Theintz G, Buchs B, Rizzoli R, Slosman D, Clavien H, Sizonenko P C, Bonjour J P
World Health Organization Collaborating Center for Osteoporosis and Bone Diseases, Department of Medicine, Geneva, Switzerland.
J Clin Endocrinol Metab. 1992 Oct;75(4):1060-5. doi: 10.1210/jcem.75.4.1400871.
The amount of skeletal mass acquired during adolescence is one of the most important determinants for the risk of postmenopausal and involutional osteoporosis. In both sexes, a large variance in bone mineral density (BMD) and content (BMC) is observed among healthy individuals at the beginning of the third decade. To determine the crucial pubertal years during which bone mass accumulation mainly occurs, we longitudinally monitored the gain in BMD/BMC at clinically important sites, such as lumbar spine and femoral neck, with respect to osteoporotic fracture risk. The changes in BMD (grams per cm2) and BMC (grams) were determined at 1-yr intervals at the level of lumbar spine vertebrae (L2-L4), femoral neck, and midfemoral shaft, using dual energy x-ray absorptiometry (Hologic QDR 1000), in 198 healthy adolescents (98 females and 100 males), aged 9-19 yr. Mean daily energy and calcium intakes, height, weight, and body mass index of the studied cohort were within the normal range for age. In females, the increment rate in BMD/BMC was particularly pronounced over a 3-yr period, i.e. from 11-14 yr of age. This increment dramatically fell after 16 yr and/or 2 yr after menarche. The mean gains in lumbar, femoral neck, and midfemoral shaft BMD were not statistically significant between 17-20 yr. In males, the gain in BMD/BMC was particularly high over a 4-yr period, i.e. from 13-17 yr. Then the increment rate markedly declined, but remained significant between 17-20 yr for L2-L4 BMD/BMC and midfemoral shaft BMD. In contrast, no significant increase was observed for femoral neck BMD. An impressive interindividual variation was observed between the yearly height increment and the bone mass accumulation. The bone mass-height gains relationship during puberty evolved according to a loop pattern, with maximal variance at Tanner stages P3-P4. This longitudinal study delineates the crucial pubertal years during which the skeletal mass accumulates at high, but various, rates at skeletal sites where the consequences of the osteoporosis are particularly dramatic. Furthermore, the results indicate that in a cohort of healthy females with apparently adequate intakes of energy and calcium, bone mass accumulation is drastically reduced by 16 yr of age in both lumbar spine and femoral neck.
青春期获得的骨骼质量是绝经后骨质疏松症和退行性骨质疏松症风险的最重要决定因素之一。在两性中，在第三个十年开始时，健康个体的骨矿物质密度（BMD）和骨矿物质含量（BMC）存在很大差异。为了确定骨量积累主要发生的关键青春期年份，我们纵向监测了腰椎和股骨颈等临床上重要部位的BMD/BMC增加情况，以及骨质疏松性骨折风险。使用双能X线吸收法（Hologic QDR 1000），在198名年龄在9至19岁的健康青少年（98名女性和100名男性）中，每隔1年测定腰椎（L2-L4）、股骨颈和股骨干中部的BMD（克/平方厘米）和BMC（克）变化。研究队列的平均每日能量和钙摄入量、身高、体重和体重指数均在年龄正常范围内。在女性中，BMD/BMC的增加率在3年期间，即从11至14岁时特别明显。16岁后和/或初潮后2年，这种增加显著下降。17至20岁之间，腰椎、股骨颈和股骨干中部BMD的平均增加量无统计学意义。在男性中，BMD/BMC的增加在4年期间，即从13至17岁时特别高。然后增加率明显下降，但L2-L4的BMD/BMC和股骨干中部BMD在17至20岁之间仍有显著增加。相比之下，股骨颈BMD未观察到显著增加。在年身高增加和骨量积累之间观察到了令人印象深刻的个体间差异。青春期骨量-身高增加关系呈环状模式演变，在坦纳分期P3-P4时差异最大。这项纵向研究描绘了关键的青春期年份，在此期间，骨骼质量在骨质疏松后果特别严重的骨骼部位以高但不同的速率积累。此外，结果表明，在一组能量和钙摄入量明显充足的健康女性中，16岁时腰椎和股骨颈的骨量积累均大幅减少。
