Relationship between chronological and bone ages and pubertal stage of
               breasts with bone biomarkers and bone mineral density in adolescents

Fortes, Cristina Maria Teixeira; Goldberg, Tamara Beres Lederer; Kurokawa, Cilmery Suemi; Silva, Carla Cristiani; Moretto, Maria Regina; Biason, Talita Poli; Teixeira, Altamir Santos; Nunes, Hélio Rubens de Carvalho

doi:10.1016/j.jped.2014.04.008

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Original Articles • J. Pediatr. (Rio J.) 90 (6) • Nov-Dec 2014 • https://doi.org/10.1016/j.jped.2014.04.008 copy

Relationship between chronological and bone ages and pubertal stage of breasts with bone biomarkers and bone mineral density in adolescents ^☆ ☆ Please cite this article as: Fortes CM, Goldberg TB, Kurokawa CS, Silva CC, Moretto MR, Biason TP, et al. Relationship between chronological and bone ages and pubertal stage of breasts with bone biomarkers and bone mineral density in adolescents. J Pediatr (Rio J). 2014;90:624-31.

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVE:

To study bone mineral density (BMD) in adolescent females according to five groups of chronological age (CA), bone age (BA), and breast development stage (B), and to correlate these parameters with plasma bone biomarkers (BB).

METHODS:

This was a cross-sectional study performed in 101 healthy adolescent females between 10 and 20 years old. The study variables were: weight, height, body mass index (BMI), CA, B, BA, calcium intake, BMD, and BB. Osteocalcin (OC), bone alkaline phosphatase (BAP), and C-terminal telopeptide (S-CTx) were evaluated for BB. BMD was measured using dual energy X-ray absorptiometry (DXA).

RESULTS:

BMD in lumbar spine, proximal femur, and total body increased with age, and the respective observed averages were: in CA1 (10 years old), 0.631, 0.692, 0.798 g/cm²; in CA2 (11 to 12 years old), 0.698, 0.763, 0.840 g/cm²; in CA3 (13 to 14 years old), 0.865, 0.889, 0.972 g/cm²; in CA4 (15 to 16 years old), 0.902, 0.922, 1.013 g/cm²; and in CA5 (17 to 19 years old), 0.944, 0.929, 1.35 g/cm². These results showed significant differences between 13 and 14 years of age (CA3) or when girls reached the B3 stage (0.709, 0.832, 0.867 g/cm²⁾. The highest median concentrations of BB were between 10 and 12 years of age when adolescents were in the B2-B3 (p < 0.001). Median BB concentrations decreased in advanced BA and B.

CONCLUSIONS:

BB concentrations were positively correlated with the peak height velocity and negatively correlated with BMD in the study sites. Increased BMD and BB concentrations were observed in B3.

Adolescents; Bone mineral density; Bone mineralization; Bone remodeling; Bone reabsorption; Osteocalcin; Osteoporosis; Growth; Bone health

Variables	Groups Mean ± SD (n total = 101)
	1	2	3	4	5
CA (years)	(n = 10)	(n = 19)	(n = 26)	(n = 27)	(n = 19)
Weight (kg)	35.38 ± 7.2	42.90 ± 7.36	49.39 ± 7.02	52.33 ± 5.39	53.46 ± 7.62
Height (m)	1.39 ± 0.07	1.50 ± 0.08	1.59 ± 0.05	1.60 ± 0.05	1.61 ± 0.04
BMI (kg/m²)	17.64 ± 2.27	18.92 ± 2.59	19.26 ± 2.10	20.39 ± 1.77	20.44 ± 2.32
Calcium(mg/day)	652 ± 176	624 ± 271	533 ± 150	490 ± 153	532 ± 267
B	(n = 5)	(n = 7)	(n 11)	(n = 37)	(n = 41)
Weight (kg)	31.92 ± 4.7	39.18 ± 5.56	45.75 ± 7.98	50.31 ± 7.46	51.69 ± 6.04
Height (m)	1.38 ± 0.05	1.43 ± 0.08	1.54 ± 0.09	1.60 ± 0.06	1.59 ± 0.05
BMI (kg/m²)	16.24 ± 1.62	19.02 ± 2.84	18.81 ± 2.18	19.59 ± 2.18	20.31 ± 1.91
BA	(n = 9)	(n = 14)	(n = 21)	(n = 31)	(n = 26)
Weight (kg)	33.02 ± 4.4	45.20 ± 5.73	48.92 ± 6.68	53.46 ± 5.46	49.31 ± 12.6
Height (m)	1.38 ± 0.05	1.52 ± 0.06	1.59 ± 0.05	1.60 ± 0.05	1.52 ± 0.37
BMI (kg/m²)	16.99 ± 1.57	19.26 ± 2.58	19.24 ± 2.17	20.78 ± 1.73	18.88 ± 4.62

Variable	Age and breast development stage			Bone biomarker
	CA	B	BA	BAP	OC	S-CTx
BMD (g/cm²) Spine, L1-L4	0.754 ^a	0.649 ^a	0.760 ^a	-0.696 ^a	-0.367 ^b	-0.627 ^a
Femur	0.605 ^a	0.516 ^a	0.652 ^a	-0.519 ^a	-0.334 ^c	-0.644 ^a
Whole body	0.766 ^a	0.665 ^a	0.789 ^a	-0.655 ^a	-0.425 ^a	-0.695 ^a
BAP (IU/L)	-0.822 ^a	-0.638 ^a	-0.831 ^a	-	-	-
OC (ng/ml)	-0.552 ^a	-0.602 ^a	-0.482 ^a	-	-	-
S-CTx (ng/ml)	-0.769 ^a	-0.653 ^a	-0.812 ^a	-	-	-

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[1] * Corresponding author.E-mail: tamara@fmb.unesp.br (T.B.L. Goldberg).