Top

Published in:

01-12-2013 | Original Article

Normative data and percentile curves of bone mineral density in healthy Iranian children aged 9–18 years

Authors: Marjan Jeddi, Mohammad Jafar Roosta, Mohammad Hossein Dabbaghmanesh, Gholamhossein Ranjbar Omrani, Sayed Mohammad Taghi Ayatollahi, Zahra Bagheri, Ali Reza Showraki, Marzieh Bakhshayeshkaram

Published in: Archives of Osteoporosis | Issue 1-2/2013

Abstract

Summary

We provide the first reference values for bone mineral content and bone mineral density according to age and sex in Iranian children and adolescents. The prevalence of hypovitaminosis D was high, and levels of physical activity were low in our sample. Multiple regression analyses showed age, BMI, and Tanner stage to be the main indicators of bone mineral apparent density.

Purpose

Normal bone structure is formed in childhood and adolescence. The potential determinants which interact with genetic factors to influence bone density include gender, nutritional, lifestyle, and hormonal factors. This study aimed to evaluate bone mineral content (BMC) and the bone mineral density (BMD) and factors that may interfere with it in Iranian children.

Methods

In this cross-sectional study, 476 healthy Iranian children and adolescents (235 girls and 241 boys) aged 9–18 years old participated. BMC and BMD of the lumbar spine, femoral neck, and total body were measured by dual-energy X-ray absorptiometry using a Hologic Discovery device, and bone mineral apparent density (BMAD) of the lumbar spine and the femoral neck were calculated.

Results

We present percentile curves by age derived separately for BMC, BMD, and BMAD of the lumbar spine, left femoral neck, and total body excluding the head for boys and girls. Maximum accretion of BMC and BMD was observed at ages of 11–13 years (girls) and 12–15 years (boys).The prevalence of hypovitaminosis D was high and physical activity was low in our participants. However, in multiple regression analyses, age, BMI, and Tanner stage were the main indicators of BMD and BMAD

Conclusion

These normative data aid in the evaluation of bone density in Iranian children and adolescents. Further research to evaluate the evolution of BMD in Iranian children and adolescents is needed to identify the reasons for significant differences in bone density values between Iranian populations and their Western counterparts.

Rizzoli R, Bonjour JP (2010) Determination of peak bone mass acquistion. In: Adler RA (ed) Osteoporosis pathophysiology and clinical management, 2nd edn. Humana, New York, pp 1–23

Pocock NA, Eisman JA, Hopper JL, Yeates MG, Sambrook PN, Eberl S (1987) Genetic determinants of bone mass in adult. A twin study. J Clin Invest 80:706–710PubMedCentralPubMedCrossRef

Gordon CM, Bachrach LK, Carpenter TO, Crabtree N, El-Hajj Fuleihan G, Kutilek S, Lorenc RS, Tosi LL, Ward KA, Ward LM, Kalkwarf HJ (2008) Dual energy X-ray absorptiometry interpretation and reporting in children and adolescents. The 2007 ISCD pediatric official positions. J Clin Densitom 11:43–58PubMedCrossRef

Bogunovic L, Doyle SM, Vogiatzi MG (2009) Measurement of bone density in the pediatric population. Curr Opin Pediatr 21:77–82PubMedCrossRef

Bianchi ML, Baim S, Bishop NJ, Gordon CM, Hans DB, Langman CB, Leonard MB, Kalkwarf HJ (2010) Official positions of the International Society for Clinical Densitometry (ISCD) on DXA evaluation in children and adolescents. Pediatr Nephrol 25:37–47PubMedCrossRef

Jones G, Deqiong M, Cameron F (2006) Bone density interpretation and relevance in Caucasian children aged 9–17 years of age: insights from a population-based fracture study. J Clin Densitom 9:202–209PubMedCrossRef

Binkovitz LA, Henwood MJ (2007) Pediatric DXA: technique and interpretation. Pediatr Radiol 37:21–31PubMedCentralPubMedCrossRef

Mckay HA, Petit MA, Bailey DA, Wallace WM, Schutz RW, Khan KM (2000) Analysis of proximal femur DXA scans in growing children: comparisons of different protocols for cross-sectional 8-month and 7-year longitudinal data. J Bone Miner Res 15:1181–1188PubMedCrossRef

Carter DR, Bouxsein ML, Marcus R (1992) New approaches for interpreting projected bone densitometry data. J Bone Miner Res 7:137–145PubMedCrossRef

10.

Cole JH, Scerpella TA, van der Meulen MC (2005) Fan-beam densitometry of the growing skeleton. J Clin Densitom 8:57–64PubMedCrossRef

11.

Fewtrell MS, on behalf of the British Paediatric & Adolescent Bone Group (2003) Bone densitometry in children assessed by dual x-ray absorptiometry: uses and pitfalls. Arch Dis Child 88:795–798CrossRef

12.

Lu PW, Cowell CT, Lloyd-Jones SA, Briody JN, Howman-Giles R (1996) Volumetric bone mineral density in normal subjects, aged 5–27 years. J Clin Endocrinol Metab 81:1586–1590PubMedCrossRef

13.

Horlick M, Wang J, Pierson RN Jr, Thornton JC (2004) Prediction models for evaluation of total-body bone mass with dual energy X-ray absorptiometry among children and adolescents. Pediatrics 114:337–345CrossRef

14.

Bachrach LK, Hastie T, Wang MC, Narasimhan B, Marcus R (1999) Bone mineral acquisition in healthy Asian, Hispanic, black and Caucasian youth: a longitudinal study. J Clin Endocrinol Metab 84:4702–4712PubMedCrossRef

15.

Kohrt WM, Bloomfield SA, Little KD, Nelson ME, Yingling VR (2004) American College of Sports Medicine Position Stand: physical activity and bone health. Med Sci Sports Exerc 36:1985–1996PubMedCrossRef

16.

Katzman DK, Bachrach LK, Carter DR, Marcus R (1991) Clinical and anthropometric correlates of bone mineral acquisition in healthy adolescent girls. J Clin Endocrinol Metab 73:1332–1339PubMedCrossRef

17.

Cole TJ, Green PJ (1992) Smoothing reference centile curves: the LMS method and penalized likelihood. Stat Med 11:1305–1319PubMedCrossRef

18.

Cole TJ (1998) Fitting smoothed centile curves to reference data. J Royal Stat Soc 15:385–418

19.

Pan H, Cole TJ (1997) User’s guide to LMS chart marker. MRC, UK

20.

Bhudhikanok GS, Wang MC, Eckert K, Matkin C, Marcus R, Bachrach LK (1996) Differences in bone mineral in young Asian and Caucasian Americans may reflect differences in bone size. J Bone Miner Res 11:1545–1556PubMedCrossRef

21.

Alwis G, Rosengren B, Stenevi-Lundgren S, Düppe H, Sernbo I, Karlsson MK (2010) Normative dual energy X-ray absorptiometry data in Swedish children and adolescents. Acta Paediatr 99:1091–1099PubMedCrossRef

22.

Khadilkar AV, Sanwalka NJ, Chiplonkar SA, Khadilkar VV, Mughal MZ (2011) Normative data and percentile curves for dual energy X-ray absorptiometry in healthy Indian girls and boys aged 5–17 years. Bone 48:810–819PubMedCrossRef

23.

Arabi A, Nabulsi M, Maalouf J, Choucair M, Khalife H, Vieth R, EI-Hajj FG (2004) Bone mineral density by age, gender, pubertal stages and socio-economic status in healthy Lebanese children and adolescents. Bone 35:116–179CrossRef

24.

Foley S, Quinn S, Jones G (2009) Tracking of bone mass from childhood to adolescence and factors predict deviation from tracking. Bone 44:752–757PubMedCrossRef

25.

Nguyen TV, Maynard LM, Towne B, Roche AF, Wisemandle W, Li J, Guo SS, Chumlea WC, Siervogel RM (2001) Sex differences in bone mass acquisition during growth: the Fels Longitudinal Study. J Clin Densitom 4:147–157PubMedCrossRef

26.

Van Coeverden SC, De Ridder CM, Roos JC, Van’t Hof MA, Netelenbos JC, Delemarre-Van De Waal HA (2001) Pubertal maturation characteristics and the rate of bone mass development longitudinally toward menarche. J Bone Miner Res 16:774–781PubMedCrossRef

27.

van der Sluis IM, de Ridder MAJ, Boot AM, Krenning EP, de Muinck K-SSMPF (2002) Reference data for bone density and body composition measured with dual energy x ray absorptiometry in white children and young adults. Arch Dis Child 87:341–347PubMedCrossRef

28.

Faulkner RA, Bailey DA, Drinkwater DT, Mckay HA, Arnold C, Wilkinson AA (1996) Bone densitometry in Canadian children 8–17 years of age. Calcif Tissue Int 59:344–351PubMedCrossRef

29.

Boot AM, de Ridder MAJ, Pols HA, Krenning EP, de Muinck K-SSMPF (1997) Bone mineral density in children and adolescents: relation to puberty, calcium intake, and physical activity. J Clin Endocrinol Metab 82:57–62PubMedCrossRef

30.

Glastre C, Braillon P, David L, Cochat P, Meunier PJ, Delmas PD (1990) Measurement of bone mineral content of the lumbar spine by dual energy X-ray absorptiometry in normal children: correlations with growth parameters. J Clin Endocrinol Metab 70:1330–1333PubMedCrossRef

31.

Jones G, Dwyer T (1998) Bone mass in prepubertal children: gender differences and the role of physical activity and sunlight exposure. J Clin Endocrinol Metab 83:4274–4279PubMedCrossRef

32.

Maynard LM, Guo SS, Chumlea WC, Roche AF, Wisemandle WA, Zeller CM, Towne B, Siervogel RM (1998) Total-body and regional bone mineral content and areal bone mineral density in children aged 8–18 y: the Fels Longitudinal Study. Am J Clin Nutr 68:1111–1117PubMed

33.

Unger MD, Cuppari L, Titan SM, Magalhães MC, Sassaki AL, dos Reis LM, Jorgetti V, Moysés RM (2010) Vitamin D status in a sunny country: where has the sun gone? Clin Nutr 29:784–788PubMedCrossRef

34.

Marwaha RK, Tandon N, Reddy DHK, Aggarwal R, Singh R, Sawhney RC, Saluja B, Ganie MA, Singh S (2005) Vitamin D and bone mineral density status of healthy schoolchildren in northern India. Am J Clin Nutr 82:477–482PubMed

35.

Outila TA, Kärkkäinen MU, Lamberg-Allardt CJ (2001) Vitamin D status affects serum parathyroid hormone concentrations during winter in female adolescents: associations with forearm bone mineral density. Am J Clin Nutr 74:206–210PubMed

36.

Kardinaal AF, Ando S, Charles P, Charzewska J, Rotily M, Väänänen K, Van Erp-Baart AM, Heikkinen J, Thomsen J, Maggiolini M, Deloraine A, Chabros E, Juvin R, Schaafsma G (1999) Dietary calcium and bone density in adolescent girls and young women in Europe. J Bone Miner Res 14:583–592PubMedCrossRef

37.

Rubin K, Schirduan V, Gendreau P, Sarfarazi M, Mendola R, Dalsky G (1993) Predictors of axial and peripheral bone mineral density in healthy children and adolescents, with special attention to the role of puberty. J Pediatr 123:863–870PubMedCrossRef

38.

Kroger H, Kotameini A, Vainio P, Alhava E (1992) Bone densitometry of the spine and femur in children by dual-energy x-ray absorptiometry. Bone Miner 17:75–85PubMedCrossRef

39.

Crabtree NJ, Kent K, Zemel BS (2007) Acquisition of DXA in children and adolescents. In: Aenor J, Sawyer AE, Bachrach LK, Funy EB (eds) Bone densitometry in growing patients. Guidelines for clinical practice, 1st edn. Humana, Totowa, pp 73–93CrossRef

Title: Normative data and percentile curves of bone mineral density in healthy Iranian children aged 9–18 years
Authors: Marjan Jeddi
Mohammad Jafar Roosta
Mohammad Hossein Dabbaghmanesh
Gholamhossein Ranjbar Omrani
Sayed Mohammad Taghi Ayatollahi
Zahra Bagheri
Ali Reza Showraki
Marzieh Bakhshayeshkaram
Publication date: 01-12-2013
Publisher: Springer London
Published in: Archives of Osteoporosis / Issue 1-2/2013
Print ISSN: 1862-3522
Electronic ISSN: 1862-3514
DOI: https://doi.org/10.1007/s11657-012-0114-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Normative data and percentile curves of bone mineral density in healthy Iranian children aged 9–18 years

Abstract

Summary

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Summary

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1-2/2013

Osteoporosis in the European Union: a compendium of country-specific reports

The relationship between body mass index and physical activity levels in relation to bone mineral density in premenopausal and postmenopausal women

Prevalence of osteoporosis in otherwise healthy Indian males aged 50 years and above

Is lung function associated with bone mineral density? Results from the Hertfordshire Cohort Study

Sri Lankan FRAX model and country-specific intervention thresholds

Incidence of hip fracture in Rohtak district, North India