Graduate Thesis Or Dissertation

Sex differences in vertebral bone characteristic, loading patterns and the factor of risk in prepubertal children

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  • Sex differences in bone mass and size are thought to contribute to the greater incidence of vertebral fractures in women. While these sex differences are widely recognized, the relative contributions of bone mass, bone density, and bone size to the differences in vertebral strength and fracture risk between men and women have not been fully delineated. Furthermore, it is unknown whether the roles of each of these factors in determining vertebral strength change differently with age in men and women. We studied the bone content, density and geometry as well as vertebral loading and the factor of risk of the L3 vertebra in a sample of prepubertal males and females. Our first aim was to assess differences in vertebral bone dimensions, bone density, vertebral loading patterns and fracture risk, as measured by the factor of risk, in prepubertal children. Our second aim was to determine whether pre-pubertal growth affects the geometry and density of L3 differently in boys and girls. We measured vertebral dimensions, cross-sectional area and volumetric BMD of the third lumbar vertebral body in 93 prepubertal children (54 boys and 39 girls), using dual-energy X-ray absorptiometry scans obtained in the posterior-anterior and lateral projections. We also employed basic biomechanics to estimate vertebral loading during upright standing and forward bending. Bone strength and loading data were used to assess sex differences in the factor of risk in prepubertal children. Twenty children (11 boys and 9 girls) were assessed at baseline and seven months later to examine the effects of growth on bone size and vBMD. At baseline, boys and girls were similar for age, height, weight and calcium intake. L3 width and depth were 6.7% and 5.8% greater in boys than girls, respectively (P<0.001 and P=0.01, respectively). In contrast, vertebral height was 3.5% greater in girls than boys (P= 0.04). While vertebral loading was similar between sexes, stresses on the spine were 12.2% lower in boys during upright standing and 12.0% lower in boys during forward bending at both 50° and 90°, as compared to girls (P<0.001, P<0.01 and P<0.01, respectively). The factor of risk was similar between boys and girls under each loading condition. During growth, changes in vertebral size and density were not different between boys and girls. Our results indicate that even prior to puberty, sex differences in vertebral size contribute to differences in vertebral stress during standing and forward bending. Furthermore, before the onset of puberty, growth does not result in disparate changes between sexes.
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