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Журнал «Здоровье ребенка» 2 (45) 2013

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Age and Gender Peculiarities of Children’s Bone Mineral Density in Donetsk Region

Age and Gender Peculiarities of Children’s Bone Mineral Density in Donetsk Region

Авторы: F. V. Klymovytsky 2, V. V. Povoroznyuk 1, 1 D. F. Chebotarev Institute of Gerontology of UNAMS, 2 Research Institute of Traumatology and Orthopedics of M. Gorky Donetsk National Medical University

Рубрики: Травматология и ортопедия, Педиатрия/Неонатология

Разделы: Клинические исследования

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Резюме

Using dual-energy densitometer Discovery QPR (Bedford, USA) there had been examined 168 children from of one of comprehensive schools of Donetsk. Parameters of bone mineral density at the lumbar spine, proximal femur and the entire skeleton had been studied, that for the first time made it possible to create reference database of children and adolescents. It has been proved also that age has significant impact on variability of bone mineral density indices. It is found that the critical period for the formation of peak bone mass in girls is the age of 10–15 years, in boys — 12–15 years.

За допомогою двохенергетичного денситометра Discovery QPR (Bedford, США) проведено обстеження 168 дітей однієї з загальноосвітніх шкіл Донецька. Вивчалися показники мінеральної щільності кісткової тканини на рівні поперекового відділу, проксимального відділу стегна та всього скелета, що вперше дозволило створити референтну базу даних для дітей та підлітків. Також доведено, що вік вірогідно впливає на варіабельність показників мінеральної щільності кісткової тканини. Встановлено, що критичним періодом формування піку кісткової маси у дівчаток є вік 10–15 років, а у хлопчиків — 12–15 років.

При помощи двухэнергетического денситометра Discovery QPR (Bedford, США) проведено обследование 168 детей одной из общеобразовательных школ Донецка. Изучались показатели минеральной плотности костной ткани на уровне поясничного отдела позвоночника, проксимального отдела бедра и всего скелета, что впервые позволило создать референтную базу данных для детей и подростков. Также доказано, что возраст достоверно влияет на вариабельность показателей минеральной плотности костной ткани. Установлено, что критическим периодом формирования пика костной массы у девочек является возраст 10–15 лет, а у мальчиков — 12–15 лет.


Ключевые слова

bone mineral density, children, age, sex.

мінеральна щільність кісткової тканини, діти, вік, стать.

минеральная плотность костной ткани, дети, возраст, пол.

Osteoporosis appears the most widespread systematic skeleton disease characterized with low bone mass and defective bone tissue architectonics, these resulting in extra bone fragility and increased fracture risk [1]. Osteoporosis develops through two main factors: bone mass peak formed in childhood and youth and rate this mass is being lost during lifetime [2].

Bone mass peak age differs in various skeleton sections (lumbar spine, femoral neck, femoral head, Ward’s triangle, ultradistal forearm and spoke bone sections (33 %) with compact bone tissue prevailing) [3-6]. Bone mass peak in the specified section is reached on third lifetime decade [3, 7-9]. Bane mass peak formation may be influenced with sexual development peculiarities, physical activity level, nutrition, somatic pathology and area the child inhabits [10-14].

Research goal – research age and sex peculiarities about mineral density of bone tissue on the skeleton level (MDBTS), lumbar spine – (MDBTL), proximal section of left femur (MDBTF) in case with healthy children and teenagers in Donetsk.

Research object

There were examined 168 children aged 10 tо 17 (average age – 13.1 ± 1.6 years; average height – 1.62 ± 0.12 m; average weight – 52.6 ± 12.41 kg); girls – 89 (average age – 13 ± 1.6 years; average height – 1.59 ± 0.1 m; average weight – 50.52 ± 10.92 kg); boys – 79 (average age – 13 ± 1.6 years; average height – 1.65 ± 0.14 m; average weight – 54.9 ± 13.9 kg) who study in one of Donetsk secondary schools. Research report was approved by ethics committees of D. F. Chebotarev Institute of Gerontology of UNAMS and Research Institute of Traumatology and Orthopedics of M. Gorky Donetsk National Medical University. Participants, their parents and school administration gave their consent for research. The research excluded children who were taking corticosteroids, anticonvulsants and heparin were or are ill with metabolic bone tissue diseases, kidney or liver diseases and diabetes. Research participants had height and weight within the range of 10 – 90 percentiles.

Research methods

All pupils were subject to generally accepted examination and anthropometric research (height and weight measurement). Weight index (WI) was calculated with the following formula: weight (kg)/height, (m2). Moreover, children filled in the form specifying presence, location, age, cause and details of their fractures, as well as immobility period. Indices MDBTS, MDBTL and MDBTF were identified with duo-energetic densitometry device Hologic QDR 4500A, Bedford, MA. In course of MDBTL identification the patients were lying on their backs, with physiological lordosis smoothed via knee joint bent legs. For MDBTF standard manufacturer’s device was used.

All measurements were performed and analyzed by the same researcher.

Statistic analysis was made via Excel and Statistiсa 6.1. software. Applied were general characteristics and Anova dispersive single-factor analysis, results were evaluated under Fisher’s criterion, Student’s coefficient and Sheffe’s method. Table data show average index (M) and standard deviation (SD).

Demographic details of examined children subject to their age and sex are specified in Table 1 and picture 1.       

Examined groups of children apparently differed with their demographic features, namely weight and height.

The performed dispersive analysis revealed apparent age effect upon variability of MDBT indices (Table 1). Apparent increase of MDBT in whole skeleton, lumber spine and proximal section of left femur was identified both with boys and girls.

Histograms showing MDBT indices in lumber spine and proximal femur section of boys and girls are specified in picture 2.

In case with 14- (р = 0.02) and 15-year (р = 0.02) old girls apparent MDBTS differences were identified if compared to 10-year old ones. Moreover, 15-year old girls had higher MDBTS index if compared to 13-year old ones (р = 0.02). MDBTL indices are apparently higher in case with 11- (р = 0.06), 13- (р = 0.027) and 15-year old girls (р = 0.05) if compared to 10-year old ones. MDBTF index was specified as apparently higher in case with 16-year old girls (р = 0.038) if compared to 10-year old ones. As regards mineral saturation of the skeleton, apparent increase of this index was identified in case with 14- (р = 0.03), 15- (р = 0.001) and 16-year old girls (р = 0.022) if compared to 10-year old ones.

In case with boys, apparent increase of MDBTS index, if compared to 10-year old ones, was identified within groups of 15-year old boys (р = 0.03); if compared to 11-year old ones – within groups of 14- (р = 0.03), 15- (р = 0.0002) and 16-year old boys (р = 0.04); if compared to 12-year old ones – within groups of 14- (р = 0.04), 15- (р = 0.00002) and 16-year old ones (р = 0.008). MDBTL index with the boys is apparently higher, if compared to 11-year old ones, in the age of 14 (р = 0.03), 15 (р = 0.001) and 16 years (р = 0.004); if compared to 12-year old ones, in the age of 14 (р = 0.007), 15 (0.0007) and 16 years (р = 0.0007). As for MDBTF index, apparent increase was identified with 15-year old boys if compared to 11- (р = 0.024) 12-year old ones (р = 0.008). As regards mineral saturation of the skeleton, this index was apparently increasing, if compared to 10-year old boys, in the age of 15 (р = 0.06) and 16 (р = 0.02); if compared to 11-year old boys, in the age of 14 (р = 0.0001), 15 (р = 0.000001) and 16 (р = 0.002).

Thus, indices MDBTS, MDBTL and MDBTF are increasing with age, and certain differences are obscured in age groups of 14-15 years in comparison to 10-year old children.

According to DXA data, in case with girls, MDBT index lower than reference level (Z criterion is lower than minus 2 SD) was registered in 5.6% cases in proximal section of left femur and 2.2% – in lumber spine. As for the boys, they had much better densitometry indices.

This far, MDBT index lower than reference level was registered only in 2.5% cases in proximal section of left femur and 1.3% – in lumber spine. MDBT indices on the skeleton level were apparently worse both with the boys and girls (Table 2, pictures 4 and 5). 

Low MDBTL index is diagnosed only with 12-15-year old children. The girls in the age of 12-15 have low MDBT indices in 3.0%, and the boys of the same age – 1.7% cases (Picrure 6).

MDBTF indices appeared worse in comparison to MDBTL. MDBT index lower than reference level was diagnosed with the girls in the age of 10-11 and those of 12-15 years (5.3 and 6.0% correspondently), and in case with the boys – only within the age group of 12-15 years (9.7%) (Picture 7).

So, the most critical period in course of bone mass peak formation is the age of 10-15 years with the girls, and 12-15 years with the boys.

Conclusion

1. The performed research has provided for creating MDBT reference database (according to X-ray densitometry results) for 10-16-year old children in Donetsk.

2. It has been fixed that critical period in course of bone mass peak formation is the age of 10-15 years with the girls, and 12-15 years with the boys. These details should be considered by the pediatricians and school doctors throughout making rehabilitation plans for the aforementioned age groups.


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