title: Early initiation of smoking and alcohol drinking as a predictor of lower forearm bone mineral density in late adolescence: a cohort study in girls.
abstract: BACKGROUND
  Adolescence is a critical stage for bone accrual. It is also decisive for the establishment of behaviors such as smoking and alcohol drinking.
  
  
  OBJECTIVE
  To quantify the short- and long-term associations between smoking and drinking initiation and bone mineral density in adolescent girls.
  
  
  METHODS
  We used prospective data from 731 girls identified in public and private schools in Porto, Portugal. Evaluations were conducted when participants were 13 and 17 years old. Bone mineral density (BMD) was measured at the forearm by dual-energy X-ray absorptiometry and weight, height and fat-free mass were measured. Pubertal development status was estimated using menarche age. Self-administered questionnaires were used to collect data on smoking and alcohol drinking, physical exercise and calcium and vitamin D intakes. BMD in early and late adolescence was analyzed as a continuous or dichotomous (Z-score cutoff: -1.0) variable. Associations were calculated using linear or logistic regression.
  
  
  RESULTS
  Over one quarter of these girls had tried smoking by 13, while 59% had drunk alcoholic beverages and 20% had experienced both behaviors by that age. Lower mean BMD at 17 years of age was observed in girls who had ever smoked by 13, as well as in those who reported drinking at that age. There were no significant cross-sectional associations between experience and frequency of smoking or drinking and BMD at 13 years of age. However, we observed significant associations between BMD z-score<-1 in late adolescence and having ever smoked by 13, after adjustment for menarche age and sports practice, (OR = 1.92; 95% CI: 1.21, 3.05) and with ever smoking and drinking in the same period (OR = 2.33; 95% CI: 1.36, 4.00).
  
  
  CONCLUSIONS
  Our study adds prospective evidence to the role of early initiation of smoking and alcohol drinking as relevant markers of lower bone mineral density in late adolescence.
authors.affiliation: Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal. rlucas@med.up.pt
authors.forename: Raquel
authors.initials: R
authors.lastname: Lucas
authors.forename: Sílvia
authors.initials: S
authors.lastname: Fraga
authors.forename: Elisabete
authors.initials: E
authors.lastname: Ramos
authors.forename: Henrique
authors.initials: H
authors.lastname: Barros
mesh_terms: D015502:Absorptiometry, Photon; D000293:Adolescent; D000428:Alcohol Drinking / Q000009:adverse effects*; D001827:Body Height / Q000187:drug effects; D001835:Body Weight / Q000187:drug effects; D015519:Bone Density / Q000187:drug effects*; D002136:Calcium, Dietary / Q000494:pharmacology; D015444:Exercise; D005260:Female; D005542:Forearm / Q000033:anatomy & histology* / Q000254:growth & development; D006801:Humans; D011446:Prospective Studies; D011627:Puberty / Q000502:physiology; D012907:Smoking / Q000009:adverse effects*; D013334:Students; D011795:Surveys and Questionnaires; D013997:Time Factors; D014807:Vitamin D / Q000494:pharmacology
chemical_list: D002136:Calcium, Dietary; D014807:Vitamin D