Endocrine Abstracts

Introduction: The relationship between early puberty and abnormal bone health has garnered significant research attention, with varying outcomes.

Objectives: This review systematically examines studies up to March 2023 to determine whether early puberty is associated with abnormal bone health, specifically low bone mineral density (BMD), osteopenia, and osteoporosis. We analyze and summarize research articles (n=25) to elucidate the potential link between early puberty and the occurrence of abnormal bone health, particularly low BMD, osteopenia, and osteoporosis.

Results: Peak Bone Mass and Pubertal Timing: Peak bone mass (PBM), a critical determinant of osteoporosis risk and fractures, shares similarities with pubertal timing in terms of physiological variability and genetic influence. Factors influencing pubertal timing also affect bone acquisition. Fetal and infancy exposure to nutrients like vitamin D, calcium, and protein influence both traits. The Gothenburg Osteoporosis and Obesity Determinants study shows a negative association between age at peak height velocity (PHV) and bone density in young adult men. Using National Health and Nutrition Examination Survey (NHANES) data, a study reveals that an age of menarche ≥16 years is associated with lower lumbar spine (LS) BMD, even after adjusting for confounding factors. This suggests that late menarche may increase the risk of lumbar osteoporotic fractures. A large study on Swedish men finds that late pubertal timing is associated with increased adult fracture risk. Age at peak height velocity (PHV) predicts fractures, independent of factors like birth weight, childhood BMI, and adult height. Girls with idiopathic central precocious puberty (CPP) show increased bone mineral density, but this advantage wanes when corrected for bone age. GnRH agonist treatment seems to have no detrimental effect on bone mineral density. Longitudinal studies on British participants suggest that male participants gain bone density faster than females. Late pubertal age is associated with persistently lower bone mineral density in both genders. Studies analyzing GnRH agonist treatment in children with CPP reveal mixed results. While some suggest a reversible reduction in bone mineral density during treatment, others find restoration of bone mass after cessation of therapy.

Conclusion: Overall, this review highlights the complex relationship between early puberty and abnormal bone health. While some studies indicate associations between early puberty and decreased bone health, others emphasize the potential for recovery post-treatment cessation. Further research is necessary to fully elucidate the impact of early puberty on bone health, especially in the context of preventative measures for osteoporosis and fractures.