Use this URL to cite or link to this record in EThOS: https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.725513
Title: The muscle-bone in children and adolescents with and without cystic fibrosis
Author: Riddell, Amy
ISNI:       0000 0004 6423 9723
Awarding Body: University of Cambridge
Current Institution: University of Cambridge
Date of Award: 2016
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Abstract:
Introduction: Puberty is a crucial period for rapid changes in bone mineral, size, geometry, and microarchitecture. The mechanostat theory postulates that increased mechanical loading will affect bone phenotype and strength during development and in later life. Individuals with cystic fibrosis (CF) have an increased risk of developing osteoporosis and fragility fractures in young adulthood, which may be caused by poor growth. The aim was to investigate whether sex and disease status modified the relationship between: 1) puberty and bone, and 2) muscle and bone. This would contribute to the understanding of how sex (males vs. females) and disease group (CF vs.controls) alters the relationship between bone and muscle in children and adolescents as they transition through puberty and who, on a population level, differ in the prevalence of osteoporosis and risk of fracture in later life. Methods and Analyses: This observational study used novel imaging and muscle assessment techniques to measure bone and muscle parameters in White Caucasian children and adolescents, aged 8 to 16 years, living in the UK, with children with CF (n=65) and controls (n=151). Anthropometry and pubertal status were assessed. Dual energy X-ray absorptiometry, peripheral quantitative computed tomography (pQCT), high-resolution pQCT, and jumping mechanography were used to measure bone and muscle outcomes. ANCOVA with Scheffé post hoc and multiple linear regression tests were performed. Data were adjusted according to the research aims and included covariates; sex, disease group, pubertal stage, age, quadratic age, height, weight, maximum force (Fmax), and maximum power (Pmax). Data are presented as beta-coefficient (%) and p-value, with the significance level set to p < 0.05. Results: In height adjusted analyses, among healthy participants, females had smaller bones and lower bone density compared to males. With pubertal maturation, females had lower apparent gains in the distal and proximal total area (Tt.Ar and CSA), distal cortical porosity (Ct.Po) and proximal bone strength (SSI) but higher apparent gains in distal and proximal cortical bone density(Ct.BMD, Ct.TMD, vBMD). Females had consistently lower distal total area (total CSA) and density (total vBMD), distal trabecular density(BV/TV) and number(Tb.N), and proximal cortical area(CSA) compared to males, across all stages of puberty. With increasing muscle force (Fmax), females had higher apparent gains in total body less head bone mineral (TBLH BMC) and bone area(BA), distal total and trabecular density (total and trab vBMD) compared to males. In contrast, with increasing muscle power (Pmax), females had higher apparent gains in distal total and cortical densities (D100, Ct.BMD and Ct.TMD), and distal trabecular thickness (Tb.Th), and proximal cortical density (cortical vBMD) but lower apparent gains in distal cortical porosity (Ct.Po) and trabecular number (Tb.N) compared to males. In height adjusted analyses, participants with CF had smaller bones and lower bone density compared to controls. With increasing pubertal maturation, participants with CF had lower apparent gains in total body less head bone mineral and bone area, and in distal trabecular density, cortical porosity, and trabecular thickness compared to controls. Participants with CF had consistently lower distal total and cortical area, distal total and trabecular densities and proximal bone strength compared to controls, across all stages of puberty. With increasing muscle force, participants with CF had lower apparent gains in total body less head bone mineral and bone area, distal total density, trabecular density, and trabecular number. In contrast, with increasing muscle power (Pmax), participants with CF had higher apparent gains in distal trabecular density (BV/TV) and trabecular number (Tb.N) compared to controls. Conclusion: These findings suggests that sex and disease status do modify the relationships between puberty and bone, and between muscle function and bone. Skeletal adaptation to muscle differs between sexes and in populations with chronic disease, which may explain sex and disease group differences in risks of osteoporosis and fracture. Bone adaptation to muscle in children with CF is altered, which may lead to narrow, under-mineralised bones, with lower bone strength in later life. Understanding better impairments in muscle functions may provide targets for intervention to improve skeletal health in later life.
Supervisor: Ward, Kate Sponsor: MRC
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID: uk.bl.ethos.725513  DOI:
Keywords: Bone ; Muscle ; cystic fibrosis ; children ; adolescents ; growth ; muscle-bone unit ; imagining ; pQCT ; HR-pQCT ; DXA
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