Fracture risk and areal bone mineral density in adolescent females with anorexia nervosa

Abstract Summary Areal bone mineral density (aBMD) predicts future fracture risk. This study explores associations between use of tobacco and bone accretion in Norwegian adolescents. Our results indicate that use of snuff is negatively associated with accretion of aBMD in adolescence and may be a signal of increased future fracture risk. Purpose Bone mineral accrual in childhood and adolescence is a long-term primary preventive strategy of osteoporosis. Areal bone mineral density (aBMD) is a surrogate measure of bone strength and a predictor of fracture risk. The aim of this population-based 2-year follow-up cohort study was to explore associations between use of snuff and smoking and changes (∆) in aBMD in Norwegian girls and boys aged 15–17 years at baseline. Methods The first wave of the Tromsø study, Fit Futures was conducted from 2010 to 2011. Femoral neck (FN), total hip (TH), and total body (TB) bone mineral content (BMC) and aBMD were measured by dual-energy X-ray absorptiometry. Information on use of snuff, smoking habits, and other lifestyle related variables were collected through self-administered questionnaires. Two years later, during 2012–2013, the measurements were repeated in the second wave. The present study included 349 girls and 281 boys and compared “non-users” (n = 243 girls, 184 boys) with “users” (n = 105 girls, 96 boys) of snuff and “non-smokers” (n = 327 girls, 249 boys) with “smokers” (n = 21 girls, 31 boys) using linear regression adjusted for age, baseline height and weight, change in height and weight, pubertal maturation, physical activity, ethnicity, alcohol consumption, diagnosis known to affect bone, and medication known to affect bone. The influence of “double use” on bone accretion was also explored. Results In girls, no associations between use of snuff and ∆aBMD were found. In boys, use of snuff was associated with reduced bone accretion in all ∆aBMD models. Sensitivity analysis with exclusion of “sometimes” users of snuff strengthened associations at femoral sites in girls and attenuated all associations in boys. In girls, no associations between smoking and ∆aBMD were found. In boys, only the association with TB ∆aBMD was significant in the fully adjusted models. In girls, “double users” analyses showed similar association to smoking. In boys, nearly all models showed statistically significant associations with a difference of ~ 1–2% in ∆aBMD between “non-users” and “double users” during 2 years of follow-up. Conclusions Our results indicate that tobacco use in late adolescence could be detrimental to bone accretion and may be a signal of increased fracture risk in adult life.

Download Full-text

Bone mineral density in adolescent females with recently diagnosed anorexia nervosa

International Journal of Eating Disorders ◽

10.1002/1098-108x(200101)29:1<11::aid-eat2>3.0.co;2-b ◽

2000 ◽

Vol 29 (1) ◽

pp. 11-16 ◽

Cited By ~ 22

Author(s):

Joseph C. H. Wong ◽

Peter Lewindon ◽

Robin Mortimer ◽

Ross Shepherd

Keyword(s):

Bone Mineral Density ◽

Anorexia Nervosa ◽

Bone Mineral ◽

Adolescent Females ◽

Mineral Density

Download Full-text

Diabetes and Femoral Neck Strength: Findings from The Hip Strength Across the Menopausal Transition Study

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2011-1883 ◽

2012 ◽

Vol 97 (1) ◽

pp. 190-197 ◽

Cited By ~ 54

Author(s):

Shinya Ishii ◽

Jane A. Cauley ◽

Carolyn J. Crandall ◽

Preethi Srikanthan ◽

Gail A. Greendale ◽

...

Keyword(s):

Bone Mineral Density ◽

Insulin Resistance ◽

Femoral Neck ◽

Fracture Risk ◽

Bone Mineral ◽

Areal Bone Mineral Density ◽

Mineral Density ◽

Femoral Neck Strength ◽

Composite Indices ◽

Neck Strength

Context: Diabetes mellitus is associated with increased hip fracture risk, despite being associated with higher bone mineral density in the femoral neck. Objective: The objective of the study was to test the hypothesis that composite indices of femoral neck strength, which integrate dual-energy x-ray absorptiometry derived femoral neck size, femoral neck areal bone mineral density, and body size and are inversely associated with hip fracture risk, would be lower in diabetics than in nondiabetics and be inversely related to insulin resistance, the primary pathology in type 2 diabetes. Design: This was a cross-sectional analysis. Setting and Participants: The study consisted of a multisite, multiethnic, community-dwelling sample of 1887 women in pre- or early perimenopause. Outcome Measurements: Composite indices for femoral neck strength in different failure modes (axial compression, bending, and impact) were measured. Results: Adjusted for age, race/ethnicity, menopausal stage, body mass index, smoking, physical activity, calcium and vitamin D supplementation, and study site, diabetic women had higher femoral neck areal bone mineral density [+0.25 sd, 95% confidence interval (CI) (+0.06, +0.44) sd] but lower composite strength indices [−0.20 sd, 95% CI (−0.38, −0.03) sd for compression, −0.19 sd, 95% CI (−0.38, −0.003) sd for bending, −0.19 sd, 95% CI (−0.37, −0.02) sd for impact] than nondiabetic women. There were graded inverse relationships between homeostasis model-assessed insulin resistance and all three strength indices, adjusted for the same covariates. Conclusions: Despite having higher bone density, diabetic women have lower indices of femoral neck strength relative to load, consistent with their documented higher fracture risk. Insulin resistance appears to play an important role in bone strength reduction in diabetes.

Download Full-text

Glucocorticoid-Induced Bone Loss Is Associated with Abnormal Intravertebral Areal Bone Mineral Density Distribution

International Journal of Endocrinology ◽

10.1155/2013/768579 ◽

2013 ◽

Vol 2013 ◽

pp. 1-9 ◽

Cited By ~ 4

Author(s):

Louise I. Manning ◽

Andrew M. Briggs ◽

Sharon Van Doornum ◽

Ashwini Kale ◽

Susan Kantor ◽

...

Keyword(s):

Bone Mineral Density ◽

Vertebral Fracture ◽

Bone Loss ◽

Fracture Risk ◽

Bone Mineral ◽

Vertebral Body ◽

Areal Bone Mineral Density ◽

Primary Osteoporosis ◽

Mineral Density ◽

Vertebral Fracture Risk

Individuals with glucocorticoid-induced osteoporosis experience vertebral fractures at an increased rate and at higher vertebral areal bone mineral density (aBMD) than individuals with primary osteoporosis. Standard posteroanterior- (PA-) projection dual energy X-ray absorptiometry (DXA) lacks the diagnostic sensitivity required for reliable estimation of vertebral fracture risk in individuals. Assessment of subregional vertebral aBMD using lateral-projection DXA may improve the predictive value of DXA parameters for fracture. One hundred and four individuals were recruited and grouped for this study: primary osteoporosis with no history of vertebral fracture (n=43), glucocorticoid-induced bone loss (n=13), and healthy controls (n=48). Standard PA-projection and supine-lateral scans were performed, and lateral scans were analysed according to an established protocol to measure aBMD within 6 subregions. Main effects for subregion and group were assessed and observed, by ANCOVA. Ratios were calculated between subregions and compared between groups, to overcome the potentially confounding influence of variability in subregional geometry. Significantly lower values were observed in the glucocorticoid group for the ratios of (i) anterior subregion: whole vertebral body and (ii) posterior: whole vertebral body when compared to the primary osteoporosis and control groups (P<0.05). Lower anterior subregional aBMD in individuals on glucocorticoid therapy may help to explain the increased vertebral fracture risk in this patient group.

Download Full-text