R. A. Faulkner

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

To investigate the influence of physical activity on bone mineral accrual during the adolescent years, we analyzed 6 years of data from 53 girls and 60 boys. Physical activity, dietary intakes, and anthropometry were measured every 6 months and dual‐energy X‐ray absorptiometry scans of the total body (TB), lumbar spine (LS), and proximal femur (Hologic 2000, array mode) were collected annually. Distance and velocity curves for height and bone mineral content (BMC) were fitted for each child at several skeletal sites using a cubic spline procedure, from which ages at peak height velocity (PHV) and peak BMC velocity (PBMCV) were identified. A mean age‐ and gender‐specific standardized activity (Z) score was calculated for each subject based on multiple yearly activity assessments collected up until age of PHV. This score was used to identify active (top quartile), average (middle 2 quartiles), or inactive (bottom quartile) groups. Two‐way analysis of covariance, with height and weight at PHV controlled for, demonstrated significant physical activity and gender main effects (but no interaction) for PBMCV, for BMC accrued for 2 years around peak velocity, and for BMC at 1 year post‐PBMCV for the TB and femoral neck and for physical activity but not gender at the LS (all p < 0.05). Controlling for maturational and size differences between groups, we noted a 9% and 17% greater TB BMC for active boys and girls, respectively, over their inactive peers 1 year after the age of PBMCV. We also estimated that, on average, 26% of adult TB bone mineral was accrued during the 2 years around PBMCV.

Measuring general levels of physical activity: preliminary evidence for the Physical Activity Questionnaire for Older Children.

This article reports three studies that investigated psychometric properties of the Physical Activity Questionnaire for Older Children (PAQ-C). The PAQ-C is a guided self-administered 7-day recall measure designed to assess general physical activity levels during the school year for children in grades four and higher. Study one, with 215 students ranging in age from 9 to 15 yr, found the PAQ-C had acceptable item and test score characteristics such as item distribution, corrected item-total correlations, and internal consistency. Study two, involving 84 students ranging from 9 to 14 yr, indicated acceptable levels of test-retest reliability for both males (r = 0.75) and females (r = 0.82) after 1 wk. The third study used Generalizability theory to investigate the reliability for using the average of either two or three PAQ-C scores collected during fall, winter, and spring seasons. Based on the responses of 200 students ranging from 8 to 16 yr, generalizability coefficients exceeded 0.80 for either the average of two or three responses for both younger (<13 yr) and older subjects. In all three studies, the PAQ-C demonstrated acceptable internal consistency and males were significantly more active than females. These results provide preliminary support for the PAQ-C as a cost efficient method of assessing general levels of childrens physical activity during the school year.

Bone mineral accrual from 8 to 30 years of age: An estimation of peak bone mass

Bone area (BA) and bone mineral content (BMC) were measured from childhood to young adulthood at the total body (TB), lumbar spine (LS), total hip (TH), and femoral neck (FN). BA and BMC values were expressed as a percentage of young‐adult values to determine if and when values reached a plateau. Data were aligned on biological ages [years from peak height velocity (PHV)] to control for maturity. TB BA increased significantly from −4 to +4 years from PHV, with TB BMC reaching a plateau, on average, 2 years later at +6 years from PHV (equates to 18 and 20 years of age in girls and boys, respectively). LS BA increased significantly from −4 years from PHV to +3 years from PHV, whereas LS BMC increased until +4 from PHV. FN BA increased between −4 and +1 years from PHV, with FN BMC reaching a plateau, on average, 1 year later at +2 years from PHV. In the circumpubertal years (−2 to +2 years from PHV): 39% of the young‐adult BMC was accrued at the TB in both males and females; 43% and 46% was accrued in males and females at the LS and TH, respectively; 33% (males and females) was accrued at the FN. In summary, we provide strong evidence that BA plateaus 1 to 2 years earlier than BMC. Depending on the skeletal site, peak bone mass occurs by the end of the second or early in the third decade of life. The data substantiate the importance of the circumpubertal years for accruing bone mineral.

Bone Densitometry in Canadian Children 8–17 Years of Age

Abstract. Normative bone mineral density (BMD) and bone mineral content (BMC) values for the total body (TB), proximal femur (PF), and antero-posterior lumbar spine (LS) were obtained from a large cross-sectional sample of children and adolescents who were 8–17 years of age. There were 977 scans for the TB, 892 for the PF, and 666 for the LS; bone mineral values were obtained using a HOLOGIC QDR 2000 in array mode. Data are presented for the subregions of the PF (femoral neck, trochanter, intertrochanter, and the total region) and for the LS (L1–L4 and L3). Female and male values for the FN, LS (L1–L4), and the TB were compared across age groups using a two-way ANOVA. In addition, we compared the 17-year-old female values to a separate sample of young adult women (age 21). At all these sites, BMC and BMD increased significantly with age. There was no gender difference in TB BMC until age 14 or in TB BMD until age 16, when male values were significantly greater. Females had significantly greater LS BMC at ages 12 and 13, but by age 17 the male values were significantly greater. Females had significantly greater LS BMD across all age groups, however. Males had significantly greater FN BMC and BMD across all age groups. There were no significant differences in BMC or BMD at any sites between the 17- and 21-year-old women.

Do physical maturity and birth date predict talent in male youth ice hockey players

Abstract The aim of this study was to examine the relationships among biological maturity, physical size, relative age (i.e. birth date), and selection into a male Canadian provincial age-banded ice hockey team. In 2003, 619 male ice hockey players aged 14 – 15 years attended Saskatchewan provincial team selection camps, 281 of whom participated in the present study. Data from 93 age-matched controls were obtained from the Saskatchewan Pediatric Bone Mineral Accrual Study (1991 – 1997). During the initial selection camps, birth dates, heights, sitting heights, and body masses were recorded. Age at peak height velocity, an indicator of biological maturity, was determined in the controls and predicted in the ice hockey players. Data were analysed using one-way analysis of variance, logistic regression, and a Kolmogorov-Smirnov test. The ice hockey players selected for the final team were taller, heavier, and more mature (P < 0.05) than both the unselected players and the age-matched controls. Furthermore, age at peak height velocity predicted (P < 0.05) being selected at the first and second selection camps. The birth dates of those players selected for the team were positively skewed, with the majority of those selected being born in the months January to June. In conclusion, team selectors appear to preferentially select early maturing male ice hockey players who have birth dates early in the selection year.

Regional and total body bone mineral content, bone mineral density and total body tissue composition in children 8-16 years of age

SummaryNormative values for total body bone mineral content (TBBM) and total body bone mineral density (TBMD) were derived from measurements on 234 children 8–16 years of age. In addition, bone mineral content (BMC) and bone mineral density (BMD) values for selected regions of interest and soft tissue (bone free lean and fat) for the total body are presented. Bone mineral and soft tissue values were determined by dual energy X-ray absorptiometry (DXA) using a Hologic QDR-2000 in the array mode. Results of a stepwise multiple regression analysis revealed a significant correlation between bone-free lean tissue (BFLT) and BMD (r2 = 0.80) in girls. Adding age to the equation accounted for an additional 2% of the variance (P < 0.05) and height accounted for another 1% of the variance (P < 0.05). Body weight and fat tissue (FT) did not account for any additional variance. In boys BFLT correlated significantly with BMD (r2 = 0.75;P < 0.05); none of the other predictor variables accounted for additional variance. No significant differences were found in TBBM or TBMD between boys and girls at any age. There was a significant overall gender effect for only three regions of interest. Boys had greater BMC in the head region and had greater BMD in the upper limbs, but post hoc analysis revealed no significant differences for any specific age groups. Girls had greater overall BMD in the pelvis, but this difference was only significant at the 15–6-year age group. The changes in BFLT and FT over the age ranges were consistent with the growth literature.The normative values can be applied to the assessment of children and adolescents with health problems that may impact on the skeleton as well as to research studies investigating bone mineral development in children.

A longitudinal study of the relationship of physical activity to bone mineral accrual from adolescence to young adulthood

Physical activity in adolescence is beneficial for increasing bone mineral accrual; however, its unclear whether these benefits persist into adulthood. This prospective study investigated whether physically active adolescents maintained their higher bone mineral content (BMC) into the third decade of life when compared to their less active peers. Data were from 154 subjects (82 females and 72 males) who participated in the University of Saskatchewans Pediatric Bone Mineral Accrual Study (1991-1997), entry age 8 to 15 years. Participants returned for follow-up as young adults (2002-2006), follow-up age 23 to 30 years. Dual energy X-ray absorptiometry was used to measure BMC of total body (TB), lumbar spine (LS), total hip (TH) and femoral neck (FN) annually from 1991 to 1997 and from 2002 to 2006. Peak height velocity (PHV) was determined for each child as a measure of maturity. Age and gender-specific activity Z-scores were calculated for each participant based on the mean physical activity scores obtained from bi-annual questionnaire data during childhood and adolescence. Subjects were ranked into three adolescent activity groups: active, average and inactive (top, middle two, and bottom quartiles, respectively). Analysis of covariance (ANCOVA) was used to compare adjusted TB, LS, TH and FN BMC across the three adolescent activity groups at 1 year post PHV and in young adulthood. When compared to the inactive group, active males had 8% greater adjusted BMC at the TB, 13% at the LS and 11% at the TH (p<0.05) in adolescence. Active females also had 8% and 15% more adjusted BMC (p<0.05) at the TB and LS, respectively, during adolescence. In young adulthood the male and female adolescent active groups were still significantly more active than their peers (p>0.05). It was found that active adolescent males had 8-10% more adjusted BMC at the TB, TH and FN (p<0.05) in young adulthood and that active adolescent females had 9% and 10% more adjusted BMC at the TH and FN. These results suggest that the skeletal benefits of physically activity in adolescents are maintained into young adulthood.

Peak bone mineral accrual and age at menarche in adolescent girls: A 6-year longitudinal study

BACKGROUND AND OBJECTIVES The greatest increase in bone mineral content occurs during adolescence. The amount of bone accrued may significantly affect bone mineral status in later life. We carried out a longitudinal investigation of the magnitude and timing of peak bone mineral content velocity (PBMCV) in relation to peak height velocity (PHV) and the age at menarche in a group of adolescent girls over a 6-year period. METHODS The 53 girls in this study are a subset of the 115 girls (initially 8 to 16 years) in a 6-year longitudinal study of bone mineral accretion. The ages at PBMCV and PHV were determined by using a cubic spline curve fitting procedure. Determinations were based on height (n = 12) and bone (n = 6) measurements over 6 years. RESULTS The timing of PBMCV and menarche were coincident, preceded approximately 1 year earlier by PHV. Correlation showed a negative relationship between age at menarche and both peak bone mineral accrual (r = -0.42, P < .002) and PHV (r = -0.45, P < .001). CONCLUSIONS This longitudinal study demonstrated the close association between age at PBMCV and age at menarche and confirmed the relationship between greater PBMCV and PHV in earlier, as compared with later, maturing girls.

The history of falls and the association of the timed up and go test to falls and near-falls in older adults with hip osteoarthritis

BackgroundFalling accounts for a significant number of hospital and long-term care admissions in older adults. Many adults with the combination of advancing age and functional decline associated with lower extremity osteoarthritis (OA), are at an even greater risk. The purpose of this study was to describe fall and near-fall history, location, circumstances and injuries from falls in a community-dwelling population of adults over aged 65 with hip OA and to determine the ability of the timed up and go test (TUG) to classify fallers and near-fallers.MethodA retrospective observational study of 106 older men and women with hip pain for six months or longer, meeting a clinical criteria for the presence of hip OA at one or both hips. An interview for fall and near-fall history and administration of the TUG were administered on one occasion.ResultsForty-five percent of the sample had at least one fall in the past year, seventy-seven percent reported occasional or frequent near-falls. The majority of falls occurred during ambulation and ascending or descending steps. Forty percent experienced an injury from the fall. The TUG was not associated with history of falls, but was associated with near-falls. Higher TUG scores occurred for those who were older, less mobile, and with greater number of co-morbidities.ConclusionA high percentage of older adults with hip OA experience falls and near-falls which may be attributed to gait impairments related to hip OA. The TUG could be a useful screening instrument to predict those who have frequent near-falls, and thus might be useful in predicting risk of future falls in this population.

Positive effects of vegetable and fruit consumption and calcium intake on bone mineral accrual in boys during growth from childhood to adolescence : the University of Saskatchewan Pediatric Bone Mineral Accrual Study

BACKGROUND Nutrition is an important modifiable factor in the development of bone mass during adolescence. Recent studies of children and adolescents examined the effects of foods such as milk products and fruit and vegetables on bone growth; however, few studies included both boys and girls. OBJECTIVE The purpose was to ascertain the role of consumption of milk products and vegetables and fruit in the accrual of total-body bone mineral content (TBBMC) in boys and girls from childhood to late adolescence. DESIGN Seven-year longitudinal data were obtained from 85 boys and 67 girls aged 8-20 y. Biological maturity was defined by the number of years from the age at peak height velocity. Dietary intake was assessed by serial 24-h recalls. Anthropometric measurements and physical activity were assessed every 6 mo. TBBMC assessed with dual-energy X-ray absorptiometry in the fall of each year was the indicator of bone mass. RESULTS Most boys (87.8%) met Canadian recommendations for milk product intake. Few subjects (<30%) consumed vegetables and fruit in recommended amounts. Using a multilevel modeling statistical approach containing important biological and environmental factors, we found that vegetable and fruit intakes, calcium intake, and physical activity were significant independent environmental predictors of TBBMC in boys but not in girls. CONCLUSIONS In addition to adequate dietary calcium intake, appropriate intakes of vegetables and fruit have a beneficial effect on TBBMC in boys aged 8-20 y. Underreporting of dietary intake by girls may explain why this effect was not apparent in girls.