Bonjour J P, Theintz G, Buchs B, Slosman D, Rizzoli R
Department of Medicine, University Hospital, Geneva, Switzerland.
J Clin Endocrinol Metab. 1991 Sep;73(3):555-63. doi: 10.1210/jcem-73-3-555.
Maximizing peak bone mass is advocated as a way to prevent osteoporosis. As a prerequisite to the elaboration of any preventive program aimed at maximizing peak bone mass, it is important to determine how the rate of skeletal growth at clinically relevant sites, such as lumbar spine and femoral neck, proceeds in relation to age and pubertal stages in both sexes. Bone mass was assessed in 207 healthy caucasian boys and girls, aged 9-18 yr. Bone mineral density (BMD; grams per cm2) and content (BMC; grams) were determined in lumbar spine (L2-L4), femoral neck (FN), and midfemoral shaft (FS), using dual energy x-ray absorptiometry. Bone variables were correlated with both chronological age and pubertal stage, and compared with young adult (20-35 yr) reference values. The main results are: 1) in males, compared to females, there was a marked age-related delay in L2-L4 BMD or BMC increase, but no delay was observed in relation to pubertal stages; 2) at the end of the rapid growth spurt, trends for higher mean values in males were observed for L2-L4 BMC, FN BMD, and particularly FS BMD, but no sex difference was observed for L2-L4 BMD; 3) in females, but not in males, a dramatic reduction in bone mass growth was observed after 15 yr of age, particularly for L2-L4 BMD/BMC and FN BMD. This sharp reduction occurred between the second and fourth years after menarche. In the 14- to 15-yr-old female group, BMD in L2-L4, FN, and FS corresponded to 99.2%, 105.1%, and 94.1%, respectively, and BMC in L2-L4 to 97.6% of the mean values recorded in 20- to 35-yr-old women. In conclusion, this cross-sectional study indicates that during pubertal development, major differences are observed in bone mass growth according to sex and skeletal site. Whereas in males bone mass at different skeletal sites continues to increase substantially between 15-18 yr, skeletal mass growth appears to dramatically slow down at the levels of both lumbar spine and FN at 15-16 yr of age in female adolescents. This suggests that the generally accepted notion that in both males and females bone mass continues to substantially accumulate at all skeletal sites until the fourth decade may not be a constant in human physiology.
增加峰值骨量被认为是预防骨质疏松症的一种方法。作为制定任何旨在增加峰值骨量的预防计划的前提，确定诸如腰椎和股骨颈等临床相关部位的骨骼生长速率如何随年龄和青春期阶段在两性中变化是很重要的。对207名年龄在9至18岁的健康白种男孩和女孩进行了骨量评估。使用双能X线吸收法测定腰椎（L2-L4）、股骨颈（FN）和股骨干中部（FS）的骨矿物质密度（BMD；克/平方厘米）和骨矿物质含量（BMC；克）。将骨变量与实际年龄和青春期阶段进行相关性分析，并与年轻成年人（20-35岁）的参考值进行比较。主要结果如下：1）在男性中，与女性相比，L2-L4的BMD或BMC增加存在明显的年龄相关延迟，但在青春期阶段方面未观察到延迟；2）在快速生长突增结束时，观察到男性L2-L4的BMC、FN的BMD，特别是FS的BMD有更高平均值的趋势，但L2-L4的BMD未观察到性别差异；3）在女性中，而非男性中，15岁后骨量增长显著下降，特别是L2-L4的BMD/BMC和FN的BMD。这种急剧下降发生在初潮后的第二至第四年。在14至15岁的女性组中，L2-L4、FN和FS的BMD分别相当于20至35岁女性记录平均值的99.2%、105.1%和94.1%，L2-L4的BMC相当于该平均值的97.6%。总之，这项横断面研究表明，在青春期发育过程中，根据性别和骨骼部位，骨量增长存在主要差异。在男性中，不同骨骼部位的骨量在15至18岁之间仍持续大幅增加，而在女性青少年中，15至16岁时腰椎和FN水平的骨骼质量增长似乎急剧放缓。这表明，普遍认为男性和女性在所有骨骼部位的骨量在第四个十年之前都持续大幅积累的观点在人体生理学中可能并非一成不变。
