Can BMD Assessed by DXA at Age 8 Predict Fracture Risk in Boys and Girls During Puberty?: An Eight-Year Prospective Study

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Abstract
This study reports on the association between DXA at age 8 and subsequent fractures in both male and female children. Bone densitometry at the total body and spine (but not hip) is a strong predictor of fracture (especially upper limb) during puberty. Introduction: The aim of this study was to determine if prepubertal DXA can predict fracture risk during puberty. Materials and Methods: We studied 183 children who were followed for 8 yr (1460 person‐years). Bone densitometry was measured at the total body, hip, and spine by DXA and reported as BMC, BMD, and bone mineral apparent density (BMAD). Fractures were self‐reported at age 16 with X‐ray confirmation. Results: There were a total of 63 fractures (43 upper limb). In unadjusted analysis, only total body BMD showed an inverse relationship with upper limb fracture risk (p = 0.03). However, after adjustment for height, weight, age (all at age 8), and sex, total body BMC (HR/SD, 2.47; 95% CI, 1.52–4.02), spine BMC (HR/SD, 1.97: 95% CI, 1.30–2.98), total body BMD (HR/SD, 1.67; 95% CI, 1.18–2.36), total body BMAD (HR/SD, 1.54; 95% CI, 1.01–2.37), and spine BMD (HR/SD, 1.53; 95% CI, 1.10, 2.22) were all significantly associated with upper limb fracture risk. Similar, but weaker associations were present for total fractures. There was a trend for overweight/obesity to be associated with increased upper limb fracture risk (HR, 1.53/category; p = 0.08). Conclusions: Measurement of bone mass by DXA is a good predictor of upper limb fracture risk during puberty. Although we did not measure true BMD, the constancy of fracture prediction after a single measure suggests bone strength remains relatively constant during puberty despite the large changes in bone size.