BMD loss seen in early adulthood for women, despite healthy behaviors
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A menarche-centered model assessing age at peak bone mineral density suggests bone loss women may begin as soon as 5 years after menarche, even among athletes, according to an analysis of longitudinal data.
“Our results suggest that even individuals who maximize their bone quality through healthy behaviors in childhood and adolescence may lose bone density in their early 20s, and we do not know much about what happens from there,” Jodi Dowthwaite, PhD, a research assistant professor in public health at Binghamton University and a research scientist in orthopedic surgery at SUNY Upstate Medical University, told Healio. “It is critical that we set up a strong peak bone mass foundation for later life, through policies that provide all children and adolescents with healthy foods and daily exercise from preschool into adulthood, ideally through public school systems and subsidized community programs. Second, we need more research to understand how to prevent osteoporosis during the decades leading from adolescence up to and including menopause.”
Dowthwaite and colleagues measured height lumbar spine and femoral neck areal BMD annually 124 female youth gymnasts and non-gymnasts, assessing menarche date semiannually, as part of an ongoing study prospectively tracking bone accrual from childhood through adulthood. All participants were non-Hispanic white to reduce known race variation in growth and had a median BMD measurements.
“This analysis aimed to establish timing of peak BMD by evaluating longitudinal data in a maturational context, specifically targeting these two key sites for fragility fracture and osteoporosis diagnosis,” Dowthwaite said during a presentation at the American Society of Bone and Mineral Research annual meeting.
Researchers modeled longitudinal height data to yield age at peak height velocity using Super-Imposition by Translation and Rotation (SITAR), a form of growth curve analysis. SITAR distills growth into three independent parameters: size of growth magnitude, timing of age at peak velocityand intensity of peak growth rate, Dowthwaite said.
“We tested three different maturational clocks, including a typical, chronological age clock with zero at birth, a menarche-centered clock to account for estrogen as a driver of bone accrual, and a [peak height velocity]-centered clock, to account for peak height velocity as a body size growth rate metric,” Dowthwaite said.
Researchers defined age at peak BMD within a range, with the lower-bound the earliest age where BMD gain did not exceed 3%, and the upper-bound capped at an annual BMD gain of 1%, allowing for possible low-level gains in early adulthood, Dowthwaite said.
Mean ages at peak height velocity and menarche for the cohort were 12 and 13 years, respectively.
The models showed women reached mean peak femoral neck BMD and mean peak lumbar spine BMD by chronological age of 16 to 18 years, 3 to 5 years after menarche using the menarche-centered model, or 5 to 7 years post-peak height velocity using the peak height velocity-centered model.
BMD decreased after age at peak BMD across all three femoral neck BMD models — before expected perimenopausal ranges, Dowthwaite said. However, lumbar spine BMD patterns varied, with two of the models suggesting subtle declines.
Dowthwaite said more data are needed to evaluate whether femoral neck BMD and lumber spine BMD decline with parity, lactation or decreasing physical activity in early adulthood, and if so, whether they may rebound before extreme circum-menopausal losses.
“I recommend developing appropriate preventive medicine policies and care systems for all adolescents,” Dowthwaite told Healio. “It may be appropriate to screen females at the lumbar spine and femoral neck with DXA during the first-year post-menarche and again at age 18 years, or 5 years post-menarche. The circum-menarcheal time point could inform intervention to promote optimal peak bone mass.”
Perspective
Back to TopAhmed Elhakeem, PhD
The results reported in this conference abstract are in line with previous studies showing that on average peak hip BMD in females is achieved by around age 18 years. These data highlight the need for high-quality research into modifiable early life factors that can help to maximize BMD.
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Dowthwaite J, et al. Abstract 1034. Presented at: ASBMR Annual Meeting; Oct. 1-4, 2021; San Diego (hybrid meeting).
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