Factors Affecting Bone Health in Children: A Preliminary Study in Kocaeli

Authors: GÜLCAN TÜRKER, KADİR BABAOĞLU, DEMET GEDİKBAŞI, HAKAN DEMİR, FATMA BERK, METİN AYDOĞAN, ŞÜKRÜ HATUN

Abstract: Unhealthy bones in childhood are likely to be reflected as osteoporosis in the future. This study was planned to assess the bone health of children in the Kocaeli region and to determine the risk factors in terms of osteopenia. A total of 46 healthy children aged 6-16 years (21 girls and 25 boys, mean age: 8.74±2.56 years) were included in the study. A questionaire was used by the physicians to determine the sunlight exposure, dressing habits, calcium content of the diet, vitamin supplementation and daily physical activity. Bone mineral density was evaluated using dual-energy X-ray absorptiometry at L_2-L_4 levels of the lumbar spine, Ward's triangle and femur neck. Z-scores of bone mineral density were calculated. Serum calcium, phosphorus, alkaline phosphatase, ferritin levels and urinary calcium creatinine ratio were measured and an X-ray of the right wrist was taken. In 84% of the study group bone mineral density was lower than the expected values. Mean values of bone mineral density for the femur neck, L_2-L_4 level of lumbar spine and Ward's triangle were 0.64+0.11g/cm2, 0.54+0.07 g/cm2, and 0.55+0.10 g/cm2, respectively. None of the children had hypoferritenemia, which has an adverse effect on matrix development. We only found a statistically significant correlation between bone mineral density, bone age and serum alkaline phosphatase levels. When the etiology of the decreased bone mineral density was evaluated, no correlation was found with dietary calcium intake physical activity, vitamin D supplementation, sunlight exposure, dressing habits and urinary calcium excretion. Although none of the children was osteopenic (Z-score of BMD below - 2 SD), the majority had BMD values below those expected. We were unable to determine the etiology of the decreased BMD in this study. However, we suggest that air pollution might be an etiologic factor that must be studied in future in larger series. In addition, we think that weight-bearing activities and dietary calcium intake must be encouraged.

Keywords: Bone density, children, affecting factor, air pollution

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