Home Physical activity and bone mineral density at the femoral neck subregions in adolescents with Down syndrome
Article
Licensed
Unlicensed Requires Authentication

Physical activity and bone mineral density at the femoral neck subregions in adolescents with Down syndrome

  • Ángel Matute-Llorente , Alejandro González-Agüero , Germán Vicente-Rodríguez , Luís B. Sardinha , Fátima Baptista and José A. Casajús EMAIL logo
Published/Copyright: September 13, 2017
Journal of Pediatric Endocrinology and Metabolism
From the journal Journal of Pediatric Endocrinology and Metabolism Volume 30 Issue 10

Abstract

Background:

Low bone mineral density (BMD) has been frequently described in subjects with Down syndrome (DS). Reduced physical activity (PA) levels may contribute to low BMD in this population. The objective of the study was to investigate whether PA levels were related to the femoral neck bone mass distribution in a sample of 14 males and 12 females with DS aged 12–18 years.

Methods:

BMD was evaluated by dual energy X-ray absorptiometry (DXA) at the integral, superolateral and inferomedial femoral neck regions and PA levels were assessed by accelerometry. The BMDs between the sexes and PA groups (below and above the 50th percentile of the total PA) were compared using independent t-tests and analyses of covariance (ANCOVAs) controlling for age, height and body weight.

Results:

No differences were found between the BMDs of males and females in any femoral neck region (p>0.05). Females with higher PA levels demonstrated increased integral (0.774 g/cm2 vs. 0.678 g/cm2) and superolateral femoral neck BMDs (0.696 g/cm2 vs. 0.595 g/cm2) compared to those with lower PA levels (p<0.05). In males, no differences (p<0.05) were found in the BMDs between the PA groups.

Conclusions:

This investigation shows that females accumulating more total PA presented increased BMDs at the integral and superolateral femoral neck regions (14.1% and 17.0%, respectively) when compared to their less active peers. These data highlight the importance of PA in females with DS to counteract their low bone mass and to improve their bone health.

Keywords: accelerometry; bone density; bone health; Down syndrome; femoral neck; physical activity
Corresponding author: José A. Casajús, MD, PhD, GENUD (Growth, Exercise, Nutrition and Development) Research Group, Universidad de Zaragoza, C/Pedro Cerbuna 12, Grupo GENUD, 50009, Zaragoza, Spain, Phone: +34 876553755

Acknowledgments

We gratefully acknowledge the help of all the adolescents and their parents who participated in the study for their understanding and dedication to the project. Specials thanks are given to Fundación Down Zaragoza and Special Olympics Aragón for their support.

  1. Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

  2. Research funding: This work was supported by ‘Ministerio de Ciencia e Innovación’ ‘Plan Nacional I+D+i 2009–2011 (Project DEP 2009-09183)’. AML received a Grant AP12/02854 from ‘Ministerio de Educación Cultura y Deportes’.

  3. Employment or leadership: None declared.

  4. Honorarium: None declared.

  5. Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

References

1. Parker SE, Mai CT, Canfield MA, Rickard R, Wang Y, et al. Updated national birth prevalence estimates for selected birth defects in the United States, 2004–2006. Birth Defects Res A Clin Mol Teratol 2010;88:1008–16.10.1002/bdra.20735Search in Google Scholar PubMed

2. Morris JK, Cole TJ, Springett AL, Dennis J. Down syndrome birth weight in England and Wales: implications for clinical practice. Am J Med Genet A 2015;167:3070–5.10.1002/ajmg.a.37366Search in Google Scholar

3. WHO. Genes and chromosomal diseases: World Health Organization; 2016. Available at: http://www.who.int/genomics/public/geneticdiseases/en/index1.html.Search in Google Scholar

4. Srikanth R, Cassidy G, Joiner C, Teeluckdharry S. Osteoporosis in people with intellectual disabilities: a review and a brief study of risk factors for osteoporosis in a community sample of people with intellectual disabilities. J Intellect Disabil Res 2011;55:53–62.10.1111/j.1365-2788.2010.01346.xSearch in Google Scholar

5. González-Agüero A, Vicente-Rodríguez G, Moreno LA, Guerra-Balic M, Ara I, et al. Health-related physical fitness in children and adolescents with Down syndrome and response to training. Scand J Med Sci Sports 2010;20:716–24.10.1111/j.1600-0838.2010.01120.xSearch in Google Scholar PubMed

6. Stagi S, Iurato C, Lapi E, Cavalli L, Brandi ML, et al. Bone status in genetic syndromes: a review. Hormones (Athens) 2015;14:19–31.10.1007/BF03401378Search in Google Scholar PubMed

7. McKelvey KD, Fowler TW, Akel NS, Kelsay JA, Gaddy D, et al. Low bone turnover and low bone density in a cohort of adults with Down syndrome. Osteoporos Int 2013;24:1333–8.10.1007/s00198-012-2109-4Search in Google Scholar

8. Angelopoulou N, Souftas V, Sakadamis A, Mandroukas K. Bone mineral density in adults with Down’s syndrome. Eur Radiol 1999;9:648–51.10.1007/s003300050726Search in Google Scholar PubMed

9. González-Agüero A, Vicente-Rodríguez G, Gómez-Cabello A, Casajús JA. Cortical and trabecular bone at the radius and tibia in male and female adolescents with Down syndrome: a peripheral quantitative computed tomography (pQCT) study. Osteoporos Int 2013;24:1035–44.10.1007/s00198-012-2041-7Search in Google Scholar PubMed

10. Sepulveda D, Allison DB, Gomez JE, Kreibich K, Brown RA, et al. Low spinal and pelvic bone mineral density among individuals with Down syndrome. Am J Ment Retard 1995;100:109–14.Search in Google Scholar PubMed

11. Center J, Beange H, McElduff A. People with mental retardation have an increased prevalence of osteoporosis: a population study. Am J Ment Retard 1998;103:19–28.10.1352/0895-8017(1998)103<0019:PWMRHA>2.0.CO;2Search in Google Scholar PubMed

12. Matute-Llorente A, González-Agüero A, Gómez-Cabello A, Vicente-Rodríguez G, Casajús JA. Decreased levels of physical activity in adolescents with down syndrome are related with low bone mineral density: a cross-sectional study. BMC Endocr Disord 2013;13:22.10.1186/1472-6823-13-22Search in Google Scholar PubMed

13. Gordon CM, Bachrach LK, Carpenter TO, Crabtree N, El-Hajj Fuleihan G, et al. Dual energy X-ray absorptiometry interpretation and reporting in children and adolescents: the 2007 ISCD Pediatric Official Positions. J Clin Densitom 2008;11:43–58.10.1016/j.jocd.2007.12.005Search in Google Scholar PubMed

14. Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, et al. Incidence and economic burden of osteoporosis-related fractures in the United States, 2005–2025. J Bone Miner Res 2007;22:465–75.10.1359/jbmr.061113Search in Google Scholar PubMed

15. Lohiya GS, Crinella FM, Tan-Figueroa L, Caires S, Lohiya S. Fracture epidemiology and control in a developmental center. West J Med 1999;170:203–9.Search in Google Scholar

16. Tannenbaum TN, Lipworth L, Baker S. Risk of fractures in an intermediate care facility for persons with mental retardation. Am J Ment Retard 1989;93:444–51.Search in Google Scholar

17. Gnudi S, Ripamonti C, Lisi L, Fini M, Giardino R, et al. Proximal femur geometry to detect and distinguish femoral neck fractures from trochanteric fractures in postmenopausal women. Osteoporos Int 2002;13:69–73.10.1007/s198-002-8340-2Search in Google Scholar PubMed

18. Singh M, Nagrath AR, Maini PS. Changes in trabecular pattern of the upper end of the femur as an index of osteoporosis. J Bone Joint Surg Am 1970;52:457–67.10.2106/00004623-197052030-00005Search in Google Scholar PubMed

19. Cardadeiro G, Baptista F, Rosati N, Zymbal V, Janz KF, et al. Influence of physical activity and skeleton geometry on bone mass at the proximal femur in 10- to 12-year-old children–a longitudinal study. Osteoporos Int 2014;25:2035–45.10.1007/s00198-014-2729-ySearch in Google Scholar

20. Matute-Llorente A, Gonzalez-Aguero A, Gomez-Cabello A, Olmedillas H, Vicente-Rodriguez G, et al. Effect of whole body vibration training on bone mineral density and bone quality in adolescents with Down syndrome: a randomized controlled trial. Osteoporos Int 2015;26:2449–59.10.1007/s00198-015-3159-1Search in Google Scholar

21. von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, et al. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 2007;370:1453–7.10.1016/S0140-6736(07)61602-XSearch in Google Scholar PubMed

22. Marfell-Jones M, Olds T, Stewart A, Carter L. International standards for anthropometric assessment. Potchefstroom, South Africa: International Society for the Advancement of Kinanthropometry; 2006.10.4324/9780203970157Search in Google Scholar

23. Tanner JM, Whitehouse RH. Clinical longitudinal standards for height, weight, height velocity, weight velocity, and stages of puberty. Arch Dis Child 1976;51:170–9.10.1136/adc.51.3.170Search in Google Scholar PubMed PubMed Central

24. Gracia-Marco L, Ortega FB, Jimenez-Pavon D, Rodriguez G, Castillo MJ, et al. Adiposity and bone health in Spanish adolescents. The HELENA study. Osteoporos Int 2012;23:937–47.10.1007/s00198-011-1649-3Search in Google Scholar PubMed

25. Ojiambo R, Konstabel K, Veidebaum T, Reilly J, Verbestel V, et al. Validity of hip-mounted uniaxial accelerometry with heart-rate monitoring vs. triaxial accelerometry in the assessment of free-living energy expenditure in young children: the IDEFICS Validation Study. J Appl Physiol 2012;113:1530–6.10.1152/japplphysiol.01290.2011Search in Google Scholar PubMed

26. Pfeiffer KA, McIver KL, Dowda M, Almeida MJ, Pate RR. Validation and calibration of the Actical accelerometer in preschool children. Med Sci Sports Exerc 2006;38:152–7.10.1249/01.mss.0000183219.44127.e7Search in Google Scholar PubMed

27. Trost SG, Pate RR, Freedson PS, Sallis JF, Taylor WC. Using objective physical activity measures with youth: how many days of monitoring are needed? Med Sci Sports Exerc 2000;32:426–31.10.1097/00005768-200002000-00025Search in Google Scholar PubMed

28. Esposito PE, Macdonald M, Hornyak JE, Ulrich DA. Physical activity patterns of youth with down syndrome. Intellect Dev Disabil 2012;50:109–19.10.1352/1934-9556-50.2.109Search in Google Scholar PubMed

29. R Core Team. R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria, 2014. URL: http://www.R-project.org/.Search in Google Scholar

30. Ojiambo R, Cuthill R, Budd H, Konstabel K, Casajus JA, et al. Impact of methodological decisions on accelerometer outcome variables in young children. Int J Obes (Lond) 2011;35(Suppl 1):S98–103.10.1038/ijo.2011.40Search in Google Scholar PubMed

31. Evenson KR, Catellier DJ, Gill K, Ondrak KS, McMurray RG. Calibration of two objective measures of physical activity for children. J Sports Sci 2008;26:1557–65.10.1080/02640410802334196Search in Google Scholar PubMed

32. Trost SG, Loprinzi PD, Moore R, Pfeiffer KA. Comparison of accelerometer cut points for predicting activity intensity in youth. Med Sci Sports Exerc 2011;43:1360–8.10.1249/MSS.0b013e318206476eSearch in Google Scholar PubMed

33. González-Agüero A, Vicente-Rodríguez G, Moreno LA, Casajús JA. Bone mass in male and female children and adolescents with Down syndrome. Osteoporos Int 2011;22:2151–7.10.1007/s00198-010-1443-7Search in Google Scholar PubMed

34. Crabtree NJ, Arabi A, Bachrach LK, Fewtrell M, El-Hajj Fuleihan G, et al. Dual-energy X-ray absorptiometry interpretation and reporting in children and adolescents: the revised 2013 ISCD Pediatric Official Positions. J Clin Densitom 2014;17:225–42.10.1016/j.jocd.2014.01.003Search in Google Scholar PubMed

35. Cohen J. Statistical power analysis for the behavioural sciences. New York: Academic Press, 1969.Search in Google Scholar

36. Hedges LV. Distribution theory for Glass’s estimator of effect size and related estimators. J Educ Stat 1981;6:107–28.10.3102/10769986006002107Search in Google Scholar

37. Higgins JP, Green S. Cochrane handbook for systematic reviews of interventions Version 5.10 2011 [updated March 2011]. Available at: www.cochrane-handbook.org.Search in Google Scholar

38. Weaver CM, Gordon CM, Janz KF, Kalkwarf HJ, Lappe JM, et al. The National Osteoporosis Foundation’s position statement on peak bone mass development and lifestyle factors: a systematic review and implementation recommendations. Osteoporos Int 2016;27:1281–386.10.1007/s00198-015-3440-3Search in Google Scholar PubMed PubMed Central

39. Baptista F, Janz KF. Habitual physical activity and bone growth and development in children and adolescents: a public health perspective. In: Handbook of growth and growth monitoring in health and disease Preedy, Victor R, editor. New York: Springer, 2012: 2395–411.10.1007/978-1-4419-1795-9_143Search in Google Scholar

40. Whitt-Glover MC, O’Neill KL, Stettler N. Physical activity patterns in children with and without Down syndrome. Pediatr Rehabil 2006;9:158–64.10.1080/13638490500353202Search in Google Scholar PubMed

41. Shields N, Dodd KJ, Abblitt C. Do children with Down syndrome perform sufficient physical activity to maintain good health? A pilot study. Adapt Phys Activ Q 2009;26:307–20.10.1123/apaq.26.4.307Search in Google Scholar PubMed

42. Duboeuf F, Hans D, Schott AM, Kotzki PO, Favier F, et al. Different morphometric and densitometric parameters predict cervical and trochanteric hip fracture: the EPIDOS Study. J Bone Miner Res 1997;12:1895–902.10.1359/jbmr.1997.12.11.1895Search in Google Scholar PubMed

43. Wu J. Bone mass and density in preadolescent boys with and without Down syndrome. Osteoporos Int 2013;24:2847–54.10.1007/s00198-013-2393-7Search in Google Scholar PubMed

44. Maatta M, Terho E, Jokinen H, Pulkkinen P, Korpelainen J, et al. Lifestyle factors and site-specific risk of hip fracture in community dwelling older women–a 13-year prospective population-based cohort study. BMC Musculoskelet Disord 2012;13:173.10.1186/1471-2474-13-173Search in Google Scholar PubMed PubMed Central

45. Guijarro M, Valero C, Paule B, Gonzalez-Macias J, Riancho JA. Bone mass in young adults with Down syndrome. J Intellect Disabil Res 2008;52(Pt 3):182–9.10.1111/j.1365-2788.2007.00992.xSearch in Google Scholar PubMed

46. Ferry B, Gavris M, Tifrea C, Serbanoiu S, Pop AC, et al. The bone tissue of children and adolescents with Down syndrome is sensitive to mechanical stress in certain skeletal locations: a 1-year physical training program study. Res Dev Disabil 2014;35:2077–84.10.1016/j.ridd.2014.05.004Search in Google Scholar PubMed

47. González-Agüero A, Vicente-Rodríguez G, Gómez-Cabello A, Ara I, Moreno LA, et al. A 21-week bone deposition promoting exercise programme increases bone mass in young people with Down syndrome. Dev Med Child Neurol 2012;54:552–6.10.1111/j.1469-8749.2012.04262.xSearch in Google Scholar PubMed

48. Gardiner K. Transcriptional dysregulation in Down syndrome: predictions for altered protein complex stoichiometries and post-translational modifications, and consequences for learning/behavior genes ELK, CREB, and the estrogen and glucocorticoid receptors. Behav Genet 2006;36:439–53.10.1007/s10519-006-9051-1Search in Google Scholar PubMed

49. Phillips AC, Holland AJ. Assessment of objectively measured physical activity levels in individuals with intellectual disabilities with and without Down’s syndrome. PLoS One 2011;6:e28618.10.1371/journal.pone.0028618Search in Google Scholar PubMed

50. Ragusa L, Valetto MR, Proto C, Alberti A, Romano C, et al. IGF-I levels in prepubertal and pubertal children with Down syndrome. Minerva Endocrinol 1998;23:31–6.Search in Google Scholar PubMed

51. González-Agüero A, Ara I, Moreno LA, Vicente-Rodríguez G, Casajús JA. Fat and lean masses in youths with Down syndrome: gender differences. Res Dev Disabil 2011;32:1685–93.10.1016/j.ridd.2011.02.023Search in Google Scholar PubMed

52. Mayhew PM, Thomas CD, Clement JG, Loveridge N, Beck TJ, et al. Relation between age, femoral neck cortical stability, and hip fracture risk. Lancet 2005;366:129–35.10.1016/S0140-6736(05)66870-5Search in Google Scholar PubMed

53. Baptista F, Varela A, Sardinha LB. Bone mineral mass in males and females with and without Down syndrome. Osteoporos Int 2005;16:380–8.10.1007/s00198-004-1687-1Search in Google Scholar PubMed

54. Robinson RJ, Krzywicki T, Almond L, al-Azzawi F, Abrams K, et al. Effect of a low-impact exercise program on bone mineral density in Crohn’s disease: a randomized controlled trial. Gastroenterology 1998;115:36–41.10.1016/S0016-5085(98)70362-2Search in Google Scholar

55. Gracia-Marco L, Moreno LA, Ortega FB, Leon F, Sioen I, et al. Levels of physical activity that predict optimal bone mass in adolescents: the HELENA study. Am J Prev Med 2011;40:599–607.10.1016/j.amepre.2011.03.001Search in Google Scholar PubMed

56. Chen CJ, Ringenbach SD. Dose-response relationship between intensity of exercise and cognitive performance in individuals with Down syndrome: a preliminary study. J Intellect Disabil Res 2016;60:606–14.10.1111/jir.12258Search in Google Scholar PubMed

57. Shields N, Hussey J, Murphy J, Gormley J, Hoey H. An exploratory study of the association between physical activity, cardiovascular fitness and body size in children with Down syndrome. Dev Neurorehabil 2017:20:92–8.10.3109/17518423.2015.1077901Search in Google Scholar PubMed

Received: 2017-1-17
Accepted: 2017-7-31
Published Online: 2017-9-13
Published in Print: 2017-10-26

©2017 Walter de Gruyter GmbH, Berlin/Boston

Articles in the same Issue

  1. Frontmatter
  2. Review
  3. Individualised growth response optimisation (iGRO) tool: an accessible and easy-to-use growth prediction system to enable treatment optimisation for children treated with growth hormone
  4. Original Articles
  5. Relation of insulin resistance to neurocognitive function and electroencephalography in obese children
  6. Body weight misperception and health-related factors among Iranian children and adolescents: the CASPIAN-V study
  7. Do sufficient vitamin D levels at the end of summer in children and adolescents provide an assurance of vitamin D sufficiency at the end of winter? A cohort study
  8. Type 3 renal tubular acidosis associated with growth hormone deficiency
  9. Serum α-klotho levels are not informative for the evaluation of growth hormone secretion in short children
  10. Evaluation of neurodevelopment of children with congenital hypothyroidism by the Denver Developmental Screening Test
  11. Pediatric differentiated thyroid carcinoma: trends in practice and outcomes over 40 years at a single tertiary care institution
  12. Physical activity and bone mineral density at the femoral neck subregions in adolescents with Down syndrome
  13. A pilot study on the utility of reduced urine collection frequency protocols for the assessment of reproductive hormones in adolescent girls
  14. MODY in Ukraine: genes, clinical phenotypes and treatment
  15. A retrospective review of initial bisphosphonate infusion in an inpatient vs. outpatient setting for bisphosphonate naïve patients
  16. Molecular genetic and clinical delineation of 22 patients with congenital hypogonadotropic hypogonadism
  17. Letter to the Editor
  18. Rare cases of galactose metabolic disorders: identification of more than two mutations per patient
  19. Case Reports
  20. When one disease is not enough: succinyl-CoA: 3-oxoacid coenzyme A transferase (SCOT) deficiency due to a novel mutation in OXCT1 in an infant with known phenylketonuria
  21. Pseudohypoparathyroidism type 1B associated with assisted reproductive technology
  22. Long QT syndrome diagnosed in two sisters with propionic acidemia: a case report
  23. Delayed diagnosis of proopiomelanocortin (POMC) deficiency with type 1 diabetes in a 9-year-old girl and her infant sibling
https://doi.org/10.1515/jpem-2017-0024
Keywords for this article
accelerometry; bone density; bone health; Down syndrome; femoral neck; physical activity

Articles in the same Issue

  1. Frontmatter
  2. Review
  3. Individualised growth response optimisation (iGRO) tool: an accessible and easy-to-use growth prediction system to enable treatment optimisation for children treated with growth hormone
  4. Original Articles
  5. Relation of insulin resistance to neurocognitive function and electroencephalography in obese children
  6. Body weight misperception and health-related factors among Iranian children and adolescents: the CASPIAN-V study
  7. Do sufficient vitamin D levels at the end of summer in children and adolescents provide an assurance of vitamin D sufficiency at the end of winter? A cohort study
  8. Type 3 renal tubular acidosis associated with growth hormone deficiency
  9. Serum α-klotho levels are not informative for the evaluation of growth hormone secretion in short children
  10. Evaluation of neurodevelopment of children with congenital hypothyroidism by the Denver Developmental Screening Test
  11. Pediatric differentiated thyroid carcinoma: trends in practice and outcomes over 40 years at a single tertiary care institution
  12. Physical activity and bone mineral density at the femoral neck subregions in adolescents with Down syndrome
  13. A pilot study on the utility of reduced urine collection frequency protocols for the assessment of reproductive hormones in adolescent girls
  14. MODY in Ukraine: genes, clinical phenotypes and treatment
  15. A retrospective review of initial bisphosphonate infusion in an inpatient vs. outpatient setting for bisphosphonate naïve patients
  16. Molecular genetic and clinical delineation of 22 patients with congenital hypogonadotropic hypogonadism
  17. Letter to the Editor
  18. Rare cases of galactose metabolic disorders: identification of more than two mutations per patient
  19. Case Reports
  20. When one disease is not enough: succinyl-CoA: 3-oxoacid coenzyme A transferase (SCOT) deficiency due to a novel mutation in OXCT1 in an infant with known phenylketonuria
  21. Pseudohypoparathyroidism type 1B associated with assisted reproductive technology
  22. Long QT syndrome diagnosed in two sisters with propionic acidemia: a case report
  23. Delayed diagnosis of proopiomelanocortin (POMC) deficiency with type 1 diabetes in a 9-year-old girl and her infant sibling
Sign up now to receive a 20% welcome discount
Institutional Access
How does access work?
Have an idea on how to improve our website?
Please write us.
© 2025 De Gruyter Brill
Downloaded on 17.9.2025 from https://www.degruyterbrill.com/document/doi/10.1515/jpem-2017-0024/html
Scroll to top button