The association between childhood fractures and adolescence bone outcomes: a population-based study, the Tromsø Study, Fit Futures
Childhood fracture may predict persistent skeletal fragility, but it may also reflect high physical activity which is beneficial to bone development. We observe a difference in the relationship between previous fracture and bone outcome across physical activity level and sex. Further elaboration on this variation is needed.
Childhood fracture may be an early marker of skeletal fragility, or increased levels of physical activity (PA), which are beneficial for bone mineral accrual. This study investigated the association between a previous history of childhood fracture and adolescent bone mineral outcomes by various PA levels.
We recruited 469 girls and 492 boys aged 15–18 years to this study. We assessed PA levels by questionnaire and measured areal bone mineral density (aBMD) and bone mineral content (BMC) using dual-energy X-ray absorptiometry (DXA) at arm, femoral neck (FN), total hip (TH), and total body (TB) and calculated bone mineral apparent density (BMAD, g/cm3). Fractures from birth to time of DXA measurements were retrospectively recorded. We analyzed differences among participants with and without fractures using independent sample t test. Multiple linear regression was used to examine the association between fractures and aBMD and BMC measurements according to adolescent PA.
Girls with and without a previous history of fracture had similar BMC, aBMD, and BMAD at all sites. In multiple regression analyses stratified by physical activity intensity (PAi), there was a significant negative association between fracture and aBMD-TH and BMC-FN yet only in girls reporting low PAi. There was a significant negative association between forearm fractures, BMAD-FN, and BMAD-arm among vigorously active boys.
Our findings indicate a negative association between childhood fractures and aBMD/BMC in adolescent girls reporting low PAi. In boys, such an association appears only in vigorously active participants with a history of forearm fractures.
KeywordsBone mineral density Child DXA Fracture Physical activity
peak bone mass
areal bone mineral density
bone mineral content
bone mineral apparent density
the Tromsø Study, Fit Futures
dual-energy X-ray absorptiometry
coefficient of variation
physical activity intensity
Health Behavior in School-aged Children
We are grateful to the study participants, the staff at the Clinical Research Unit at University Hospital of North Norway (UNN HF), and the Fit Futures administration for conducting the study. We thank Robert Kechter at Finnmark Hospital Trust and Carsten Rolland at School of Sport Sciences UiT The Arctic University of Norway for office and administration contribution. We also thank the Norwegian Osteoporosis Association for supporting pediatric software and the Northern Norway Regional Health Authorities for funding this work.
North Norwegian Health Authorities (SFP1160-14) funded this study. The funders had no role in the study design, data collection, analysis, or interpretation, or in the decision to submit this manuscript for publication.
Compliance with ethical standards
The study was approved by the Norwegian Data Protection Authority (reference number 2009/1282) and by the Regional Committee of Medical and Health Research Ethics (reference number 2011/1702/REKnord).
Conflicts of interest
- 7.Jones IE, Williams SM, Dow N, Goulding A (2002) How many children remain fracture-free during growth? A longitudinal study of children and adolescents participating in the Dunedin Multidisciplinary Health and Development Study. Osteoporos Int 13(12):990–995. https://doi.org/10.1007/s001980200137 CrossRefPubMedGoogle Scholar
- 9.Berger C, Goltzman D, Langsetmo L, Joseph L, Jackson S, Kreiger N, Tenenhouse A, Davison KS, Josse RG, Prior JC, Hanley DA, CaMos Research Group (2010) Peak bone mass from longitudinal data: implications for the prevalence, pathophysiology, and diagnosis of osteoporosis. J Bone Miner Res 25(9):1948–1957. https://doi.org/10.1002/jbmr.95 CrossRefPubMedPubMedCentralGoogle Scholar
- 12.Landin L, Nilsson BE (1983) Bone mineral content in children with fractures. Clin Orthop Relat Res 178:292–296Google Scholar
- 17.Weaver CM, Gordon CM, Janz KF, Kalkwarf HJ, Lappe JM, Lewis R, O’Karma M, Wallace TC, Zemel BS (2016) The National Osteoporosis Foundation’s position statement on peak bone mass development and lifestyle factors: a systematic review and implementation recommendations. Osteoporos Int 27(4):1281–1386. https://doi.org/10.1007/s00198-015-3440-3 CrossRefPubMedPubMedCentralGoogle Scholar
- 18.Gracia-Marco L, Moreno LA, Ortega FB, León F, Sioen I, Kafatos A, Martinez-Gomez D, Widhalm K, Castillo MJ, Vicente-Rodríguez G, HELENA Study Group (2011) Levels of physical activity that predict optimal bone mass in adolescents: the HELENA study. Am J Prev Med 40(6):599–607. https://doi.org/10.1016/j.amepre.2011.03.001 CrossRefPubMedGoogle Scholar
- 20.Clark EM, Ness AR, Tobias JH (2008) Vigorous physical activity increases fracture risk in children irrespective of bone mass: a prospective study of the independent risk factors for fractures in healthy children. J Bone Miner Res 23(7):1012–1022. https://doi.org/10.1359/jbmr.080303 CrossRefPubMedPubMedCentralGoogle Scholar
- 22.Christoffersen T, Winther A, Nilsen OA, Ahmed LA, Furberg AS, Grimnes G, Dennison E, Emaus N (2015) Does the frequency and intensity of physical activity in adolescence have an impact on bone? The Tromso Study, Fit Futures. BMC Sports Sci Med Rehabil 7(1):26. https://doi.org/10.1186/s13102-015-0020-y CrossRefPubMedPubMedCentralGoogle Scholar
- 30.Heidemann M, Molgaard C, Husby S et al (2013) The intensity of physical activity influences bone mineral accrual in childhood: the childhood health, activity and motor performance school (the CHAMPS) study, Denmark. BMC Pediatr 13(1):32. https://doi.org/10.1186/1471-2431-13-32 CrossRefPubMedPubMedCentralGoogle Scholar
- 31.Kontulainen S, Sievanen H, Kannus P et al (2002) Effect of long-term impact-loading on mass, size, and estimated strength of humerus and radius of female racquet-sports players: a peripheral quantitative computed tomography study between young and old starters and controls. J Bone Miner Res 17(12):2281–2289. https://doi.org/10.1359/jbmr.2002.17.12.2281 CrossRefPubMedGoogle Scholar
- 32.Bailey DA, McKay HA, Mirwald RL et al (1999) A six-year longitudinal study of the relationship of physical activity to bone mineral accrual in growing children: the university of Saskatchewan bone mineral accrual study. J Bone Miner Res 14(10):1672–1679. https://doi.org/10.1359/jbmr.1918.104.22.1682 CrossRefPubMedGoogle Scholar
- 33.Bradney M, Pearce G, Naughton G, Sullivan C, Bass S, Beck T, Carlson J, Seeman E (1998) Moderate exercise during growth in prepubertal boys: changes in bone mass, size, volumetric density, and bone strength: a controlled prospective study. J Bone Miner Res 13(12):1814–1821. https://doi.org/10.1359/jbmr.1922.214.171.1244 CrossRefPubMedGoogle Scholar