < .0001), osteocalcin (r = -.129, p < .05), and uNTX (r = -.202, p < .001) levels. Conclusions: Our data demonstrate that chronological age, gynecologic age, race/ethnicity, BMI, and previous history of pregnancy are markedly associated with BMD in postmenarchal adolescent girls. Bone accretion in the postmenarchal years continues in the face of a slowdown in bone turnover during this time period.

AB - Purpose: During adolescence, bone formation prevails over resorption, resulting in accumulation of 40% of peak bone mass throughout this time period. Although multiple studies have explored bone mass accrual during the early stages of puberty, less is known about factors that may influence bone accrual during later years of adolescence. In the present cross-sectional study we examined relationships among bone mineral density (BMD) and demographic factors, behavioral variables, and bone metabolism markers in postmenarchal adolescent girls. Methods: The population was comprised of 389 healthy postmenarchal adolescent girls aged 11-18 years, who were recruited into a prospective study of the effect of depot medroxyprogesterone acetate (DMPA) on bone health in adolescents. At the baseline visit, investigators collected demographic, reproductive health, and lifestyle data, and performed a complete physical examination. Body mass index (BMI) was calculated. Before study initiation, BMD at the lumbar spine, total hip, and femoral neck was measured by dual-energy X-ray absorptiometry (DXA), and markers of bone metabolism (serum bone-specific alkaline phosphatase [BAP], serum osteocalcin, and urinary N-telopeptide [uNTX]) were measured. The baseline data from this study were analyzed to evaluate possible correlates of BMD in postmenarchal adolescent girls. Potential associations between BMD values and other parameters were assessed by analysis of variance and Pearson's correlation coefficient. Results: Participants enrolled in the study had a mean (± SD) chronological age of 14.9 ±1.7 years (range 11-18), mean gynecologic age of 39.9 ±23.0 months (range 1-120) postmenarche, and mean BMI of 23.5 ±4.6 kg/m2 (range 16.0-42.2). Racial/ethnic distribution was 46% African American, 35% Caucasian, and 19% other races; 9% had previously been pregnant. Positive correlations were observed between lumbar spine BMD and chronological age (r = .301, p < .0001), gynecologic age (r = .349, p < .0001), and BMI (r = .371, p < .0001). Total hip and femoral neck BMD values were significantly higher (p < .05 and p < .05, respectively) in African American participants compared with non-African American participants. Previous history of pregnancy was significantly associated with a lower BMD at the lumbar spine (p < .0001) and the total hip (p < .01) when compared with the BMD of adolescents who had never been pregnant. Cigarette smoking and alcohol use were not associated with significant differences in BMD. Negative correlations were observed between gynecologic age and the levels of BAP (r = -.564, p < .0001), osteocalcin (r = -.349, p < .0001), and uNTX (r = -.281, p < .0001), and between lumbar spine BMD and BAP (r = -.363, p < .0001), osteocalcin (r = -.129, p < .05), and uNTX (r = -.202, p < .001) levels. Conclusions: Our data demonstrate that chronological age, gynecologic age, race/ethnicity, BMI, and previous history of pregnancy are markedly associated with BMD in postmenarchal adolescent girls. Bone accretion in the postmenarchal years continues in the face of a slowdown in bone turnover during this time period.

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KW - Bone markers

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