Skip to main content

Advertisement

SpringerLink
Log in

Longitudinal monitoring of bone accretion measured by quantitative multi-site ultrasound (QUS) of bones in patients with delayed puberty (a pilot study)

  • Original Article
  • Published:
Osteoporosis International Aims and scope Submit manuscript

Abstract

Objective: to compare the effect of anabolic agents on bone accretion in boys with constitutional delay of puberty (CGDP). Rationale: it has been suggested that an appropriate timing of puberty is necessary for normal bone mineral density (BMD) acquisition. Proper bone development during childhood is the key factor in achieving higher peak bone mass during middle age, which may not be achievable in CGDP children, and thereby osteoporosis may appear at an earlier age then expected. Patients and methods: 45 boys with CGDP aged 14–16 years were monitored longitudinally, every 3 months over 12 months with Sunlight Omnisense, a quantitative ultrasound device (Tel Aviv, Israel). The apparatus is a multi-site bone sonometer that obtains axial Speed of Sound (SOS). Based on a reference database obtained on n=1,085 (490 boys) 0–18 years, a normative curve was determined. Fifteen (14–16 years old) of the CGDP patients were treated with I.M. testovirone depot 100 mg monthly for 6 months, 15 (14–16 years old) were treated with oxandrolone 5 mg/m2 daily for 6 months, and 15 (14–16 years old) were in an observation group. Results: whereas the quantitative ultrasound (QUS) Z-score had shown some increase over time in CGDP-treated patients, an increase was found in tibia Z-score from −0.5(−0.64, −0.36) to −0.4(−0.54, −0.26) and from −0.52(−0.67, −0.38) to −0.31(−0.44, −0.11) in the testosterone and oxandrolone-treated groups, respectively, [median (25%, 75%)]. An increase in radius Z-score from −0.52(−0.65, −0.25) to −0.4(−0.54, −0.15) and from −0.51(−0.61, −0.21) to −0.37(−0.47, −0.07) in the testosterone- and oxandrolone-treated groups respectively [median (25%,75%)]. Z-score SOS decreased in the observation group −0.5(−0.66, −0.3) to −0.69(−0.85, −0.54) and −0.5(−0.59, −0.41) to −0.81(−0.95, −0.55) in tibia (P = 0.032) and radius (P = 0.029), respectively. Despite the fact that QUS remained in the normative range in all patients, a clear deterioration was demonstrated in untreated CGDP patients. Conclusion: longitudinal follow-up of patients with CGDP may detect an early pattern of deterioration of bone mass.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Finkelstein JS, Neer RM, Biller BMK, Crawford JD, Klibanski A (1992) Osteopenia in men with history of delayed puberty. N Engl J Med 326:600–604

    CAS  Google Scholar 

  2. Finkelstein JS, Klibanski A, Neer RM (1996) A longitudinal evaluation of bone mineral density in adult men with histories of delayed puberty. J Clin Endocrinol Metab 81:1152–1155

    Article  CAS  PubMed  Google Scholar 

  3. Lee PDK, Rosenfeld RG (1987) Psychosocial correlates of short stature and delayed puberty. Pediatr Adolesc Endocrinol 4:851–863

    Google Scholar 

  4. De Luca F, Argente J, Cavallo L, Crowne E, Delemarre-Van de Waal HA, De Sanctis C, Di Maio S, Norjavaara E, Oostdijk W, Severi F, Tonini G, Trifiro G, Voorhoeve PG, Wu F (2001) International workshop on management of puberty for optimum auxological results. Management of puberty in constitutional delay of growth and puberty. J Pediatr Endocrinol Metab 14 [Suppl]:953–957

  5. Wilson DM, McCauley E, Brown DR, Dudley R (1995) Oxandrolone therapy in constitutionally delayed growth and puberty. Bio-technology general corporation cooperative study group. Pediatrics 96:1095–1100

    Google Scholar 

  6. National Research Council (1989) Recommended dietary allowances, 10th edn. National Academy, Washington, D.C., USA

  7. Zadik Z, Price D, Diamond G (2003) Pediatric reference curves for multi-site quantitative ultrasound and its modulators. Osteoporos Int 14:857–862

    Article  Google Scholar 

  8. Weiss M, Ben-Shlomo A, Hagag P, Rapoport M (2000) Reference database for bone speed of sound measurement by a novel quantitative multi-site ultrasound device. Osteoporos Int 11:688–696

    Article  Google Scholar 

  9. Weiss M, Ben-Shlomo A, Hagag P, Ish-Shalom S (2000) Discrimination of proximal hip fractures by quantitative ultrasound measurement of the radius. Osteoporos Int 11:411–416

    Article  Google Scholar 

  10. Barkmann R, Kantorovich E, Singal C, Hans D, Genant HK, Heller M, Gluer CC (2000) A new method for quantitative ultrasound measurements at multiple skeletal sites. J Clin Densitom 3:1–7

    Article  CAS  PubMed  Google Scholar 

  11. Hans D, Srivastav SK, Singal C, Barkmann R, Njeh CF, Kantorovich E, Gluer CC, Genant HK (1999) Does combining the results from multiple bone sites measured by a new quantitative ultrasound device improve discrimination of hip fracture? J Bone Miner Res 14:644–651

    CAS  PubMed  Google Scholar 

  12. Drake WM, McClung M, Njeh CF, Genant HK, Rosen C, Watts N, Kendler DL (2001) Multisite bone ultrasound measurement on a North American female reference population. J Clin Densitom 4:239–249

    Article  Google Scholar 

  13. Knapp KM, Blake GM, Spector TD, Fogelman I (2001) Multisite quantitative ultrasound: precision, age-and menopause-related changes, fracture discrimination, and t-score equivalence with dual-energy X-ray absorptiometry. Osteoporos Int 12:456–464

    Article  Google Scholar 

  14. Sunlight Medical (2001) Omnisense 7000S intended use; as approved by FDA

  15. Glüer CC (1999) Monitoring skeletal changes by radiological techniques. J Bone Miner Res 14:1952–1962

    CAS  PubMed  Google Scholar 

  16. Goulding A, Cannan R, Williams SM, Gold EJ, Taylor RW, Lewis-Bamed NJ (1998) Bone mineral density in girls with forearm fractures. J Bone Miner Res.13:143–148

    Google Scholar 

  17. Markovic V, Jelic T, Wardlaw GM, Ilich JZ, GoeI PK, Wright JK (1994) Timing of peak bone mass in Caucasian females and its implication for the prevention of osteoporosis. J Clin Invest 93:199–808

    Google Scholar 

  18. Bonjour JP, Theintz G, Buchs B, Slosman D, Rizzoli R (1991) Critical years and stages of puberty for spinal and femoral bone mass accumulation during adolescence. J Clin Endocrinol Metab 73:555–563

    CAS  PubMed  Google Scholar 

  19. Landin L, Nilsson BE (1983) Bone mineral content in children with fractures. Clin Orthop 178:292–296

    Google Scholar 

  20. Frank GR (1997) Are there long-term sequelae of delayed puberty? Highlights 5:8–10

    Google Scholar 

  21. Kulin HE (1996) Delayed puberty. J Clin Endocrinol Metab 81:3460–3464

    Google Scholar 

  22. Compston JE (1995) Bone density: BMC, BMD, or corrected BMD? Bone 16:5–7

    Article  Google Scholar 

  23. Bertelloni S, Baroncelli GI, Ferdeghini M, Perri G, Saggese G (1998) Normal volumetric bone mineral density and bone turnover in young men with histories of constitutional delay of puberty. J Clin Endocrinol Metab 83:4280–4283

    Article  CAS  PubMed  Google Scholar 

  24. Glastre C, Braillon P, David L, Cochat P, Meunier PJ, Delmas PD (1990) Measurement of bone mineral content of the lumbar spine by dual energy X-ray absorptiometry in normal children: correlations with growth parameters. J Clin Endocrinol Metab 70:1330–1333

    CAS  PubMed  Google Scholar 

  25. Rubin K, Schirduan V, Gendreau P, Sarfarazi M, Mendola R, Dalsky G (1993) Predictors of axial and peripheral bone mineral density in healthy children andadolescents, with special attention to the role of puberty. J Pediatr 123:863–870

    CAS  PubMed  Google Scholar 

  26. Theintz G, Buchs B, Rizzoli R, Slosman D, Clavien H, Sizonenko PC, BonjourJP (1992) Longitudinal monitoring of bone mass accumulation in healthy adolescents: evidence for a marked reduction after 16 years of age at the levels of lumbar spine and femoral neck in female subjects. J Clin Endocrinol Metab 75:1060–1065

    Google Scholar 

  27. Bass S, Delmas PD, Pearce G, Hendrich E, Tabensky A, Seeman E (1999) The differing tempo of growth in bone size, mass, and density in girls is region-specific. J Clin Invest 104:795–804

    CAS  PubMed  Google Scholar 

  28. Slemenda CW, Reister TK, Hui SL, Miller JZ, Christian JC, Johnston CC Jr (1994) Influences on skeletal mineralization in children and adolescents: evidence for varying effects of sexual maturation and physical activity. J Pediatr 125:201–207

    Google Scholar 

  29. Frank GR (1995) The role of estrogen in pubertal skeletal physiology: epiphyseal maturation andmineralization of the skeleton. Acta Paediatr 84:627–630

    Google Scholar 

  30. Hock JM, Centrella M, Canalis E (1988) Insulin-like growth factor I has independent effects on bone matrix formationand cell replication. Endocrinology 122:254–260

    CAS  PubMed  Google Scholar 

  31. Van Wyk JJ, Smith EP (1999) Insulin-like growth factors and skeletal growth: possibilities for therapeutic interventions. J Clin Endocrinol Metab 84:4349–4354

    Google Scholar 

  32. Le Roith D, Butler AA (1999) Insulin-like growth factors in pediatric health and disease. J Clin Endocrinol Metab 84:4355–4361

    Google Scholar 

  33. Canalis E, McCarthy TL, Centrella M (1989) The role of growth factors in skeletal remodeling. Endocrinol Metab Clin North Am 18:903–918

    Google Scholar 

  34. Soyka LA, Grinspoon S, Levitsky LL, Herzog DB, Klibanski A (1999) The effects of anorexia nervosa on bone metabolism in female adolescents. J Clin Endocrinol Metab 84:4489–4496

    Google Scholar 

  35. Soroko S, Holbrook TL, Edelstein S, Barrett-Connor E (1994) Lifetime milk consumption and bone mineral density in older women. Am J Public Health 84:1319–1322

    CAS  PubMed  Google Scholar 

  36. Matkovic V, Kostial K, Simonovic I, Buzina R, Brodarec A, Nordin BE (1979) Bone status and fracture rates in two regions of Yugoslavia. Am J Clin Nutr 32:540–549

    Google Scholar 

  37. Halioua L, Anderson JJ (1989) Lifetime calcium intake and physical activity habits: independent and combined effects on the radial bone of healthy premenopausal Caucasian women. Am J Clin Nutr 49:534–541

    Google Scholar 

  38. Murphy S, Khaw KT, May H, Compston JE (1994) Milk consumption and bone mineral density in middle aged and elderly women. BMJ 308:939–941

    CAS  PubMed  Google Scholar 

  39. Forbes RM, Weingartner KE, Parker HM, Bell RR, Erdman JW Jr (1979) Bioavailability to rats of zinc, magnesium and calcium in casein-, egg-, and soy protein-containing diets. J Nutr 109:1652–1660

    CAS  PubMed  Google Scholar 

  40. Forbes RM, Erdman JW Jr (1983) Bioavailability of trace mineral elements. Annu Rev Nutr 3:213–221

    Article  Google Scholar 

Download references

Acknowledgement

Sunlight Medical kindly allowed the use of an Omnisense device for this study, but did not provide financial support to any of the authors

Author information

Authors and Affiliations

  1. The Pediatric Endocrine Unit, Kaplan Medical Center, Hadassah Medical School, 76100, Rehovot, Israel

    Zvi Zadik, Ella Borondukov & Amnon Zung

  2. The School of Nutritional Sciences, The Hebrew University of Jerusalem, Israel

    Zvi Zadik, Tali Sinai & Ram Reifen

  3. Sunlight Medical, Tuval 5, Tel-aviv, Israel

    Irit Yaniv

Authors
  1. Zvi Zadik
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tali Sinai
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ella Borondukov
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Amnon Zung
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Irit Yaniv
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ram Reifen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Zvi Zadik.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Zadik, Z., Sinai, T., Borondukov, E. et al. Longitudinal monitoring of bone accretion measured by quantitative multi-site ultrasound (QUS) of bones in patients with delayed puberty (a pilot study). Osteoporos Int 16, 1036–1041 (2005). https://doi.org/10.1007/s00198-004-1795-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00198-004-1795-y

Keywords

Search

Navigation