Optimizing Bone Mass Accrual in Healthy Adolescents

  • Keith J. Loud


Adolescence provides a uniquely important period of opportunity to improve skeletal health across the lifespan, potentially even reducing the lifetime risk of osteoporosis. Because inherited factors account for as much as 80% of predicted peak bone mass, the relatively few factors amenable to modification become essential to understand for those clinicians who monitor the growth and development of children and adolescents. The modifiable factors include such lifestyle choices as dietary intake, physical activity, maintaining a healthy weight for height, contraceptive choice, and use of tobacco and alcohol. In addition to ensuring normal pubertal development, primary care providers can help guide patients to healthy choices for the bone that are aligned perfectly with other lifelong benefits.


Adolescence Puberty Bone mass accrual Areal bone mineral density (aBMD) Peak bone mass (PBM) 


  1. 1.
    Bonjour JP, Thientz G, Buchs B, et al. Critical years and stages of puberty for spinal and femoral bone mass accumulation during adolescence. J Clin Endocrinol Metab. 1991;73:555–63.CrossRefPubMedGoogle Scholar
  2. 2.
    Thientz G, Buchs G, Rizzoli R, et al. Longitudinal monitoring of bone mass accumulation in healthy adolescents: evidence for a marked reduction after 16 years of age at the levels of lumbar spine and femoral neck in female subjects. J Clin Endocrinol Metab. 1992;75:1060–5.Google Scholar
  3. 3.
    Southard RN, Morris JD, Mahan JD, et al. Bone mass in healthy children: measurement with quantitative DXA. Radiology. 1991;179:735–8.CrossRefPubMedGoogle Scholar
  4. 4.
    McCormick DP, Ponder SW, Fawcett HD, Palmer JL. Spinal bone mineral density in 335 normal and obese children and adolescents: evidence for ethnic and sex differences. J Bone Miner Res. 1991;6:507–13.CrossRefPubMedGoogle Scholar
  5. 5.
    Zemel BS, Kalkwarf HJ, Gilsanz V, et al. Revised reference curves for bone mineral content and areal bone mineral density according to age and sex for black and non-black children: results of the bone mineral density in childhood study. J Clin Endocrinol Metab. 2011;96:3160–9.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Bachrach LK. Acquisition of optimal bone mass in childhood and adolescence. Trends Endocrinol Metab. 2001;12:22–8.CrossRefPubMedGoogle Scholar
  7. 7.
    Weaver CM, Gordon CM, Janz KF, et al. The National Osteoporosis Foundation’s position statement on peak bone mass development and lifestyle factors: a systematic review and implementation recommendations. Osteoporos Int. 2016;27:1281–386.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Bailey DA, McKay HA, Mirwald RL, et al. A six-year longitudinal study of the relationship of physical activity to bone mineral accrural in growing children: the University of Saskatchewan Bone Mineral Accrural Study. J Bone Miner Res. 1999;14:1672–9.CrossRefPubMedGoogle Scholar
  9. 9.
    Bailey DA, Martin AD, McKay HA, et al. Calcium accretion in girls and boys during puberty: a longitudinal analysis. J Bone Miner Res. 2000;15:2245–50.CrossRefPubMedGoogle Scholar
  10. 10.
    Bachrach LK, Hastie T, Marcus R, et al. Bone mineral acquisition in healthy Asian, Hispanic, black, and Caucasian youth: a longitudinal study. J Clin Endocrinol Metab. 1999;84:4702–12.PubMedGoogle Scholar
  11. 11.
    Kalkwarf HJ, Zemel BS, Gilsanz V, et al. The bone mineral density in childhood study: bone mineral content and density according to age, sex, and race. J Clin Endocrinol Metab. 2007;92:2087–99.CrossRefPubMedGoogle Scholar
  12. 12.
    Gilsanz V, Roe TF, Mora S, et al. Changes in vertebral bone density in black girls and white girls during childhood and puberty. N Engl J Med. 1991;325:1597–600.CrossRefPubMedGoogle Scholar
  13. 13.
    Seeman E, Hopper JL, Bach LA, et al. Reduced bone mass in daughters of women with osteoporosis. N Engl J Med. 1989;320:554–8.CrossRefPubMedGoogle Scholar
  14. 14.
    Pocock NA, Eisman JA, Hopper JL, et al. Genetic determinants of bone mass in adults. J Clin Invest. 1987;80:706–10.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Brown MA, Haughton MA, Grant SF, et al. Genetic control of bone density and turnover: role of the collagen1alpha1, estrogen receptor, and vitamin D receptor genes. J Bone Miner Res. 2001;16:758–64.CrossRefPubMedGoogle Scholar
  16. 16.
    Richards JB, Zheng HF, Spector TD. Genetics of osteoporosis from genome-wide association studies: advances and challenges. Nat Rev Genet. 2012;13:576–88.CrossRefPubMedGoogle Scholar
  17. 17.
    Gerdhem P, Obrant KJ. Bone mineral density in old age: the influence of age at menarche and menopause. J Bone Miner Metab. 2004;22:372–5.CrossRefPubMedGoogle Scholar
  18. 18.
    Riggs BL, Khosla S, Melton LJ. Sex steroids and the construction and conservation of the adult skeleton. Endocr Rev. 2002;23:279–302.CrossRefPubMedGoogle Scholar
  19. 19.
    McKay HA, Bailey DA, Mirwald RL, et al. Peak bone mineral accrual and age at menarche in adolescent girls: a 6-year longitudinal study. J Pediatr. 1998;133:682–7.CrossRefPubMedGoogle Scholar
  20. 20.
    Naka H, Iki M, et al. Effects of pubertal development, height, weight, and grip strength on the bone mineral density of the lumbar spine and hip in peripubertal Japanese children: Kyoto kids increase density in the skeleton study (Kyoto KIDS study). J Bone Miner Metab. 2005;23:463–9.CrossRefPubMedGoogle Scholar
  21. 21.
    Gilsanz V, Chalfant J, Kalkwarf H, et al. Age at onset of puberty predicts bone mass in young adulthood. J Pediatr. 2011;158:100–5.CrossRefPubMedGoogle Scholar
  22. 22.
    Blum M, Harris SS, Must A, et al. Weight and body mass index at menarche are associated with premenopausal bone mass. Osteoporos Int. 2001;12:588–94.CrossRefPubMedGoogle Scholar
  23. 23.
    Goulding A, Grant AM, Williams SM. Bone and body composition of children and adolescents with repeated forearm fractures. J Bone Miner Res. 2005;20:2090–6.CrossRefPubMedGoogle Scholar
  24. 24.
    Goulding A, Taylor RW, Jones IE, et al. Overweight and obese children have low bone mass and area for their weight. Int J Obes Relat Metab Disord. 2000;24:627–32.CrossRefPubMedGoogle Scholar
  25. 25.
    El Hage R, Moussa E, Jacob C. Bone mineral content and density in obese, overweight, and normal-weighted sedentary adolescent girls. J Adolesc Health. 2010;47:591–5.CrossRefPubMedGoogle Scholar
  26. 26.
    Russell M, Mendes N, et al. Visceral fat is a negative predictor of bone density measures in obese adolescent girls. J Clin Endocrinol Metab. 2010;95:1247–55.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Russell M, Misra M. Influence of ghrelin and adipocytokines on bone mineral density in adolescent female athletes with amenorrhea and eumenorrheic athletes. Med Sport Sci. 2010;55:103–13.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    MacKelvie KJ, Khan KM, McKay HA. Is there a critical period for bone response to weight-bearing exercise in children and adolescents? A systematic review. Br J Sports Med. 2002;36:250–7.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Strong WB, Malina RM, Blimkie CJR, et al. Evidence based physical activity for school-age youth. J Pediatr. 2005;146:732–7.CrossRefPubMedGoogle Scholar
  30. 30.
    Kohrt WM, Bloomfield SA, Little KD, et al. American College of Sports Medicine position stand: physical activity and bone health. Med Sci Sports Exerc. 2004;36:1985–96.CrossRefPubMedGoogle Scholar
  31. 31.
    National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (CDC). Trends in the prevalence of physical activity and sedentary behaviors. National YRBS: 1991—2015. Accessed 8 May 2017.
  32. 32.
    Specker BL. Evidence for an interaction between calcium intake and physical activity on changes in bone mineral density. J Bone Miner Res. 1996;11:1539–44.CrossRefPubMedGoogle Scholar
  33. 33.
    Bailey RL, Dodd KW, et al. Estimation of total usual calcium and vitamin D intakes in the United States. J Nutrition. 2010;140:817–22.CrossRefGoogle Scholar
  34. 34.
    Wyshak G. Teenaged girls, carbonated beverage consumption, and bone fractures. Arch Pediatr Adolesc Med. 2000;154:610–3.CrossRefPubMedGoogle Scholar
  35. 35.
    Wyshak G, Frisch RE. Carbonated beverages, dietary calcium, the dietary calcium/phosphorous ratio, and bone fractures in girls and boys. J Adolesc Health. 1994;15:210–5.CrossRefPubMedGoogle Scholar
  36. 36.
    Whiting SJ, Vatanparast H, Baxter-Jones A, et al. Factors that affect bone mineral accrual in the adolescent growth spurt. J Nutr. 2004;134:696S–700S.CrossRefPubMedGoogle Scholar
  37. 37.
    Kaunitz AM. Depo-Provera’s black box: time to reconsider? Contraception. 2005;72:165–7.CrossRefPubMedGoogle Scholar
  38. 38.
    Need AG, Kemp A, Giles N, et al. Relationships between intestinal calcium absorption, serum vitamin D metabolites and smoking in postmenopausal women. Osteoporos Int. 2002;13:83–8.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Department of PediatricsGeisel School of Medicine at DartmouthLebanonUSA

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