Relationship of total body fat mass to weight-bearing bone volumetric density, geometry, and strength in young girls

Abstract

Understanding the influence of total body fat mass (TBFM) on bone during the peri-pubertal years is critical for the development of future interventions aimed at improving bone strength and reducing fracture risk. Thus, we evaluated the relationship of TBFM to volumetric bone mineral density (vBMD), geometry, and strength at metaphyseal and diaphyseal sites of the femur and tibia of young girls. Data from 396 girls aged 8-13 years from the "Jump-In: Building Better Bones" study were analyzed. Bone parameters were assessed using peripheral quantitative computed tomography (pQCT) at the 4% and 20% distal femur and 4% and 66% distal tibia of the non-dominant leg. Bone parameters at the 4% sites included trabecular vBMD, periosteal circumference, and bone strength index (BSI), while at the 20% femur and 66% tibia, parameters included cortical vBMD, periosteal circumference, and strength-strain index (SSI). Multiple linear regression analyses were used to assess associations between bone parameters and TBFM, controlling for muscle cross-sectional area (MCSA). Regression analyses were then repeated with maturity, bone length, physical activity, and ethnicity as additional covariates. Analysis of covariance (ANCOVA) was used to compare bone parameters among tertiles of TBFM. In regression models with TBFM and MCSA, associations between TBFM and bone parameters at all sites were not significant. TBFM explained very little variance in all bone parameters (0.2-2.3%). In contrast, MCSA was strongly related (p<0.001) to all bone parameters, except cortical vBMD. The addition of maturity, bone length, physical activity, and ethnicity did not alter the relationship between TBFM and bone parameters. With bone parameters expressed relative to total body mass, ANCOVA showed that all outcomes were significantly (p<0.001) greater in the lowest compared to the middle and highest tertiles of TBFM. Although TBFM is correlated with femur and tibia vBMD, periosteal circumference, and strength in young girls, this relationship is significantly attenuated after adjustment for MCSA. Nevertheless, girls with higher TBFM relative to body mass have markedly diminished vBMD, geometry, and bone strength at metaphyseal and diaphyseal sites of the femur and tibia.

Keywords: Adiposity; Bone strength; Girls; Peripheral quantitative computed tomography (pQCT); Volumetric bone mineral density (vBMD).

FIGURE 1

Adjusted femur (a) and tibia (b) pQCT bone parameter to body mass ratios for tertiles of TBFM normalized to the middle tertile after being divided by total body mass. Differences in outcome values among tertiles of TBFM were evaluated by ANCOVA using MCSA, maturity offset, bone length, physical activity score, and ethnicity as covariates. TrabBMD = trabecular volumetric bone mineral density (mg/cm³); Pcir = periosteal circumference (mm); BSI = bone strength index (mg²/mm⁴); CortBMD = cortical volumetric bone mineral density (mg/cm³); SSI = strength-strain index (mm³). ^a Significantly (p < 0.001) different from lowest and highest tertiles. ^b Significantly (p < 0.001) different from lowest and middle tertiles.

FIGURE 1

Adjusted femur (a) and tibia (b) pQCT bone parameter to body mass ratios for tertiles of TBFM normalized to the middle tertile after being divided by total body mass. Differences in outcome values among tertiles of TBFM were evaluated by ANCOVA using MCSA, maturity offset, bone length, physical activity score, and ethnicity as covariates. TrabBMD = trabecular volumetric bone mineral density (mg/cm³); Pcir = periosteal circumference (mm); BSI = bone strength index (mg²/mm⁴); CortBMD = cortical volumetric bone mineral density (mg/cm³); SSI = strength-strain index (mm³). ^a Significantly (p < 0.001) different from lowest and highest tertiles. ^b Significantly (p < 0.001) different from lowest and middle tertiles.