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. 2019 Sep 4;20(1):404.
doi: 10.1186/s12891-019-2785-8.

Does peak bone mass correlate with peak bone strength? Cross-sectional normative dual energy X-ray absorptiometry data in 1052 men aged 18-28 years

Erik Lindgren  1 , Björn E Rosengren  1 , Magnus K Karlsson  2
Affiliations

Does peak bone mass correlate with peak bone strength? Cross-sectional normative dual energy X-ray absorptiometry data in 1052 men aged 18-28 years

Erik Lindgren et al. BMC Musculoskelet Disord. .

Abstract

Background: Areal bone mineral density (aBMD) estimated by dual-energy X-ray absorptiometry (DXA) is used to estimate peak bone mass, define osteoporosis and predict fracture. However, as aBMD is calculated as bone mineral content (BMC) divided by the scanned area, aBMD displays an inverse relationship with bone size. In a skeleton that is increasing in size, this is a problem, as bone size is an independent factor that determines bone strength. It could therefore be questioned whether peak aBMD is the period with greatest bone strength, a period that in the hip then would occur in ages 16-19. The aim of this study was to evaluate whether there are changes in bone size in men after age 18 that may influence peak bone strength. Another aim was to provide updated normative DXA data.

Methods: We scanned left femoral neck by DXA in a cross-sectional study with a population-based selection of 1052 men aged 18-28, and then registered bone mineral content (BMC, gram), aBMD (gram/cm2) and bone area (cm2) in each one-year age group. We performed analyses of variance (ANOVA) to evaluate whether there were differences in these traits between the age groups. We then used Pearson's correlation analyses to test for trends with ageing after peak bone mass was reached.

Results: We found the highest absolute femoral neck aBMD at age 19, with statistically significant differences between the one-year age groups in BMC, aBMD, and bone area (all p < 0.05). From peak bone mass onwards (n = 962), there are negative correlations between age and BMC (r = - 0.07; p < 0.05) and age and aBMD (r = - 0.12; p < 0.001), and positive correlation between age and bone area (r = 0.06; p < 0.05).

Conclusion: As femoral neck bone size in young adult men becomes larger after peak bone mass, it could be questioned whether DXA estimated peak aBMD correlates with peak bone strength. We infer that aBMD must be interpreted with care in individuals with a growing skeleton, since skeletal strength may then increase, in spite of decreasing aBMD. This should be taken into account when performing DXA measurements in these ages.

Keywords: Bone; DXA; Mass; Men; Mineral; Normative; Size; Strength.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow-chart study population when including men aged 18–28 years
Fig. 2
Fig. 2
Femoral neck BMC (2a), area (2b) and aBMD (2c) in different age groups in 962 Swedish males aged 19 to 28 years (from peak bone mass and onwards). Age group 19 include individuals between 19.0 to 19.9 years of age etc. Data are presented as means with 95% confidence intervals. P-value represent age group differences
Fig. 3
Fig. 3
Trochanter BMC (3a), area (3b) and aBMD (3c) in different age groups in 962 Swedish males aged 19 to 28 years (from peak bone mass and onwards). Age group 19 include individuals between 19.0 to 19.9 years of age etc. Data are presented as means with 95% confidence intervals. P-value represent age group differences
Fig. 4
Fig. 4
Total hip BMC (4a), area (4b) and aBMD (4c) in different age groups in 962 Swedish males aged 19 to 28 years (from peak bone mass and onwards). Age group 19 include individuals between 19.0 to 19.9 years of age etc. Data are presented as means with 95% confidence intervals. P-value represent age group differences
See this image and copyright information in PMC

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