ESPE Yearbook of Paediatric Endocrinology

To read the full abstract: PLoS Medicine vol. 16,12 e1002986. 2 Dec. 2019. doi: https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002986

This large scale population-based cohort study identifies a slightly higher risk for adult fracture in men who had later puberty.

The pubertal period plays a key role in bone mineral acquisition. Several papers have reported that pubertal delay, for both men and women, is associated with lower bone mineral density (1–5). While several studies in women have showed that later age at menarche is associated with higher risk of osteoporosis fracture (6–7), there is no evidence in men of a causal relationship between pubertal timing, defined by age at peak height velocity (PHV), and fracture risk in adulthood. Yet, given the aging of the population and the importance of osteoporosis, fragility fractures are a public health concern. For these reasons, it is necessary to better predict which individuals are at high risk of future fractures.

In a very large dataset of 31 971 Swedish men born between 1945 and 1961, the authors demonstrate for the first time that men with age at PHV in the oldest tertile (>14.5 years old) had a 15% higher relative risk of any fracture or non-vertebral fracture than men with age at PHV in the lowest tertile (≤13.6 years). Adjustments for birthweight, childhood BMI at 8 years of age, adult educational level or young adult height did not attenuate these associations.

These findings suggests that pubertal timing might be taken into account to identify adult men at elevated risk of fracture, by combining bone density imaging and clinical risk factors. However, it should be noted that the increase in risk reported in this study was only moderate.

References:

1. Chevalley T, Bonjour JP, Ferrari S, Rizzoli R. (2009). Deleterious effect of late menarche on distal tibia microstructure in healthy 20-year-old and premenopausal middle-aged women. J Bone Miner Res. 24(1):144–152.

2. Day FR, Elks CE, Murray A, Ong KK, Perry JR. (2015). Puberty timing associated with diabetes, cardiovascular disease and also diverse health outcomes in men and women: the UK Biobank study. Sci Rep. 5:11208.

3. Cousminer DL, Mitchell JA, Chesi A, et al. (2018). Genetically Determined Later Puberty Impacts Lowered Bone Mineral Density in Childhood and Adulthood. J Bone Miner Res. 33(3):430–436.

4. Kindblom JM, Lorentzon M, Norjavaara E, et al. (2006). Pubertal timing predicts previous fractures and BMD in young adult men: the GOOD study. J Bone Miner Res. 21(5):790–795.

5. Kuh D, Muthuri SG, Moore A, et al. (2016). Pubertal timing and bone phenotype in early old age: findings from a British birth cohort study. Int J Epidemiol. 45(4):1113–1124.

6. Roy DK, O’Neill TW, Finn JD, et al. (2003). Determinants of incident vertebral fracture in men and women: results from the European Prospective Osteoporosis Study (EPOS). Osteoporos Int. 14(1):19–26.

7. Silman AJ. (2003). Risk factors for Colles’ fracture in men and women: results from the European Prospective Osteoporosis Study. Osteoporos Int. 14(3):213–218.