title: Influence of birth size and body composition on bone mineral density in early adulthood: the PROGRAM study.
abstract: OBJECTIVE
  Low bone mineral density (BMD) may lead to osteoporosis and is associated with increased fracture risk. Associations between BMD and various factors have been reported. Our objective was to investigate whether birth size, lean body mass (LBM) and fat mass (FM) are determinants of BMD of the total body (BMD(TB)) and the lumbar spine (BMD(LS)).
  
  
  METHODS
  In the PROgramming factors for GRowth And Metabolism (PROGRAM) study of a cohort of 312 young adults aged 18-24 years, BMD(TB) and BMD(LS) were determined by dual-energy X-ray absorptiometry (DXA). Subsequently, differences in BMD(TB) and BMD(LS) were analysed in four subgroups: young adults born small for gestational age with short stature (SGA-S) or with catch-up growth (SGA-CU), or born appropriate for gestational age (AGA) with idiopathic short stature (ISS) or with normal stature (controls).
  
  
  RESULTS
  Adult weight, LBM, FM and weight gain during childhood were the main positive determinants for BMD(TB) in early adulthood, whereas birth size had no influence (adjusted R(2) = 0.50). Gender, adult weight, LBM, FM and weight gain were the significant determinants of BMD(LS). In the subgroups, after correction for age, gender and adult body size, the ISS group had a significantly lower BMD(TB) than controls but there was no difference in BMD(LS) between the subgroups.
  
  
  CONCLUSIONS
  Prenatal growth has no significant influence on BMD(TB) and BMD(LS) in early adulthood. Gender and postnatal growth, particularly weight gain, are the main positive determinants. To achieve a normal BMD in adulthood, healthcare workers should aim for a normal weight gain in children.
authors.affiliation: Department of Paediatrics, Subdivision of Endocrinology, Erasmus MC, Sophia Children's Hospital, Rotterdam, the Netherlands. r.leunissen@erasmusmc.nl
authors.forename: R W J
authors.initials: RW
authors.lastname: Leunissen
authors.forename: T
authors.initials: T
authors.lastname: Stijnen
authors.forename: A M
authors.initials: AM
authors.lastname: Boot
authors.forename: A C S
authors.initials: AC
authors.lastname: Hokken-Koelega
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000375:Aging / Q000502:physiology; D001823:Body Composition / Q000502:physiology*; D001827:Body Height / Q000502:physiology; D049628:Body Size / Q000502:physiology*; D015519:Bone Density / Q000502:physiology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008161:Lumbosacral Region / Q000502:physiology; D008297:Male; D036801:Parturition / Q000502:physiology; D055815:Young Adult