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Exercise, smoking, and calcium intake during adolescence and early adulthood as determinants of peak bone mass

Third Department of Medicine, University of Helsinki, Helsinki Minerva Foundation Institute for Medical Research, Helsinki Research Unit of Alcohol Diseases, University of Helsinki, Helsinki Department of Surgery, Kuopio University Central Hospital, Kuopio Osteoporosis Clinic, Deaconess Institute of Oulu, Oulu Research and Development Unit, Social Insurance Institution, Turku Department of Obstetrics and Gynaecology, University of Helsinki, Helsinki National Public Health Institute, Helsinki UKK Institute for Health Promotion Research, Tampere Correspondence to: Dr M Valimaki, Third Department of Medicine, Helsinki University Central Hospital, FIN-00290 Helsinki, Finland.

Abstract

Objective : To evaluate the contribution to peak bone mass of exercise, smoking, and calcium intake in adolescents and young adults.
Design : Prospective cohort study with end point measurement (bone mineral density) after 11 years'20follow up for lifestyle.
Setting : Five university hospital clinics.
Subjects : 264 (153 females, 111 males) subjects aged 9 to 18 years at the beginning of the follow up20and 20 to 29 years at the time of measurement of bone mineral density.
Main outcome measure : Bone mineral density of lumbar spine and femoral neck by dual energy x ray absorptiometry; measures of physical activity and20smoking and estimates of calcium intake repeated three times during follow up.
Results : In the groups with the lowest and highest20levels of exercise the femoral bone mineral densities (adjusted for age and weight) were 0.918 and 0.988 g/cm² for women (P=0.015), analysis of covariance) and 0.943 and 1.042 g/cm² for men (P=0.005), respectively; at the lumbar spine the respective20values were 1.045 and 1.131 (P=0.005) for men. In men the femoral bone mineral densities (adjusted for age, weight, and exercise) were 1.022 and 0.923 g/cm² for the groups with the lowest and highest values of smoking index (P=0.054, analysis of covariance). In women the adjusted femoral bone mineral density increased by 4.7% together with increasing calcium intake (P=0.089, analysis of covariance). In multiple regression analysis on bone mineral density of the femoral neck, weight, exercise, age, and smoking were independent predictors for men; with weight, exercise, and age for women. These predictors together explained 38% of the variance in bone mineral density in women and 46% in men. At the lumbar spine, weight, smoking, and exercise were predictors for men; and only weight for women.
Conclusions : Regular exercise and not smoking is important in achieving maximal peak bone mass in adolescents and young adults.

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