Influence of birth size and body composition on bone mineral density in early adulthood: The PROGRAM study

Background/objectives: Low bone mineral density (BMD) may lead to osteoporosis and is associated with increased fracture risk. Associations between BMD and various factors have been reported. Our objective was to investigate whether birth size, lean body mass (LBM) and fat mass (FM) are determinants of BMD of the total body (BMDTB) and the lumbar spine (BMDLS). Methods: In the PROgramming factors for GRowth And Metabolism (PROGRAM) study of a cohort of 312 young adults aged 18-24 years, BMDTBand BMDLSwere determined by dual-energy X-ray absorptiometry (DXA). Subsequently, differences in BMDTBand BMDLSwere analysed in four subgroups: young adults born small for gestational age with short stature (SGA-S) or with catch-up growth (SGA-CU), or born appropriate for gestational age (AGA) with idiopathic short stature (ISS) or with normal stature (controls). Results: Adult weight, LBM, FM and weight gain during childhood were the main positive determinants for BMDTBin early adulthood, whereas birth size had no influence (adjusted R2= 0.50). Gender, adult weight, LBM, FM and weight gain were the significant determinants of BMDLS. In the subgroups, after correction for age, gender and adult body size, the ISS group had a significantly lower BMDTBthan controls but there was no difference in BMDLSbetween the subgroups. Conclusions: Prenatal growth has no significant influence on BMDTBand BMDLSin early adulthood. Gender and postnatal growth, particularly weight gain, are the main positive determinants. To achieve a normal BMD in adulthood, healthcare workers should aim for a normal weight gain in children.

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