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Later Age at Onset of Independent Walking Is Associated With Lower Bone Strength at Fracture-Prone Sites in Older Men

Lookup NU author(s): Professor Rachel CooperORCiD



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


© 2017 The Authors. Journal of Bone and Mineral Research Published by Wiley Periodicals Inc. Later age at onset of independent walking is associated with lower leg bone strength in childhood and adolescence. However, it is unknown whether these associations persist into older age or whether they are evident at axial (central) or upper limb sites. Therefore, we examined walking age obtained at age 2 years and bone outcomes obtained by dual-energy X-ray absorptiometry (DXA) and peripheral quantitative computed tomography (pQCT) scans at ages 60 to 64 years in a nationally representative cohort study of British people, the MRC National Survey of Health and Development. It was hypothesized that later walking age would be associated with lower bone strength at all sites. Later independent walking age was associated with lower height-adjusted hip (standardized regression coefficients with 95% confidence interval [CI] –0.179 [–0.251 to –0.107]), spine (–0.157 [–0.232 to –0.082]), and distal radius (–0.159 [–0.245 to –0.073]) bone mineral content (BMC, indicating bone compressive strength) in men (all p < 0.001). Adjustment for covariates partially attenuated these associations, primarily because of lower lean mass and adolescent sporting ability in later walkers. These associations were also evident for a number of hip geometric parameters (including cross-sectional moment of inertia [CSMI], indicating bone bending/torsional strength) assessed by hip structural analysis (HSA) from DXA scans. Similar height-adjusted associations were also observed in women for several hip, spine, and upper limb outcomes, although adjustment for fat or lean mass led to complete attenuation for most outcomes, with the exception of femoral shaft CSMI and spine bone area (BA). In conclusion, later independent walking age appears to have a lifelong association with bone strength across multiple skeletal sites in men. These effects may result from direct effects of early life loading on bone growth and mediation by adult body composition. Results suggest that late walking age may represent a novel risk factor for subsequent low bone strength. Existing interventions effective in hastening walking age may have positive effects on bone across life. © 2017 The Authors. Journal of Bone and Mineral Research Published by Wiley Periodicals Inc.

Publication metadata

Author(s): Ireland A, Muthuri S, Rittweger J, Adams JE, Ward KA, Kuh D, Cooper R

Publication type: Article

Publication status: Published

Journal: Journal of Bone and Mineral Research

Year: 2017

Volume: 32

Issue: 6

Pages: 1209-1217

Print publication date: 01/06/2017

Online publication date: 27/03/2017

Acceptance date: 09/02/2017

Date deposited: 24/01/2022

ISSN (print): 0884-0431

ISSN (electronic): 1523-4681

Publisher: John Wiley and Sons Inc.


DOI: 10.1002/jbmr.3099

PubMed id: 28181695


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