Skeleton geometry, physical activity and proximal femur bone mass distribution in 8-12 year old children

Doutoramento em Motricidade Humana, especialidade em Actividade Física e SaúdeIn the context of bone health promotion, the aim of this Ph.D dissertation was to analyze potential explanatory factors of the effects of physical activity and of bone geometry on bone mass distribution at the proximal femur in 8-12 year old children. Four studies were undertaken to compare the bone mineral density (BMD) between: (a) the sub-regions of the proximal femur – the neck and its superolateral and inferomedial aspects, the trochanter and the intertrochanter; (b) sexes, concerning the associations/effects of non-targeted physical activity and bone geometry. Sex and regional specific effects of non-targeted physical activity on bone mass distribution at the proximal femur in children were observed. The geometry of the pelvis and the proximal femur, namely the pelvis width and the abductor lever arm, emerged as predictors of bone mass distribution at the proximal femur, therefore as explanatory factors of both the regional and the sex specific patterns. These geometric features might mediate the physical activity effects on bone mineralization at the proximal femur, as long as, when they are considered, the power of physical activity to explain the distribution of bone mass at this skeletal site seems limited.Resumo : No contexto da promoção da saúde óssea, o objetivo desta dissertação de doutoramento foi analisar potenciais fatores explicativos dos efeitos da atividade física habitual e da geometria óssea na distribuição da massa óssea do fémur proximal, em crianças de 8-12 anos de idade. Para o efeito foram realizados quatro estudos comparando a densidade mineral óssea (DMO) entre: (a) as diversas sub-regiões do fémur proximal - o colo do fémur e os seus aspetos supero-lateral e infero-medial, o grande trocanter e a sub-região intertrocantérica; (b) os sexos, relativamente às associações/efeitos da atividade física habitual e da geometria óssea. Foram observadas associações/efeitos da atividade física habitual na massa óssea do fémur proximal diferenciados quanto ao sexo e sub-região. A geometria da pélvis e do femur proximal, nomeadamente a largura da pélvis e o braço de momento de força dos abdutores, surgiram como preditores da distribuição de massa óssea no fémur proximal e consequentemente como fatores explicativos de diferenciação da distribuição de massa óssea de acordo com o sexo e sub-região. Estas caraterísticas geométricas poderão mediar os efeitos da atividade física na mineralização do femur proximal uma vez que quando consideradas parecem limitar a capacidade explicativa da atividade física na distribuição de massa óssea no fémur proximal.FCT - Fundação para a Ciência e a Tecnologi

Sex specific association of physical activity on proximal femur BMD in 9 to 10 year-old children.

The results of physical activity (PA) intervention studies suggest that adaptation to mechanical loading at the femoral neck (FN) is weaker in girls than in boys. Less is known about gender differences associated with non-targeted PA levels at the FN or other clinically relevant regions of the proximal femur. Understanding sex-specific relationships between proximal femur sensitivity and mechanical loading during non-targeted PA is critical to planning appropriate public health interventions. We examined sex-specific associations between non-target PA and bone mineral density (BMD) of three sub-regions of the proximal femur in pre- and early-pubertal boys and girls. BMD at the FN, trochanter (TR) and intertrochanter (IT) regions, and lean mass of the whole body were assessed using dual-energy x-ray absorptiometry in 161 girls (age: 9.7±0.3 yrs) and 164 boys (age: 9.7±0.3 yrs). PA was measured using accelerometry. Multiple linear regression analyses (adjusted for body height, total lean mass and pubertal status) revealed that vigorous PA explained 3-5% of the variability in BMD at all three sub-regions in boys. In girls, vigorous PA explained 4% of the variability in IT BMD and 6% in TR BMD. PA did not contribute to the variance in FN BMD in girls. An additional 10 minutes per day of vigorous PA would be expected to result in a ∼1% higher FN, TR, and IT BMD in boys (p<0.05) and a ∼2% higher IT and TR BMD in girls. In conclusion, vigorous PA can be expected to contribute positively to bone health outcomes for boys and girls. However, the association of vigorous PA to sub-regions of the proximal femur varies by sex, such that girlś associations are heterogeneous and the lowest at the FN, but stronger at the TR and the IT, when compared to boys

Standardized regression coefficients (β), level of significance (p) and coefficient of determination (R²) for proximal femur sub-region models, adjusted for Tanner stage, body height, and body lean mass, with data for boys and girls treated separately.

<p>PA - physical activity; BMD – bone mineral density; FN BMD - femoral neck BMD; TR BMD - trochanter BMD; IT BMD - intertrochanter BMD; FNTR – BMD ratio of femoral neck for trochanter; FNIT – BMD ratio of femoral neck for intertrochanter; TRIT- BMD ratio of trochanter for intertrochanter; BLM – body lean mass.</p

Standardized regression coefficients (β), level of significance (p) and coefficient of determination (R²) for proximal femur sub-region models, adjusted for sex, Tanner stage, body height and body lean mass, with data for boys and girls pooled together.

<p>BMD – bone mineral density; FN BMD - femoral neck BMD; TR BMD - trochanter BMD; IT BMD - intertrochanter BMD; PA - physical activity; MVPA – moderate-through-vigorous PA; BLM – body lean mass.</p

Characteristics of participants as mean±standard deviation.

*<p>Student’s t-test comparing boys to girls was performed when both variables have normal distribution with the same variance. In cases of no normality or no homogeneity of variances, Mann-Whitney nonparametric test was used.^aGirl’s variable without normal distribution; ^bBoy’s variable without normal distribution. PA - physical activity BMD – bone mineral density.</p

Effects of 10 minutes per day of additional physical activity on femoral neck, trochanter, and intertrochanter BMD, adjusted for Tanner stage, body height, and body lean mass.

<p>PA – physical activity; BMD – bone mineral density; FN - femoral neck; TR - trochanter; IT – intertrochanter; ns – non-significant regression coefficient.</p

Sex specific association of physical activity on proximal femur BMD in 9 to 10 year-old children.

The results of physical activity (PA) intervention studies suggest that adaptation to mechanical loading at the femoral neck (FN) is weaker in girls than in boys. Less is known about gender differences associated with non-targeted PA levels at the FN or other clinically relevant regions of the proximal femur. Understanding sex-specific relationships between proximal femur sensitivity and mechanical loading during non-targeted PA is critical to planning appropriate public health interventions. We examined sex-specific associations between non-target PA and bone mineral density (BMD) of three sub-regions of the proximal femur in pre- and early-pubertal boys and girls. BMD at the FN, trochanter (TR) and intertrochanter (IT) regions, and lean mass of the whole body were assessed using dual-energy x-ray absorptiometry in 161 girls (age: 9.7±0.3 yrs) and 164 boys (age: 9.7±0.3 yrs). PA was measured using accelerometry. Multiple linear regression analyses (adjusted for body height, total lean mass and pubertal status) revealed that vigorous PA explained 3-5% of the variability in BMD at all three sub-regions in boys. In girls, vigorous PA explained 4% of the variability in IT BMD and 6% in TR BMD. PA did not contribute to the variance in FN BMD in girls. An additional 10 minutes per day of vigorous PA would be expected to result in a ∼1% higher FN, TR, and IT BMD in boys (p<0.05) and a ∼2% higher IT and TR BMD in girls. In conclusion, vigorous PA can be expected to contribute positively to bone health outcomes for boys and girls. However, the association of vigorous PA to sub-regions of the proximal femur varies by sex, such that girlś associations are heterogeneous and the lowest at the FN, but stronger at the TR and the IT, when compared to boys