Low volumetric BMD is linked to upper-limb fracture in pubertal girls and persists into adulthood: A seven-year cohort study

The aetiology of increased incidence of fracture during puberty is unclear. This study aimed to determine whether low volumetric bone mineral density (vBMD) in the distal radius is associated with upper-limb fractures in growing girls, and whether any such vBMD deficit persists into adulthood. Fracture history from birth to 20 years was obtained and verified by medical records in 1034 Finnish girls aged 10–13 years. Bone density and geometry at distal radius, biomarkers and lifestyle/behavioural factors were assessed in a subset of 396 girls with a 7.5-year follow-up. We found that fracture incidence peaked during puberty (relative risk 3.1 at age of 8–14 years compared to outside this age window), and 38% of fractures were in the upper-limb. Compared to the non-fracture cohort, girls who sustained upper-limb fracture at ages 8–14 years had lower distal radial vBMD at baseline (258.9 ± 37.5 vs. 287.5 ± 34.1 mg/cm3, p  = 0.001), 1-year (252.0 ± 29.3 vs. 282.6 ± 33.5 mg/cm3, p  = 0.001), 2-year (258.9 ± 32.2 vs. 289.9 ± 40.1 mg/cm3, p  = 0.003), and 7-year follow-ups (early adulthood, 307.6 ± 35.9 vs. 343.6 ± 40.9 mg/cm3, p  = 0.002). There was a consistent trend towards larger bone cross-sectional area in the fracture cohort compared to non-fracture. In a logistic regression model, lower vBMD (p  = 0.001) was the only significant predictor of upper-limb fracture during the period of 8–14 years. Our results indicate that low BMD is an important factor underlying elevated upper-limb fracture risk during puberty, and that low BMD in pubertal girls with fracture persists into adulthood. Hence low vBMD during childhood is not a transient deficit. Methods to monitor vBMD and to maximise bone mineral accrual and reduce risks of falling in childhood should be developed.