1. Association of selected lifestyle factors with BMD Adjusted mean BMD* N HipSpine Whole Body __________________________________________________________________ CurrentYes390.9350.9691.069 smokerNo1350.9680.9871.088 (p=0.12) (p=0.40) (p=0.30) Wt-bearing0-<55620.9470.9651.069 activity55-<70620.9620.9971.086 70+500.9760.9861.099 (p=0.39) (p=0.26) (p=0.26) Dietary0-<650600.9440.9721.072 Calcium650-<1300530.9710.9861.071 (mg/day)1300+520.9700.9921.109 (p=0.30) (p=0.58) (p=0.06) Dietary0-<45440.9530.9601.087 Protein45-<90900.9510.9761.078 (gm/day)90+310.9991.0351.095 (p=0.26) (p=0.15) (p=0.70) Dietary0-<180590.9580.9621.066 Magnesium 180-<360830.9520.9761.072 (mg/day)360+230.9991.0581.169 (p=0.29) (p=0.04) (p=0.002) Any caffeineYes1040.9520.9811.080 intakeNo700.9730.9861.089 (p=0.20) (p=0.77) (p=0.58) Caff. cola0-11230.9690.9851.095 (drinks/day) 2+500.9380.9781.053 (p=0.12) (p=0.72) (p=0.01) Alcohol0740.9540.9781.078 (drinks/mo)<5620.9690.9961.098 5+380.9600.9701.072 (p=0.71) (p=0.44) (p=0.31) _________________________________________________________________________ * Adjusted for the following baseline covariates: age, height, weight, and calcium as continuous variables; ethnicity, number of periods in last year and hormone-based contraception as categorical variables. mean ± s.e.median HIP BMD Spearman correlation Age at menarche (yrs.) 12.3 ± 0.1 12.00.05 Height (in) 64.1 ± 0.2 64.10.29* Weight (lb) 142.4 ± 2.2137.10.42* Weight-bearing activity 61 ± 1 610.25* Calcium (mg/day) 973 ± 478330.11 Protein (gm/day) 66 ± 3 590.09 Magnesium (mg/day) 235 ± 92200.09 Caffeine (mg/day) 52 ± 6 20 -0.10 Calories (kcal) 1717 ± 66 1593 -0.006 _______________________________________________________________________________ *p< 0.05 Study SettingGroup Health Cooperative (GHC), a mixed-model HMO located in Washington state Study DesignCross-sectional Participants174 adolescent women, ages 14-18 years Selected using computerized databases from this health plan Inclusion/Not pregnant or lactating, post-menarche, no Exclusion conditions or medications that might affect bone density, informed consent from parents for participants <18 Data CollectionHealth questionnaire; Food frequency questionnaire; Exam; DEXA Lifestyle FactorsCurrent smoking; weight-bearing physical activity; dietary intake of magnesium, calcium, protein, alcohol, caffeine and caffeinated cola beverages OutcomeHip, spine, and whole body bone mineral density (g/cm 2 ) using DEXA AnalysesAssociation of lifestyle factors with BMD, after adjustment for the effects of age, height, weight, ethnicity, number of periods in the past year, hormonal contraception, and dietary calcium All study procedures were reviewed and approved by the GHC Human Subjects Committee Lifestyle Factors Associated with Bone Mineral Density in Adolescent Women Delia Scholes 1,2, Andrea Z. LaCroix 1,2, Laura E. Ichikawa 1, Susan M. Ott 2, William E. Barlow 1,2 1 Group Health Cooperative and the 2 University of Washington, Seattle WA INTRODUCTION Background  Maximizing peak bone mass is essential for prevention of future morbidity from osteoporosis.  Adolescence is a particularly critical time for bone mass accrual. More than half of peak bone mass is attained during adolescence and, for many anatomic sites, bone mass accrual is virtually complete by age 18.  Heritable factors are most important in peak bone mass attainment. But identification of modifiable risk factors offers opportunities for interventions aimed at improving bone health.  A number of lifestyle factors, including dietary factors, smoking, and exercise, have been both positively and negatively associated with bone density. Purpose To evaluate the association between selected lifestyle factors and bone mineral density in a population-based study group of adolescent women. METHODS RESULTS Summary of Results  A number of biologic and lifestyle variables were associated with bone density as the hip or other anatomic site.  However, after adjusting for other factors known to affect bone density, the majority of the lifestyle factors we examined were not significantly associated with BMD in these adolescents.  Two dietary factors, magnesium and caffeinated cola consumption, were significantly associated with BMD in this study group: Dietary intake of magnesium was positively associated with BMD at two anatomic sites, the spine and whole body. Consumption of caffeinated cola beverages was negatively associated with whole body BMD. CONCLUSIONS  When compared to inherited and hormonal influences, lifestyle factors may have relatively modest effects on bone density and bone mass accrual in essentially healthy adolescent women.  Studies of these factors to date have had inconsistent methods and findings.  Future prospective studies or randomized trials of sufficient size are needed to determine whether these factors in adolescents can be modified to improve bone health. This research supported by The National Institutes of Health (NICHD, R01HD31165) Selected Baseline Characteristics Total hip BMD, g/cm 2 0.956 ± 0.009 Spine BMD, g/cm 2 0.982 ± 0.009 Whole body BMD, g/cm 2 1.082 ± 0.008 Magnesium 180-<360 mg/day (vs. <180) Calcium 1300+ mg/day (vs. <650) Calcium 650- <1300 mg/day (vs. <650) Wt. Bearing activity score 70+ (vs. <55) Wt. bearing activity score 55-<70 (vs. <55) Age 16-18 (vs. 14-15) Non-white BMI <18.5 (vs. normal) BMI 25-<30 (vs. normal) BMI 30+ (vs. normal) 0-7 periods (vs. 8+) Ever pregnant Hormonal contraception Magnesium 360+ mg/day (vs. <180) Smoker <5 alcoholic drinks/mo (vs. 0) 5+ alcoholic drinks/mo (vs. 0) 2+ caff. cola drinks/day (vs. 0-1) Personal fracture Correlation between selected variables Wt. bearingCalcium ProteinMagnesiumCaff. ColaAlcohol activity _______________________________________________________________________________ Wt bearing activity 0.24* 0.27* 0.28* -0.23* -0.09 Calcium 0.87* 0.87* -0.14 0.02 Protein 0.88* -0.11-0.002 Magnesium -0.20* 0.005 Caff. Cola 0.18* _______________________________________________________________________________ Age -0.09 -0.05 -0.01 0.03 0.11 0.22* BMI -0.05 -0.07 -0.09 -0.09 0.14 0.07 _______________________________________________________________________________ *p< 0.05