Small metacarpal bones of low quality in obese children
OBJECTIVE: It is still not known whether fat mass excess could exert a positive effect on bone. The aim of our study was to evaluate bone strength and quality in a group of overweight and obese children and adolescents by assessing bone geometry at metacarpal bones and ultrasound at phalangeal level. DESIGN AND PATIENTS: This is a cross sectional observational study performed in 123 subjects, aged 11.2 ± 2.9 years. MEASUREMENTS: Digitalized X-rays were evaluated at the level of the 2(nd) metacarpal bone for the determination of the outer (D) and inner (d) diameter, cortical area (CA), medullary endocortical area (EA), metacarpal index (MI) and bone strength (Bending Breaking Resistance Index;BBRI). 98 subjects underwent amplitude dependent speed of sound (Ad-SOS) and bone transmission time (BTT) assessment by phalangeal ultrasonography. RESULTS: SDs for each measured parameter were as follows: Males: D -0.71±0.95, d -0.29±0.86, CA -0.69±0.69, EA -0.32±0.79, Ad-SOS -1.14±0.91, BTT -1.17±1.11 and BBRI (417±151 vs 495 ± 174 mm(3)) were all significantly lower than in controls (p<0.05). Females: D -1.03±1.06, d -0.38±0.92, CA -0.91±0.72, EA -0.46±0.79, Ad-SOS -1.08±1.11, BTT -0.97±1.07 and BBRI (342±117 vs 649 ± 318 mm(3)) were all significantly lower than in controls (p<0.05). CONCLUSIONS: Obese children show an unfavorable bone geometry and a bone of low quality and reduced strength compared to controls at a non-weight bearing skeletal site. This finding seems to support a detrimental effect of fat mass on bone and explain the frequent occurrence of wrist fractures in this group of children. © 2012 Blackwell Publishing Ltd.
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