Children with chronic medical conditions are at risk of compromised bone strength and increased fracture susceptibility. Recently developed reference data have enabled clinicians to identify children 5 to 20 y with compromised bone mineral status (low bone density for age) and optimize their medical care. A glaring deficit is the inability to evaluate bone health of young children <5 y due to lack of appropriate bone density reference data, although numerous clinical conditions (e.g., prematurity, gastrointestinal and neuromuscular disorders) threaten bone health in this young age range. Early childhood differs from other developmental stages. In older children, the need to account for growth status and lean mass when interpreting bone measurements has been demonstrated, but in early childhood, these effects are unknown. Pronounced changes in gross motor skills, locomotion and physical activity also occur in early childhood. Mechanical loads on the growing skeleton promote bone mineral accrual. Understanding the impact of growth, body composition, motor skill development, and physical activity on bone accrual in young children is critical for interpretation of a clinical bone mineral status measurement. These characteristics are often affected in young children with chronic medical conditions. The long-term goal of this study is to optimize bone health of young children. The objectives of this longitudinal study are to develop regional and total body bone mineral content (BMC) and density (aBMD) reference data for children ages 1-5 y to aid identification of young children with bone deficits, and identify factor that influence bone accrual in this age group.
The aims of this longitudinal study are: (1) test fo sex and ancestry differences in BMC and aBMD at multiple skeletal sites in healthy children ages 1 to 5 y, and create appropriate reference curves;(2) assess the influence of growth and body composition, and (3) gross motor skills and physical activity on bone mineral status and bone mineral accrual, and (4) determine the degree of """"""""tracking"""""""" of bone status in young children. Hypotheses to be tested are: males will have greater BMC and aBMD than females;Blacks will have greater BMC and aBMD than non-blacks;bone mineral status and bone accrual will be greater in children with greater growth status and more lean tissue, more advanced gross motor skills, and higher physical activity levels;and BMC and aBMD z-scores will be positively correlated over 3 y. The study is unique since no previous studies have addressed these issues in children 1-5 y. It is clinically relevant as findings will facilitate medcal care of children with chronic medical conditions that threaten bone health, and it will develop and validate novel methods for bone and body composition assessment in this age range. It will also add generalizable knowledge to enhance understanding of the growing skeleton, and its relationship to motor and somatic development. Since poor bone mineral accrual can have lifelong consequences, this study addresses the major public health concern of osteoporosis.

Public Health Relevance

Many young children have chronic medical conditions that threaten bone health and increase risk of fracture and osteoporosis. The proposed research is relevant to public health because it will: (1) develop bone mineral content and density reference data for children 1 to 5 years of age that will enable bone health assessment;(2) quantify the influence of sex, race, growth, body composition, physical activity and dietary intake on bone accrual;and (3) assess the stability of bone health status across this age range. This project is relevant to NICHD's mission because it focuses on improving the health and well-being of young children.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Research Project (R01)
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Neurological, Aging and Musculoskeletal Epidemiology (NAME)
Program Officer
Winer, Karen
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Cincinnati Children's Hospital Medical Center
United States
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