A qualitative study to investigate the barriers to adoption of a lifestyle associated with optimal peak bone mass acquisition

<p>Background: Osteoporosis is a major public health problem through its association with fragility fracture. Peak bone mass is attained in the second or third decade and has been shown to be a major determinant of later osteoporosis risk. Important determinants of peak bone mass include weight bearing physical activity levels, diet, cigarette smoking, and alcohol consumption. Aim: This study aimed to elucidate knowledge of factors affecting bone health among young people and identify lifestyle barriers to attainment of peak bone mass. Methods: Participants were recruited through mass mailing of University students and staff aged 18-35 at Victoria University of Wellington. Six semi structured focus group interviews were conducted, where knowledge of factors associated with bone health and attitudes to lifestyles associated with beneficial health behaviors were explored. The interviews were audio taped and transcribed. A thematic approach for data analysis using constant comparative method was performed with Nvivo software. Results: A total of 28 students (7 males, 21 females, mean age 28 years) were included. Seven themes emerged with regard to knowledge about factors affecting bone health which included physical activity, dairy, menopause, aging, smoking, alcohol and lack of knowledge about osteoporosis. For barriers, broadly eight themes of lifestyle factors emerged that included time, lack of resources, student life, cost, weather, cultural factors, lack of motivation and lastly smoking and alcohol. Students had limited knowledge about bone health in general, prevention of osteoporosis, and the importance of weight bearing physical activity and diet in determining later bone health. Some participants, especially vegans, expressed difficulties with making diet choices adequate in calcium, while others reported time management was a barrier to incorporating physical activity into everyday life. A few voiced a lack of motivation to exercise in bad weather. Some participants reported behaviors detrimental to bone health such as smoking and heavy alcohol consumption, with peer pressure being one factor leading to an increase in such activities, compounded by cultural and social pressures. Many students aspired to a healthier lifestyle but felt that they had limited knowledge about bone health, and specifically what they might need do to improve it. Conclusions: These data highlights a lack of awareness of factors that impact peak bone mass among University students, an expressed desire to know more, and a keenness to adopt healthier behaviors. School-based education could provide stronger foundations with regards to knowledge of bone health. These observational data might help design interventions that encourage optimal peak bone mass in later life.</p>

A qualitative study to investigate the barriers to adoption of a lifestyle associated with optimal peak bone mass acquisition

<p>Background: Osteoporosis is a major public health problem through its association with fragility fracture. Peak bone mass is attained in the second or third decade and has been shown to be a major determinant of later osteoporosis risk. Important determinants of peak bone mass include weight bearing physical activity levels, diet, cigarette smoking, and alcohol consumption. Aim: This study aimed to elucidate knowledge of factors affecting bone health among young people and identify lifestyle barriers to attainment of peak bone mass. Methods: Participants were recruited through mass mailing of University students and staff aged 18-35 at Victoria University of Wellington. Six semi structured focus group interviews were conducted, where knowledge of factors associated with bone health and attitudes to lifestyles associated with beneficial health behaviors were explored. The interviews were audio taped and transcribed. A thematic approach for data analysis using constant comparative method was performed with Nvivo software. Results: A total of 28 students (7 males, 21 females, mean age 28 years) were included. Seven themes emerged with regard to knowledge about factors affecting bone health which included physical activity, dairy, menopause, aging, smoking, alcohol and lack of knowledge about osteoporosis. For barriers, broadly eight themes of lifestyle factors emerged that included time, lack of resources, student life, cost, weather, cultural factors, lack of motivation and lastly smoking and alcohol. Students had limited knowledge about bone health in general, prevention of osteoporosis, and the importance of weight bearing physical activity and diet in determining later bone health. Some participants, especially vegans, expressed difficulties with making diet choices adequate in calcium, while others reported time management was a barrier to incorporating physical activity into everyday life. A few voiced a lack of motivation to exercise in bad weather. Some participants reported behaviors detrimental to bone health such as smoking and heavy alcohol consumption, with peer pressure being one factor leading to an increase in such activities, compounded by cultural and social pressures. Many students aspired to a healthier lifestyle but felt that they had limited knowledge about bone health, and specifically what they might need do to improve it. Conclusions: These data highlights a lack of awareness of factors that impact peak bone mass among University students, an expressed desire to know more, and a keenness to adopt healthier behaviors. School-based education could provide stronger foundations with regards to knowledge of bone health. These observational data might help design interventions that encourage optimal peak bone mass in later life.</p>

A Study to Assess the Effectiveness of Self Instructional Module on Knowledge Regarding Prevention of Osteoporosis Among the Middle Aged Women in Selected Hospital, Bangalore

Bone is living, growing tissue. It is made mostly of collagen, a protein that provides a soft framework, and calcium phosphate, a mineral that adds strength and hardens the framework. This combination of collagen and calcium makes bone both flexible and strong, which in turn helps bone to withstand stress.1 More than 99 percent of the body’s calcium is contained in the bones and teeth. The remaining 1 percent is found in the blood. Throughout one’s lifetime, old bone is removed (resorption) and new bone is added to the skeleton (formation). During childhood and teenage years, new bone is added faster than old bone is removed. As a result, bones become larger, heavier, and denser. Bone formation outpaces resorption until peak bone mass (maximum bone density and strength) is reached around age 30. After that time, bone resorption slowly begins to exceed bone formation. For women, bone loss is fastest in the first few years after menopause, and it continues into the postmenopausal years. Osteoporosis, or porous bone, is a disease characterized by low bone mass and structural deterioration of bone tissue, leading to bone fragility and an increased risk of fractures of the hip, spine, and wrist. Osteoporosis is more likely to develop if you did not reach optimal peak bone mass during your bone-building years. Women are at a greater risk than men, especially women who are thin or have a small frame, as are those of advanced age. Women who are postmenopausal, including those who have had early or surgically induced menopause, or abnormal or absence of menstrual periods, are at greater risk. Cigarette smoking, eating disorders such as anorexia nervosa or bulimia, low amounts of calcium in the diet, heavy alcohol consumption, inactive lifestyle, and use of certain medications, such as corticosteroids and anticonvulsants, are also risk factors for osteoporopsis.2 The underlying mechanism in all cases of osteoporosis is an imbalance between bone resorption and bone formation. In normal bone, matrix remodeling of bone is constant; up to 10% of all bone mass may be undergoing remodeling at any point in time. The process takes place in bone multicellular units (BMUs) as first described by Frost & Thomas in 1963. Osteoclasts are assisted by transcription factor PU.1 to degrade the bone matrix, while osteoblasts rebuild the bone matrix. Low bone mass density can then occur when osteoclasts are degrading the bone matrix faster than the osteoblasts are rebuilding the bone. The three main mechanisms by which osteoporosis develops are an inadequate peak bone mass (the skeleton develops insufficient mass and strength during growth), excessive bone resorption, and inadequate formation of new bone during remodeling. An interplay of these three mechanisms underlies the development of fragile bone tissue. Hormonal factors strongly determine the rate of bone resorption; lack of estrogen (e.g. as a result of menopause) increases bone resorption, as well as decreasing the deposition of new bone that normally takes place in weight-bearing bones.this leads to weakening and softening of bones the bones become soft and it will prone to get fracture or collapse.

Evaluation of eating habits and unhealthy eating patterns in high-school girls from Varna, Bulgaria

Background Eating habits in children and adolescents are fundamental for their optimal physical and mental health and development. In adolescent girls, adequate nutritional status is paramount for the reproductive system function and reaching peak bone mass. Epidemiological studies have found an increased incidence of unhealthy eating patterns that pose a risk of nutritional deficiencies in adolescents from different European countries. More data is needed on the prevalence of the problem among Bulgarian adolescents, and especially school-aged girls, who are a specific risk group. Methods The study included 226 adolescent girls aged 17-19 from Varna, Bulgaria. Data was collected after receiving informed consent. The methods used include: Anthropometric measurements, including height and weight; Bioelectric impedance analysis using calibrated Tanita BC-420MA (ISSO 9001) and following ESPEN guidelines; Food frequency questionnaire (FFQ). Results 10% of girls were underweight, 78.5% had normal BMI (18.7-25kg/m2) and 11.5% were overweight/obese. Underweight girls had an average BF%=13.78±4.28, with the lowest BF%=3. Underweight girls had significantly lower consumption of vegetables, whole grains, and dairy products. More than half of the underweight group didn't consume vegetables daily (54.5%). 27.7% of the underweight participants consumed whole grain foods every day compared to 42.9% overweight/obese group. 27,2% of underweight girls met the recommendations for consuming daily dairy consumption, compared to 58.1% in the normal BMI and 65.4% in the overweight/obese group. Fish consumption was low in all groups - 13.6% of underweight girls, 17.7% of the participants with normal BMI, and 3.8% in the overweight/obese group consume fish at least twice per week or more. Conclusions Underweight teenage girls have inadequate intake of vegetables, whole grains, and dairy products. The majority of adolescent females do not meet the minimum requirement for fish consumption. Key messages The combination of low body weight and inadequate intake of foods rich in bioavailable calcium are risk factors for not achieving peak bone mass in adolescence. Underweight teenage girls are at an increased risk of vitamin and mineral deficiencies due to inadequate intake of vegetables, whole grains, fish, and dairy products.

Dairy products and bone health

Bone mineral mass, geometry and microstructure, hence determinants of fracture risk, result bone accrual during growth and bone loss later in life. Peak bone mass, which is reached by the end of the second decade of life, is mainly determined by genetic factors. Among other factors influencing bone capital, dietary intakes, particularly calcium and protein, play a significant role in peak bone mass attainment. Both nutrients are provided in dairy products, which accounts for 50–60% and 20–30% of the daily calcium and protein intakes, respectively. Children avoiding dairy products are at higher risk of fracture, as are adults or older individuals following a diet devoid of dairy products, like vegans. Various intervention trials have shown some beneficial effects of dairy products on bone capital accumulation during growth and on bone turnover in adults. In observational studies, dairy products intake, particularly the fermented ones, which also provide probiotics in addition to calcium, phosphorus and protein, appear to be associated with a lower risk of hip fracture.

An endocrine perspective on menstrual suppression for adolescents: achieving good suppression while optimizing bone health

Suppression of menstruation and/or ovarian function in adolescent girls may be desired for a variety of reasons. Numerous medical options exist. The choice of the appropriate modality for an individual patient depends on several factors based on differences in the efficacy of achieving menstrual suppression as well as in their side effect profiles. Adolescence is also a period of bone mass accrual in girls, and several of these modalities may negatively influence peak bone mass. This review focuses on the efficacy of achieving menstrual suppression and the effect on bone health of the various options through an overview of the current literature and also highlights areas in need of further research.

LGR6 is necessary for attaining peak bone mass and regulates osteogenesis through differential ligand use

Leucine-rich repeat containing G-protein-coupled receptor 6 (LGR6) is a marker of osteoprogenitor cells and is dynamically expressed during in vitro osteodifferentation of mouse and human mesenchymal stem cells (MSCs). While the Lgr6 genomic locus has been associated with osteoporosis in human cohorts, the precise molecular function of LGR6 in osteogenesis and maintenance of bone mass are not yet known. In this study, we performed in vitro Lgr6 knockdown and overexpression experiments in murine osteoblastic cells and find decreased Lgr6 levels results in reduced osteoblast proliferation, differentiation, and mineralization. Consistent with these data, overexpression of Lgr6 in these cells leads to significantly increased proliferation and osteodifferentiation. To determine whether these findings are recapitulated in vivo, we performed microCT and ex vivo osteodifferentiation analyses using our newly generated CRISPR-Cas9 mediated Lgr6 mouse knockout allele (Lgr6-KO). We find that ex vivo osteodifferentiation of Lgr6-KO primary MSCs is significantly reduced, and 8 week-old Lgr6-KO mice have less trabecular bone mass as compared to Lgr6 wildtype controls, indicating that Lgr6 is necessary for normal osteogenesis and to attain peak bone mass. Toward mechanism, we analyzed in vitro signaling in the context of two LGR6 ligands, RSPO2 and MaR1. We find that RSPO2 stimulates LGR6-mediated WNT/B-catenin signaling whereas MaR1 stimulates LGR6-mediated cAMP activity, suggesting two ligand-dependent functions for LGR6 receptor signaling during osteogenesis. Collectively, this study reveals that Lgr6 is necessary for wildtype levels of proliferation and differentiation of osteoblasts, and achieving peak bone mass.

A six years longitudinal cohort study on the changes in bone density and bone quality up to peak bone mass in adolescent idiopathic scoliosis (AIS) with and without 2 years of Calcium and Vit-D supplementation

Adolescent idiopathic scoliosis (AIS) is associated with osteopenia which could persist into adulthood affecting attainment of Peak Bone Mass thus resulting in osteoporosis in late adulthood. We previously reported a randomized double-blinded placebo-controlled trial(the Cal study) showing significant bone health improvement with 2-year calcium(Ca)+Vit-D supplementation for AIS girls. This study addressed the important issue whether bone health improvement from the initial 2-year Ca+Vit-D supplementation could persist as subjects approached towards Peak Bone Mass at 6-year ie after 4-year of supplement discontinuation. This was an extension of the Cal study on AIS girls (11–14 years old, mean age=12.9 years, Tanner stage<IV) with femoral neck aBMD Z-score<0 and Cobb angle≥15∘. 330 subjects were randomized to Group1(placebo), Group2(600mgCa+400-IU-Vit-D3/day) or Group3(600mgCa+800-IU-Vit-D3/day) for 2-year supplementation after which supplementation was stopped. Investigations at baseline, 2-year and 6-year included High-resolution Peripheral Quantitative Computed Tomography(HR-pQCT) at distal radius and Dual Energy X-ray Absorptiometry(DXA) at both hips. 270(81.8%) subjects completed 2-year supplementation when changes in left femoral neck aBMD, trabecular vBMD, Trabecular BV/TV, Trabecular Number and Trabecular Separation indicated significant bone health improvement with Ca+Vit-D supplementation(p<0.05). At 6-year(mean age=19.2 years), no between-group difference on bone parameters was noted except increase in Cortical Thickness being greater only in Group3 than in Group1. After 4-year supplement discontinuation, the treatment effect from the initial 2-year supplementation mostly dissipated indicating the need of continued supplementation in AIS girls to sustain therapeutic improvement on bone health as subjects approach towards Peak Bone Mass.

Biochemical and Dietary Indicators of Bone Health in Rural Adolescent Girls from Konkan Region of Maharashtra, India (DERVAN-5)

Adolescent period is marked by bone modeling and remodeling and leads to accrual of peak bone mass. Ideal peak bone mass depends on diet, hormones, genetic influence and environment and has consequences on bone health in adulthood. We measured biochemical indicators of bone health in rural adolescent girls. Methods: Five hundred fifty adolescent girls from longitudinal DERVAN cohort study from Indian state of Maharashtra underwent anthropometry. Biochemical parameters (intact parathyroid hormone, vitamin D, calcium, phosphorus and alkaline phosphatase) were measured. Results: Prevalence of underweight & stunting was 28.8%, 30.7% respectively. More than 56% were thin & only 5% were obese. Median body fat% & bone mass measured by bio-impedance were 23.3 and 1.6 Kg respectively. More than 80% were vitamin D deficient and 12.0% were calcium deficient. Median dietary calcium intake was 158.5mg/day which was far below recommended 850 mg/day. Median parathyroid hormone concentration was 8.49pmol/L and 66.7% had elevated concentrations (> 6.89pmol/L). Elevated phosphorus and alkaline phosphatase were observed in 23.3% and 23.0%. Parathyroid hormone was inversely associated with age (p<0.001) and vitamin D (p<0.001) and directly with phosphorus and alkaline phosphatase (p<0.05) for both. On multivariate analysis elevated parathyroid hormone was associated with low vitamin D (p<0.001). Conclusion: The adolescent girls of KONKAN are undernourished and vitamin D deficient. Despite poor dietary calcium intake the serum calcium levels were maintained at the cost of elevated parathyroid hormone. Thus parathyroid hormone may be used as a marker of bone health. This could be useful in planning early interventions to improve bone health.

Genetic Impact on Bone Modulation – A Review Bridging Bioscience to Genetic Engineering

Genes control approximately 60% to 75% of the variance of peak bone mass/density and a much smaller amount of variance in rate of loss.Bone mass increases during growth to a peak value and soon after begins to decline. Most of the genetic effect is exerted during growth and so influences peak bone mass; whether there is an additional genetic effect on the rate of bone loss is less clear. So, this article aims to place emphasis on various oral and systemic conditions that are manifested due to altered gene function. Genetic polymorphisms and mutations are simple, although the consequences of the mechanism are complex. The syndromic manifestation due to changes at genetic level will greatly affect the bone quality, which will ultimately affect any treatment prognosis. Hence, a better understanding of molecular mechanisms of bone remodeling helps to identify pathogenic causes of bone, skeletal diseases, and leads to the development of targeted therapies for these diseases. This review highlights notions on the connecting link between science and genetics as well as various oral scenarios where gene could bring about changes, resulting in deformities. There is an intense research awaited in the future which could intervene with the causes that bring about genetic modulations, so as to decrease the mortality rate of humans.