Bone Microstructure and Bone Strength At the Distal Radius in Relation to the Pubertal Growth Spurt in Adolescence

Increased incidence of forearm fractures during the adolescent growth spurt is well documented but it is unclear if bone structure is weaker during this rapid period of growth. The objectives of this research are to 1) determine the precision errors (CV%RMS) for bone strength outcomes under specific loading conditions, and 2) compare bone strength and microstructural (microarchitectural, geometry, density) outcomes of the distal radius across the pubertal growth spurt.

We categorized 143 typically developing children into 3 groups, based on their estimated somatic maturity (years from the age at peak height velocity, APHV): Pre -0.5y prior to APHV; Peri +0.5y within APHV, and Post >0.5y post to APHV. We analyzed distal radius HR-pQCT images to obtain trabecular and cortical bone microstructure and finite element (FE) derived strength outcomes. Two types of models were created – a homogenous model which applies a single elastic modulus to the entire bone tissue, and a scaled (E-BMD) model which determines the elastic modulus based on the imaged bone mineral density. We compared the outcomes across the groups using multiple analysis of covariance (MANCOVA), with age, height, and body mass as covariates (Wilks’ Lambda, p<0.05), followed by pairwise comparisons.

Precision error of the bone strength outcomes were 3.2% - 8.3% for homogenous and 8.6% - 11.9% for scaled model. Peri group had 20% lower bone stiffness than Pre (p=0.01), and 39% higher factor-of-risk than Post (p=0.01) groups. Peri had 12-19% lower trabecular thickness, bone volume, trabecular bone density and total bone density than Pre group. Peri group also had 5-19% lower cortical thickness, cortical bone mineral density and tissue mineral density, cortical total and bone volume, and cortical area than Post group (p<0.05).

Our findings indicate that the FE models can precisely quantify the bone strength outcomes. Additionally, it indicates lower bone strength and maturity-specific deficits in trabecular and cortical bone micro-architecture and density at the distal radius around the age at peak height velocity. Prospective monitoring of bone strength development over the pubertal growth spurt is warranted. These findings support the hypothesis of transient weakness in bone development during the peak growth spurt in adolescence.

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Year

Entry

1994

Parfitt AM. The two faces of growth: benefits and risks to bone integrity. Osteoporos Int. November 1994;4(6):382-398.

2010

Wang Q, Wang X-F, Iuliano-Burns S, Ghasem-Zadeh A, Zebaze R, Seeman E. Rapid growth produces transient cortical weakness: a risk factor for metaphyseal fractures during puberty. J Bone Miner Res. July 2010;25(7):1521-1526.

2001

Homminga J, Huiskes R, Van Rietbergen B, Rüegsegger P, Weinans H. Introduction and evaluation of a gray-value voxel conversion technique. J Biomech. April 2001;34(4):513-517.

1988

Ashman RB, Rho JY. Elastic modulus of trabecular bone material. J Biomech. 1988;21(3):177-181.

2007

MacNeil JA, Boyd SK. Accuracy of high-resolution peripheral quantitative computed tomography for measurement of bone quality. Med Eng Phys. December 2007;29(10):1096-1105.