title: Bone mineral density by age, gender, pubertal stages, and socioeconomic status in healthy Lebanese children and adolescents.
abstract: Gender, ethnicity, and lifestyle factors affect bone mass acquisition during childhood, thus the need for age- and sex-adjusted Z scores using ethnic-specific data for bone mineral density (BMD) measurement. This study aimed at establishing normative data for BMD in healthy Lebanese children and adolescents. Three hundred sixty-three healthy children aged 10 to 17 years (mean+/-SD: 13.1+/-2.0) were studied. BMD, bone mineral content (BMC), and lean mass were measured by dual-energy X-ray absorptiometry (DXA) using a Hologic 4500A device, and apparent volumetric BMD (BMAD) of the lumbar spine and the femoral neck were calculated. BMD, BMC, and BMAD were expressed by age groups and Tanner stages for boys and girls separately. There was a significant effect of age and puberty on all bone parameters, except at the femoral neck BMAD in boys. BMC and BMD were higher at cortical sites in boys, including subtotal body and hip; whereas, in girls, it was higher at a site more enriched in trabecular bone, namely the lumbar spine. At several skeletal sites, girls had significantly higher BMD adjusted for lean mass than boys. By the end of puberty, adolescents had a mean BMD that was 43-66% higher at the lumbar spine and 25-41% higher at cortical sites than pre-pubertal children, depending on the gender. Mean BMD values in the study group were significantly lower (P<0.01) than Western normative values, with Z scores ranging between -0.2 and -1.1. In both genders, children of lower socioeconomic status tended to have lower BMD than those from a higher socioeconomic background. This study allows additional insight into gender dimorphism in mineral accretion during puberty. It also provides a valuable reference database for the assessment of BMD in children with pubertal or growth disorders who are of Middle Eastern origin.
authors.affiliation: Calcium Metabolism and Osteoporosis Program, Department of Internal Medicine, American University of Beirut-Medical Center, 113-6044 Beirut, Lebanon.
authors.forename: Asma
authors.initials: A
authors.lastname: Arabi
authors.forename: Mona
authors.initials: M
authors.lastname: Nabulsi
authors.forename: Joyce
authors.initials: J
authors.lastname: Maalouf
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Choucair
authors.forename: Hassan
authors.initials: H
authors.lastname: Khalifé
authors.forename: Reinhold
authors.initials: R
authors.lastname: Vieth
authors.forename: Ghada
authors.initials: G
authors.lastname: El-Hajj Fuleihan
mesh_terms: D015502:Absorptiometry, Photon; D000293:Adolescent; D000367:Age Factors; D015992:Body Mass Index; D001837:Body Weights and Measures; D015519:Bone Density / Q000502:physiology*; D002648:Child; D016208:Databases, Factual; D005260:Female; D005269:Femur / Q000737:chemistry / Q000000981:diagnostic imaging; D005272:Femur Neck / Q000737:chemistry / Q000000981:diagnostic imaging; D006801:Humans; D007861:Lebanon; D008159:Lumbar Vertebrae / Q000737:chemistry / Q000000981:diagnostic imaging; D008297:Male; D011627:Puberty / Q000502:physiology*; D011884:Radius / Q000737:chemistry / Q000000981:diagnostic imaging; D012016:Reference Values; D012737:Sex Factors; D012923:Social Class