The Relationship of Weight-Bearing Physical Activity and Dietary Calcium Intake with Bone Mass Accrual in the Bone Mineral Density in Childhood Study Cohort

  • Joan LappeEmail author
  • Patrice Watson
  • Vicente Gilsanz
  • Heidi J. Kalkwarf
  • Thomas N. Hangartner
  • Sharon E. Oberfield
  • John Shepherd
  • Babette S. Zemel
  • Karen K. Winer


Background: Although it is widely accepted that dietary calcium intake (CaI) and weight-bearing physical activity (WBA) increase bone mass accrual during growth, few prospective studies have followed children from early childhood to sexual maturity to evaluate this relationship.

Aims: To describe the relationship between CaI and WBA and total body bone mineral content (TBBMC) accrual in a large, multiracial cohort of children followed prospectively.

Methods: Five US centers recruited 2014 healthy children (ages 5–19 years) and measured them annually for up to 7 years. Subjects with at least two annual visits are included in this analysis (944 boys, 973 girls). Assessments included TBBMC, Tanner stage, WBA, and CaI. Multiple regression was used to model annual increases in TBBMC, controlled for annualized overall height growth, Tanner stages, and baseline TBBMC. The effect of adding WBA and CaI to the model was evaluated for four subgroups: nonblack boys and girls and black boys and girls.

Results: WBA had a positive association with adjusted annual increases in TBBMC in all subgroups (p < 0.05), while CaI was positively related to TBBMC increase in nonblack males and nonblack females.

Conclusion: These findings support the importance of public health efforts to increase physical activity in children and adolescents while assuring adequate calcium intake.


Dietary calcium intake Physical activity Children Adolescents Observational study Bone mass accrual Total body bone mineral content 



Bone mineral content


Bone Mineral Density in ­Childhood Study


Calcium Intake


Changed to


Dual Energy ­Absorptiometry


National Institute for Child health and Human ­Development


Randomized Clinical Trial


Standard Deviation


Sums of Squares


Total Body Bone Mineral Content


Weight Bearing Activity



We acknowledge the study participants and their families for their dedication to this project. We thank the study staff members at each site who worked to achieve successful completion of this study.


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Copyright information

© Springer-Verlag London 2013

Authors and Affiliations

  • Joan Lappe
    • 1
    Email author
  • Patrice Watson
    • 2
  • Vicente Gilsanz
    • 3
  • Heidi J. Kalkwarf
    • 4
  • Thomas N. Hangartner
    • 5
  • Sharon E. Oberfield
    • 6
  • John Shepherd
    • 7
  • Babette S. Zemel
    • 8
  • Karen K. Winer
    • 9
  1. 1.Osteoporosis Research CenterCreighton UniversityOmahaUSA
  2. 2.Departments of Preventive Medicine and MedicineCreighton University School of MedicineOmahaUSA
  3. 3.Department of RadiologyChildren’s Hospital Los Angeles/University of Southern CaliforniaLos AngelesUSA
  4. 4.Department of General and Community PediatricsCincinnati Children’s Hospital Medical CenterCincinnatiUSA
  5. 5.BioMedical Imaging LaboratoryWright State UniversityDaytonUSA
  6. 6.Division of Pediatric Endocrinology, Diabetes, and Metabolism, Department of PediatricsColumbia University Medical CenterNew YorkUSA
  7. 7.Department of Radiology and BioimagingUniversity of California at San FranciscoSan FranciscoUSA
  8. 8.Department of PediatricsUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaUSA
  9. 9.Department of Endocrinology, Nutrition, and Growth BranchEunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of HealthBethesdaUSA

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