Journal Mobile Options
Table of Contents
Vol. 54, Suppl. 1, 2000
Issue release date: 2000

Critical Ages and Stages of Puberty in the Accumulation of Spinal and Femoral Bone Mass: The Validity of Bone Mass Measurements

Baroncelli G.I. · Saggese G.
To view the fulltext, log in and/or choose pay-per-view option

Individual Users: Register with Karger Login Information

Please create your User ID & Password

Contact Information

I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in


In growing children, lumbar and femoral areal bone mineral density (aBMD), as measured by dual-energy X-ray absorptiometry (DXA), is influenced by skeletal growth and bone size. Correction of lumbar bone mineral density (BMD) for bone volume (volumetric BMD [vBMD]), by the use of mathematical extrapolations, reduces the confounding effect of bone size, but vBMD remains dependent on age and bone size during growth. Femoral (neck and mid-shaft) vBMD, assessed by DXA, is independent of age prior to puberty, but a slight increase occurs in late puberty and after menarche. Femoral (mid-shaft) cortical bone density and radial cortical and trabecular bone densities, assessed by quantitative computed tomography (QCT), show no peak during childhood or adolescence. Bone strength index, calculated by peripheral QCT, increases with age and correlates with handgrip strength, bone cross-sectional area and cortical area. Puberty is one of the main factors that influences lumbar bone mineral content and aBMD accumulation, but a high incidence of fractures occurs during this period of life, which may be associated with a reduced aBMD.

Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.


  1. Genant HK, Engelke K, Fuerst T, Gluer CC, Grampp S, Harris ST, Jergas M, Lang T, Lu Y, Majumdar S, Mathur A, Takada M: Noninvasive assessment of bone mineral and structure: State of the art. J Bone Miner Res 1996;11:707–730.
  2. Miller PD, Zapalowski C, Kulak CAM, Bilezikian JP: Bone densitometry: The best way to detect osteoporosis and to monitor therapy. J Clin Endocrinol Metab 1999;84:1867–1871.
  3. Matkovic V, Jelic T, Wardlaw GM, Ilich JZ, Goel PK, Wright JK, Andon MB, Smith KT, Heaney RP: Timing of peak bone mass in caucasian females and its implication for the prevention of osteoporosis. Inference from a cross-sectional model. J Clin Invest 1994;93:799–808.
  4. Bonjour J, Theintz G, Buchs B, Slosman D, Rizzoli R: Critical years and stages of puberty for spinal and femoral bone mass accumulation during adolescence. J Clin Endocrinol Metab 1991;73:555–563.
  5. Theintz G, Buchs B, Rizzoli R, Slosman D, Clavien H, Sizonenko PC, Bonjour JPH: Longitudinal monitoring of bone mass accumulation in healthy adolescents: Evidence for a marked reduction after 16 years of age at the levels of lumbar spine and femoral neck in female subjects. J Clin Endocrinol Metab 1992;75:1060–1065.
  6. Takahashi Y, Minamitani K, Kobayashi Y, Minagawa M, Yasuda T, Niimi H: Spinal and femoral bone mass accumulation during normal adolescence: Comparison with female patients with sexual precocity and with hypogonadism. J Clin Endocrinol Metab 1996;81:1248–1253.

    External Resources

  7. Ott SM: Attainment of peak bone mass. J Clin Endocrinol Metab 1990;71:1082A–1082C.
  8. Recker RR, Davies KM, Hinders SM, Heaney P, Stegman MR, Kimmel DB: Bone gain in young adult women. JAMA 1992;268: 2403–2408.
  9. Del Rio L, Carrascosa A, Pons F, Gusinye M, Yeste D, Domenech FM: Bone mineral density of the lumbar spine in white Mediterranean Spanish children and adolescents: Changes related to age, sex, and puberty. Pediatr Res 1994;35:362–366.
  10. Lu PW, Cowell CT, Lloyd-Jones SA, Briody JN, Howman-Giles R: Volumetric bone mineral density in normal subjects, aged 5–27 years. J Clin Endocrinol Metab 1996;81:1586–1590.
  11. Haapasalo H, Kannus P, Sievanen H, Pasanen M, Uusi-Rasi K, Heinonen A, Oja P, Vuori I: Development of mass, density, and estimated mechanical characteristics of bones in caucasian females. J Bone Miner Res 1996;11:1751–1760.
  12. Seeman E: From density to structure: Growing up and growing old on the surfaces of bone. J Bone Miner Res 1997;12:509–521.
  13. Carter DR, Bouxsein ML, Marcus R: New approaches for interpreting projected bone densitometry data. J Bone Miner Res 1992;7:137–145.
  14. Jergas M, Breitenseher M, Gluer CC, Yu W, Genant HK: Estimates of volumetric bone density from projectional measurements improve the discriminatory capability of dual X-ray absorptiometry. J Bone Miner Res 1995;10:1101–1110.
  15. Kroger H, Kotaniemi A, Vainio P, Alhava E: Bone densitometry of the spine and femur in children by dual-energy X-ray absorptiometry. Bone Miner 1992;17:75–85.
  16. Peel NFA, Eastell R: Diagnostic value of estimated volumetric bone mineral density of the lumbar spine in osteoporosis. J Bone Miner Res 1994;9:317–320.
  17. Sievanen H, Kannus P, Nieminen V, Heinonen A, Oja P, Vuori I: Estimation of various mechanical characteristics of human bones using dual energy X-ray absorptiometry: Methodology and precision. Bone 1996;18:S17–S27.
  18. Baroncelli GI, Bertelloni S, Ceccarelli C, Saggese G: Measurement of volumetric bone mineral density accurately determines degree of lumbar undermineralization in children with growth hormone deficiency. J Clin Endocrinol Metab 1998;83:3150–3154.
  19. Katzman DK, Bachrach LK, Carter DR, Marcus R: Clinical and anthropometric correlates of bone mineral acquisition in healthy adolescent girls. J Clin Endocrinol Metab 1991;73:1332–1339.
  20. Boot AM, De Ridder MAJ, Pols HAP, Krenning EP, de Muinck Keizer-Schrama SMPF: Bone mineral density in children and adolescents: Relation to puberty, calcium intake, and physical activity. J Clin Endocrinol Metab 1997;82:57–62.
  21. Gilsanz V, Kovanlikaya A, Costin G, Roe TF, Sayre J, Kaufman F: Differential effect of gender on the sizes of the bones in the axial and appendicular skeletons. J Clin Endocrinol Metab 1997;82:1603–1607.
  22. Gilsanz V, Gibbens DT, Roe TF, Carlson M, Senac MO, Boechat MI, Huang HK, Schulz EE, Libanati CR, Cann CC: Vertebral bone density in children: Effect of puberty. Radiology 1988;166:847–850.
  23. Gilsanz V, Gibbens DT, Carlson M, Boechat MI, Cann CC, Schulz EE: Peak trabecular vertebral density: A comparison of adolescent and adult females. Calcif Tissue Int 1988;43:260–262.
  24. Gilsanz V, Skaggs DL, Kovanlikaya A, Sayre J, Loro ML, Kaufman FR, Korenman SG: Differential effect of race on the axial and appendicular skeletons of children. J Clin Endocrinol Metab 1998;83:1420–1427.

    External Resources

  25. Fournier PE, Rizzoli R, Slosman DO, Theintz G, Bonjour JP: Asynchrony between the rates of standing height gain and bone mass accumulation during puberty. Osteoporos Int 1997;7:525–532.
  26. Bass S, Delmas PD, Pearce G, Hendrich E, Tabensky A, Seeman E: The differing tempo of growth in bone size, mass, and density in girls is region specific. J Clin Invest 1999;104:795–804.
  27. Mora S, Pitukcheewanont P, Kaufman FR, Nelson JC, Gilsanz V: Biochemical markers of bone turnover and the volume and the density of bone in children at different stages of sexual development. J Bone Miner Res 1999;14:1664–1671.

    External Resources

  28. McKay HA, Bailey DA, Mirwald RL, Shawn Davison K, Faulkner RA: Peak bone mineral accrual and age at menarche in adolescent girls: A 6-year longitudinal study. J Pediatr 1998;133:682–687.
  29. Rauch F, Klein K, Lehmann R, Allolio B, Schonau E: Age at menarche and bone density. Horm Res 1997;48(suppl 2):177.
  30. Alffram PA, Bauer GCH: Epidemiology of fractures of the forearm. J Bone Joint Surg Am 1962;44A:105–114.
  31. Bailey DA, Wedge JH, McCulloch RG, Martin AD, Bernhardson SC: Epidemiology of fractures of the distal end of the radius in children as associated with growth. J Bone Joint Surg Am 1989;71A:1225–1231.
  32. Landin L, Nilsson BE: Bone mineral content in children with fractures. Clin Orthop Rel Res 1983;178:292–296.
  33. Goulding A, Cannan R, Williams SM, Gold EJ, Taylor RW, Lewis-Barned NJ: Bone mineral density in girls with forearm fractures. J Bone Miner Res 1998;13:143–148.
  34. Genant HK, Gluer CC, Lotz JC: Gender differences in bone density, skeletal geometry and fracture biomechanics. Radiology 1994;190:636–640.
  35. Cadogan J, Blumsohn A, Barker ME, Eastell R: A longitudinal study of bone gain in pubertal girls: Anthropometric and biochemical correlates. J Bone Miner Res 1998;13:1602–1612.
  36. Parfitt AM: The two faces of growth: Benefits and risks to bone integrity. Osteoporos Int 1994;4:382–398.
  37. Ogden JA: Skeletal Injury in the Child, ed 2. Philadelphia, WB Saunders, 1990, pp 23–63.
  38. Schönau E, Wentzlik U, Michalk D, Scheidhauer K, Klein K: Is there an increase of bone density in children? Lancet 1993;342:689–690.
  39. Schönau E: The development of the skeletal system in children and the influence of muscular strength. Horm Res 1998;49:27–31.
  40. De Schepper J, De Boeck H, Louis O: Measurement of radial bone mineral density and cortical thickness in children by peripheral quantitative computed tomography; in Schonau E (ed): Paediatric Osteology – New Developments in Diagnostics and Therapy. Amsterdam, Elsevier, 1996, pp 135–140.
  41. Trotter M, Hixon BB: Sequential changes in weight, density, and percentage ash weight of human skeletons from an early fetal period through old age. Anat Rec 1974;179:1–18.
  42. Schiessl H, Ferretti JL, Tysarczyk-Niemeyer G, Willnecker J: Noninvasive bone strength index as analyzed by peripheral quantitative computed tomography (pQCT); in Schonau E (ed): Paediatric Osteology – New Developments in Diagnostics and Therapy. Amsterdam, Elsevier, 1996, pp 141–146.
  43. Augat P, Reeb H, Claes L: Second moment of inertia of the distal radius predicts the stability of the radius and the femoral neck. Calcif Tiss Int 1995;56:453.
  44. Frost HM: Structural adaptations to mechanical usage (SATMU): Redefining Wolff’s Law. The bone modeling problem. Anat Rec 1990;226:403–413.

Pay-per-View Options
Direct payment This item at the regular price: USD 38.00
Payment from account With a Karger Pay-per-View account (down payment USD 150) you profit from a special rate for this and other single items.
This item at the discounted price: USD 26.50