Simchoni Maya, Landau Regev, Derazne Estela, Pinhas-Hamiel Orit, Nakhleh Afif, Goldshtein Inbal, Tsur Avishai M, Afek Arnon, Chodick Gabriel, Tripto-Shkolnik Liana, Twig Gilad
Tzameret Department of Military Medicine and Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel.
Israel Defense Forces Medical Corps, Ramat Gan, Israel.
JAMA Netw Open. 2025 Aug 1;8(8):e2525079. doi: 10.1001/jamanetworkopen.2025.25079.
There are limited data regarding adolescent weight among healthy individuals and their trajectory through early adulthood with respect to bone health.
To assess the association between adolescent body mass index (BMI) and osteoporosis risk while accounting for BMI change during early adulthood.
DESIGN, SETTING, AND PARTICIPANTS: A retrospective population-based cohort study from 1967 to 2019. Participants were Israeli-born adolescents aged 16 to 19 years who were evaluated for military service. Data were analyzed from January 2023 to March 2025.
Weight and height were measured to calculate BMI at adolescence, and additional sociodemographic and medical data were collected. Health status at baseline and incident cancer and diabetes throughout adulthood were strictly controlled.
Osteoporosis diagnosis until 2022, recorded in the osteoporosis registry of Maccabi Healthcare Services (the second-largest Israeli health care system). Cox proportional hazard models were applied. Adult BMI measurement was available for 74% of the study population and was used to assess the association between adolescence-to-adulthood weight trajectory and incident osteoporosis.
In this cohort study of 1 083 491 adolescents, 21 497 (4.58%) women and 6929 (1.13%) men were enrolled in the osteoporosis registry during a cumulative follow-up of 19 400 208 person-years (mean [SD] age at follow-up, 23.7 [8.5] years). There was a consistent inverse association between adolescent BMI and osteoporosis risk in adulthood. The crude incidence rate of osteoporosis decreased from 330.2 per 100 000 person-years among those with extreme underweight (<3rd percentile) to 78.9 among those with obesity (≥95th percentile). Adjusted hazard ratios for osteoporosis ranged from 1.88 (95% CI, 1.74-2.04) to 0.83 (95% CI, 0.77-0.89) in women and from 1.82 (95% CI, 1.64-2.01) to 1.04 (95% CI, 0.93-1.16) in men, using normal BMI as the reference. A sex-specific difference in osteoporosis risk was notable, with obesity not showing a protective association in men compared with women. The findings were robust across multiple models and sample restrictions, and the highest risk was observed in individuals who remained underweight from adolescence into adulthood.
In this cohort study, BMI at a young age and its trajectory to adulthood were significantly associated with risk for osteoporosis in adult life.
关于健康个体的青少年体重及其在成年早期与骨骼健康相关的变化轨迹的数据有限。
评估青少年体重指数（BMI）与骨质疏松症风险之间的关联，同时考虑成年早期的BMI变化。
设计、背景和参与者：一项基于人群的回顾性队列研究，时间跨度为1967年至2019年。参与者为16至19岁在以色列出生且接受兵役评估的青少年。数据于2023年1月至2025年3月进行分析。
测量体重和身高以计算青少年时期的BMI，并收集其他社会人口学和医学数据。严格控制基线时的健康状况以及成年期的癌症和糖尿病发病情况。
截至2022年的骨质疏松症诊断情况，记录在麦卡比医疗服务公司（以色列第二大医疗保健系统）的骨质疏松症登记处。应用Cox比例风险模型。74%的研究人群有成年期BMI测量数据，用于评估青少年到成年期的体重变化轨迹与骨质疏松症发病之间的关联。
在这项对1083491名青少年的队列研究中，在19400208人年的累计随访期间（随访时的平均[标准差]年龄为23.7[8.5]岁），有21497名（4.58%）女性和6929名（1.13%）男性被纳入骨质疏松症登记处。青少年BMI与成年期骨质疏松症风险之间存在一致的负相关。骨质疏松症的粗发病率从体重极轻（<第3百分位数）者的每100000人年330.2例降至肥胖（≥第95百分位数）者的每100000人年78.9例。以正常BMI为参照，女性骨质疏松症的调整后风险比范围为1.88（95%置信区间，1.74 - 2.04）至0.83（95%置信区间，0.77 - 0.89），男性为1.82（95%置信区间，1.64 - 2.01）至1.04（95%置信区间，0.93 - 1.16）。骨质疏松症风险存在性别差异，与女性相比，肥胖在男性中未显示出保护关联。这些发现在多种模型和样本限制条件下都很稳健，且在从青少年期到成年期一直体重过轻的个体中观察到最高风险。
在这项队列研究中，年轻时的BMI及其到成年期的变化轨迹与成年后骨质疏松症的风险显著相关。
