Research indicates that peak bone mineral density (BMD) at the end of the adolescent growth spurt could be linked to later risk for fracture and osteoporosis. For a study published in JAMA Network Open, Ahmed Elhakeem, PhD, and colleagues examined whether puberty timing is associated with BMD accrual, intending to create a description of BMD accrual through maturing adolescents.

The researchers analyzed data of 6,389 pediatric participants, 50% female and 50% male, gathered over15 years from the Avon Longitudinal Study of Parents and Children. “The team used multiple bone density scans taken from each child to assess their bone strength between ages 10 and 25,” explains Dr. Elhakeem. Participants underwent whole-body dual-energy x-ray absorptiometry scans as part of clinic assessments at mean ages 10, 12, 14, 16, 18, and 25. Age of puberty was calculated by tracking participant’s height to estimate when each reached their age of peak height velocity (APHV). The relationship between puberty timing (using APHV as a marker) and bone accrual was then assessed.

The study authors found that male participants gained BMD at a faster rate than female participants (0.139 g/cm2/y [95% CI, 0.127-0.151 g/cm2/y] for male participants vs 0.106 g/cm2/y [95% CI, 0.098-0.114 g/cm2/y] for female participants). In both male and female participants, the most significant increases were seen in the year before and 2 years after their APHV. Participants who went through puberty later than their peers had quicker BMD increases. However, faster BMD increases did not equate to higher BMD. “Despite some catch up during puberty, participants who matured later had persistently reduced BMD throughout growth and up to age 25, when compared with their earlier maturing peers,” notes Dr. Elhakeem.

This study indicates that the implications of delayed puberty include risks of fractures and osteoporosis in later life, according to Dr. Elhakeem. Therefore, he suggests that more advice on how BMD can be increased and maintained, such as through physical activity, should be readily available for people who reach puberty later. “Future studies should seek to identify the driving forces behind the association between puberty timing and bone accrual. This can be achieved, for example, by large multicohort collaborations, which can provide more repeated measures over longer follow-up in populations with differing confounding structures and with larger sample sizes that can support methods that are statistically inefficient,” adds Dr. Elhakeem.


Association Between Age at Puberty and Bone Accrual From 10 to 25 Years of Age