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Adipose Tissue Stimulates Bone Growth in Prepubertal Children

Departments of Community Based Medicine (E.M.C., A.R.N.) and Clinical Sciences at South Bristol (J.H.T.), University of Bristol, Bristol BS2 8HW, United Kingdom

Address all correspondence and requests for reprints to: Dr. J. Tobias, Rheumatology Unit, Bristol Royal Infirmary, Bristol BS2 8HW, United Kingdom. E-mail: Jon.Tobias{at}bristol.ac.uk.

Context: Fat mass represents a positive influence on bone mass in adults, independently of other factors such as lean mass, but whether a similar action occurs in children is unclear.

Objective: Our objective was to examine the relationship between fat mass and bone mass in children.

Design and Setting: We conducted combined cross-sectional and prospective analyses at university research clinics.

Participants: Participants included children aged 9.9 yr from a large population-based birth cohort in southwest England.

Outcomes: Relationships between total body fat mass were measured by dual-energy x-ray absorptiometry at age 9.9 yr, and 1) total-body-less-head bone mass and area at age 9.9 and 2) increase in bone mass and area over the following 2 yr.

Results: There was a strong positive relationship between total body fat mass and total-body-less-head bone mass and area, even after adjustment for height and/or lean mass (P < 0.001). There was a similar positive association between total body fat mass and increase in bone mass and area over the following 2 yr in boys and Tanner stage 1 girls. In contrast, no association was present between fat mass and gain in bone mass and size in Tanner stage 2 girls, whereas a negative association was seen in Tanner stage 3 girls (puberty-fat mass interaction, P < 0.001).

Conclusions: In prepubertal children, fat mass is a positive independent determinant of bone mass and size and of increases in these parameters over the following 2 yr, suggesting that adipose tissue acts to stimulate bone growth. However, this relationship is attenuated by puberty.

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