Skip to main content
SpringerLink
Log in

Physical Activity, Calcium Intake and Bone Health in Children and Adolescents

  • Review Article
  • Published:
Sports Medicine Aims and scope Submit manuscript

Abstract

Osteoporosis is a serious and potentially debilitating disease, which can lead to a variety of health complications and a diminished quality of life. Consequently, the development of bone mineral density (BMD) and content (BMC) during childhood and adolescence is of great importance, as it may attenuate the effects and incidence of osteoporosis later in life. Identifying the mechanisms by which bones are strengthened early in life is crucial. This review highlights research examining factors that influence BMD and BMC in children and adolescents. While a sizeable amount of variation in BMD and BMC in children and adolescents can be attributed to genetic factors and body size, studies have also shown the positive influence of physical activity and calcium intake on bone development. Research supporting the role of these modifiable factors varies according to age, sex and the bone site studied. During the pubertal years, large gains in BMD and BMC are evident. However, physical activity and calcium intake are also important to the development of BMD and BMC during the prepubertal years. Thus, actions taken throughout childhood may exert a great impact on BMD and BMC, and overall bone health as an adult.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. National Osteoporosis Foundation. Fast facts [online]. Available from URL: http://www.nof.orglosteoporosis/diseasefacts.htm [Accessed 2005 Nov 20]

    Google Scholar 

  2. Bailey DA, Faulkner RA, McKay HA. Growth, physical activity, and bone mineral acquisition. Exerc Sport Sci Rev 1996; 24: 233–66

    Article  PubMed  CAS  Google Scholar 

  3. Slemenda CW, Miller JZ, Hui SL, et al. Role of physical activity in the development of skeletal mass in children. J Bone Miner Res 1991 Nov; 6 (11): 1227–33

    Article  PubMed  CAS  Google Scholar 

  4. Bailey DA, Martin AD. Physical activity and skeletal health in adolescents. Pediatr Exerc Sci 1994; 6: 330–47

    Google Scholar 

  5. Ban SI, McKay HA. Nutrition, exercise and bone status in youth. Int J Sport Nutr 1998 Jun; 8 (2): 124–42

    Google Scholar 

  6. Branca F. Physical activity, diet and skeletal health. Public Health Nutr 1999 Sep; 2 (3A): 391–6

    Article  PubMed  CAS  Google Scholar 

  7. Forwoorl MR, Bun DB. Physical activity and bone mass: exercises in futility? Bone Miner 1993 May; 21 (2): 89–112

    Article  Google Scholar 

  8. Leonard MB, Zemel BS. Current concepts in pediatric bone disease. Pediatr Clin North Am 2002 Feb; 49 (1): 143–73

    Article  PubMed  Google Scholar 

  9. Kemper HCG. Skeletal development during childhood and adolescence and the effects of physical activity. Pediatr Exerc Sci 2000; 12: 198–216

    Google Scholar 

  10. Southard RN, Morris JD, Mahan JD, et al. Bone mass in healthy children: measurement with quantitative DNA. Radiology 1991 Jun; 179 (3): 735–8

    PubMed  CAS  Google Scholar 

  11. Rowland TW. The process of biological maturation. In: Gilly H, Johnson C, Blakley J, et al., editors. Developmental exercise physiology. Champaign (IL): Human Kinetics, 1996: 3–16

    Google Scholar 

  12. Chan GM. Dietary calcium and bone mineral status of children and adolescents. Am J Dis Child 1991 Jun; 145 (6): 631–4

    PubMed  CAS  Google Scholar 

  13. Kroger H, Kotaniomi A, Kroger L, et al. Development of bone mass and bone density of the spine and femoral neck a prospective study of 65 children and adolescents. Bone Miner 1993 Dec; 23 (3): 171–82

    Article  PubMed  CAS  Google Scholar 

  14. Lee WT, Leung SS, Ng MY, et al. Bone mineral content of two populations of Chinese children with different calcium intakes. Bone Miner 1993 Dec; 23 (3): 195–206

    Article  PubMed  CAS  Google Scholar 

  15. Janz KF, Burns TL, Turner JC, et al. Physical activity and bone measures in young children: the Iowa bone development study. Pediatrics 2001 Jun; 107 (6): 1387–93

    Article  PubMed  CAS  Google Scholar 

  16. Ruiz JC, Mandel C, Garabedian M. Influence of spontaneous calcium intake and physical exercise on the vertebral and femoral bone mineral density of children and adolescents. J Bone Miner Res 1995 May; 10 (5): 675–82

    Article  PubMed  CAS  Google Scholar 

  17. Boot AM, de Ridder MA, Pols HA, et al. Bone mineral density in children and adolescents: relation to puberty, calcium intake, and physical activity. J Clin Endocrinol Metab 1997 Jan; 82 (1): 57–62

    Article  PubMed  CAS  Google Scholar 

  18. Rubin K, Schirduan V, Gendreau P, et al. Predictors of axial and peripheral bone mineral density in healthy children and adolescents, with special attention to the role of puberty. J Pediatr 1993 Dec; 123 (6): 863–70

    Article  PubMed  CAS  Google Scholar 

  19. Horlick M, Thornton J, Wang J, et al. Bone mineral in prepubertal children: gender and ethnicity. J Bone Miner Res 2000 Jul; 15 (7): 1393–7

    Article  PubMed  CAS  Google Scholar 

  20. Lu PW, Briody JN, Ogle GD, et al. Bone mineral density of total body, spine, and femoral neck in children and young adults: a cross-sectional and longitudinal study. J Bone Miner Res 1994 Sep; 9 (9): 1451–8

    Article  PubMed  CAS  Google Scholar 

  21. Tanner JM. Growth at adolescence. 2nd ed. Oxford: Blackwell Scientific Publications, 1962

    Google Scholar 

  22. Naka H, Iki M, Morita A, et al. Effects of pubertal development, height, weight, and grip strength on the bone mineral density of the lumbar spine and hip in peripubertal Japanese children: Kyoto kids increase density in the skeleton study (Kyoto KIDS study). J Bone Miner Metab 2005 Nov; 23 (6): 463–9

    Article  PubMed  Google Scholar 

  23. Bass S, Delmas PD, Pearce G, et al. The differing tempo of growth in bone size, mass, and density in girls is region-specific. J Clin Invest 1999 Sep; 104 (6): 795–804

    Article  PubMed  CAS  Google Scholar 

  24. Goulding A, Gold E, Cannan R, et al. Changing femoral geonnotry in growing girls: a cross-sectional DENA study. Bone 1996 Dec; 19 (6): 645–9

    Article  PubMed  CAS  Google Scholar 

  25. Duppe H, Cooper C, Gardsell P, et al. The relationship between childhood growth, bone mass, and muscle strength in male and female adolescents. Calcif Tissue Int 1997 May; 60 (5): 405–9

    Article  PubMed  CAS  Google Scholar 

  26. Slemenda CW, Roister TK, Hui SL, et al. Influences on skeletal mineralization in children and adolescents: evidence for varying effects of sexual maturation and physical activity. J Pediatr 1994 Aug; 125 (2): 201–7

    Article  PubMed  CAS  Google Scholar 

  27. Afghani A, Xie B, Wiswell RA, et al. Bone mass of Asian adolescents in China: influence of physical activity and smoking. Med Sci Sports Exerc 2003 May; 35 (5): 720–9

    Article  PubMed  Google Scholar 

  28. Mora S, Goodman WG, Loan ML, et al. Age-related changes in cortical and cancellous vertebral bone density in girls: assessment with quantitative CT. AJR Am J Rcentgenol 1994 Feb; 162 (2): 405–9

    CAS  Google Scholar 

  29. Cromer B, Harel Z. Adolescents: at increased risk for esteoporosis? Clin Pediatr (Phila) 2000 Oct; 39 (10): 565–74

    Article  CAS  Google Scholar 

  30. Kelly PJ, Eisman JA, Sambrook PN. Interaction of genetic and environmental influences on peak bone density. Osteoporos Int 1990 Oct; 1 (1): 56–60

    Article  PubMed  CAS  Google Scholar 

  31. VandenBergh MF, DeMan SA, Witteman JC, et al. Physical activity, calcium intake, and bone mineral content in children in The Netherlands. J Epidenuol Community Health 1995 Jun; 49 (3): 299–304

    Article  CAS  Google Scholar 

  32. Welten DC, Kemper HC, Post GB, et al. Weight-bearing activity during youth is a more important factor for peak bone mass than calcium intake. J Bone Miner Res 1994 Jul; 9 (7): 1089–96

    Article  PubMed  CAS  Google Scholar 

  33. Branca F, Valmena S. Calcium, physical activity and bone health: building bones for a stronger future. Public Health Nutr 2001 Feb; 4 (1A): 117–23

    Article  PubMed  CAS  Google Scholar 

  34. Krall EA, Dawson-Hughes B. Heritable and life-style determinants of bone mineral density. J Bone Miner Res 1993 Jan; 8 (1): 1–9

    Article  PubMed  CAS  Google Scholar 

  35. Runyan SM, Stadler DD, Bainbridge CN, et al. Familial resemblance of bone mineralization, calcium intake, and physical activity in early-adolescent daughters, their mothers, and ma ternal grandmothers. J Am Diet Assoc 2003 Oct; 103 (10): 1320–5

    Article  PubMed  Google Scholar 

  36. Saito T, Nakamura K, Okuda Y, et al. Weight gain in childhood and bone mass in female college students. J Bone Miner Metab 2005; 23 (1): 69–75

    Article  PubMed  Google Scholar 

  37. McKay HA, Petit MA, Khan KM, et al. Lifestyle determinants of bone mineral: a comparison between prepubertal Asian-and Caucasian-Canadian boys and girls. Calcif Tissue Int 2000 May; 66 (5): 3204

    Article  Google Scholar 

  38. Cromer BA, Binkovitz L, Ziegler J, et al. Reference values for bone mineral density in 12-to 18-year-old girls categorized by weight, race, and age. Pediatr Rachel 2004 Oct; 34 (10): 787–92

    Google Scholar 

  39. McVeigh JA, Norris SA, Cameron N, et al. Associations between physical activity and bone mass in black and white South African children at age 9 yr. J Appl Physiol 2004 Sep; 97 (3): 1006–12

    Article  PubMed  CAS  Google Scholar 

  40. Zhu K, Du X, Greenfield H, et al. Bone mass in Chinese premenarcheal girls: the roles of body composition, calcium intake and physical activity. Br J Nutr 2004 Dec; 92 (6): 985–93

    Article  PubMed  CAS  Google Scholar 

  41. Lee WT, Leung SS, Lui SS, et al. Relationship between longterm calcium intake and bone mineral content of children aged from birth to 5 years. Br J Nutr 1993 Jul; 70 (1): 235–48

    Article  PubMed  CAS  Google Scholar 

  42. Molgaard C, Thomson BL, Michaelson KF. The influence of calcium intake and physical activity on bone mineral content and bone size in healthy children and adolescents. Osteoporos Int 2001; 12 (10): 887–94

    Article  PubMed  CAS  Google Scholar 

  43. Johnston Jr CC, Miller JZ, Slemenda CW, et al. Calcium supplementation and increases in bone mineral density in children. N Engl J Med 1992 Jul 9; 327 (2): 82–7

    Article  PubMed  Google Scholar 

  44. Cameron MA, Paton LM, Newson CA, et al. The effect of calcium supplementation on bone density in premenarcheal females: a co-twin approach. J Clin Endocrinol Metab 2004 Oct; 89 (10): 4916–22

    Article  PubMed  CAS  Google Scholar 

  45. Dibba B, Prentice A, Ceesay M, et al. Bone mineral contents and plasma osteocalcin concentrations of Gambian children 12 and 24 me after the withdrawal of a calcium supplement. Am J Clin Nun 2002 Sep; 76 (3): 681–6

    CAS  Google Scholar 

  46. Courteix D, Jaffre C, Lespessailles E, et al. Cumulative effects of calcium supplementation and physical activity on bone accretion in premenarchal children: a double-blind randomised placebo-controlled trial. Int J Sports Med 2005 Jun; 26 (5): 332–8

    Article  PubMed  CAS  Google Scholar 

  47. Chan GM, Hoffman K, McMurry M. Effects of dairy products on bone and body composition in pubertal girls. J Pediatr 1995 Apr; 126 (4): 551–6

    Article  PubMed  CAS  Google Scholar 

  48. Lloyd T, Andon MB, Rollings N, et al. Calcium supplementation and bone mineral density in adolescent girls. JAMA 1993 Aug 18; 270 (7): 841–4

    Article  PubMed  CAS  Google Scholar 

  49. Ho SC, Guldan GS, Woo J, et al. A prospective study of the effects of 1-year calcium-fortified soy milk supplementation on dietary calcium intake and bone health in Chinese adoles cent girls aged 14 to 16. Oskoporos Int 2005 Dec; 16 (12): 1907–16

    Article  CAS  Google Scholar 

  50. Lee WT, Leung SS, Wang SS, et al. Double-blind, controlled calcium supplementation and bone mineral accretion in children accustomed to a low-calcium diet. Am J Clin Nutr 1994 Nov; 60 (5): 744–50

    PubMed  CAS  Google Scholar 

  51. Lee WT, Leung SS, Leung DM, et al. A randomized doubleblind controlled calcium supplementation trial, and bone and height acquisition in children. Br J Nun 1995 Jul; 74 (1): 125–39

    Article  CAS  Google Scholar 

  52. Gibbons MJ, Gilchrist NL, Frampton C, et al. The effects of a high calcium dairy foal on bone health in pre-pubertal children in New Zealand. Asia Pac J Clin Nun 2004 Dec; 13 (4): 341–7

    Google Scholar 

  53. Specker B, Binkley T. Randomized trial of physical activity and calcium supplementation on bone mineral content in 3- to 5-year-old children. J Bone Miner Res 2003 May; 18 (5): 885–92

    Article  PubMed  CAS  Google Scholar 

  54. Bailey DA, McKay HA, Mirwald RL, et al. A six-year longitudinal study of the relationship of physical activity to bone mineral accrual in growing children: the university of Sas katchewan bone mineral accrual study. J Bone Miner Res 1999 Oct; 14 (10): 1672–9

    Article  PubMed  CAS  Google Scholar 

  55. Valdimarsson O, Linden C, Johnell O, et al. Daily physical education in the school curriculum in prepubertal girls during 1 year is followed by an increase in bone ntneral accrual and bone width: data from the prospective controlled Malmo Pediatric Osteoporosis Prevention Study. Calcif Tissue Int 2006 Feb; 78 (2): 65–71

    Article  PubMed  CAS  Google Scholar 

  56. Boot AM, Bouquet J, de Ridder MA, et al. Determinants of body composition measured by dual-energy X-ray absorptromeny in Dutch children and adolescents. Am J Clin Nutr 1997 Aug; 66 (2): 232–8

    PubMed  CAS  Google Scholar 

  57. Ondrak KS, Morgan DW. Factors influencing bone mineral density and content in young girls. Pediatr Exerc Sci 2006 Feb; 18 (1): 101–12

    Google Scholar 

  58. Rowlands AV, Ingledew DK, Powell SM, et al. Interactive effects of habitual physical activity and calcium intake on bone density in boys and girls. J Appl Physiol 2004 Oct; 97 (4): 1203–8

    Article  PubMed  CAS  Google Scholar 

  59. Carter LM, Whiting SJ, Drinkwater DT, et al. Self-reported calcium intake and bone mineral content in children and adolescents. J Am Coll Nutr 2001 Oct; 20 (5): 502–9

    PubMed  CAS  Google Scholar 

  60. Cheng JC, Leung SS, Lee WT, et al. Deterntinants of axial and peripheral bone mass in Chinese adolescents. Arch Dis Child 1998 Jun; 78 (6): 524–30

    Article  PubMed  CAS  Google Scholar 

  61. Gunnes M, Lehmann EH. Physical activity and dietary constituents as predictors of forearm cortical and nabecular bone gain in healthy children and adolescents: a prospective study. Acta Paediatr 1996 Jan; 85 (1): 19–25

    Article  PubMed  CAS  Google Scholar 

  62. Jones G, Dwyer T. Bone mass in prepubertal children: gender differences and the role of physical activity and sunlight exposure. J Clin Endocrinol Metab 1998 Dec; 83 (12): 4274–9

    Article  PubMed  CAS  Google Scholar 

  63. Specker BL, Mulligan L, Ho M. Longitudinal study of calcium intake, physical activity and bone mineral content in infants 6-18 months of age. J Bone Miner Res 1999 Apr; 14 (4): 569–76

    Article  PubMed  CAS  Google Scholar 

  64. Bradney M, Pearce G, Naughton G, et al. Moderate exercise during growth in prepubertal boys: changes in bone mass, size, volumetric density, and bone strength: a controlled prospective study. J Bone Miner Res 1998 Dec; 13 (12): 1814–21

    Article  PubMed  CAS  Google Scholar 

  65. McKay HA, Petit MA, Schutz RW, et al. Augmented nochanteric bone mineral density after modified physical education classes: a randomized school-based exercise interven tion study in prepubescent and early pubescent children. J Pediatr 2000 Feb; 136 (2): 156–62

    Article  PubMed  CAS  Google Scholar 

  66. French SA, Fulkerson JA, Story M. Increasing weight-bearing physical activity and calcium intake for bone mass growth in children and adolescents: a review of intervention trials. Prev Med 2000 Dec; 31 (6): 722–31

    Article  PubMed  CAS  Google Scholar 

  67. MacKelvie KJ, McKay HA, Petit MA, et al. Bone national response to a 7-month randomized controlled, school-based jumping intervention in 121 prepubertal boys: associations with ethnicity and body mass index. J Bone Miner Res 2002 May; 17 (5): 834–44

    Article  PubMed  CAS  Google Scholar 

  68. Juliano-Burns S, Saxon L, Naughton G, et al. Regional specificity of exercise and calcium during skeletal growth in girls: a randomized controlled trial. J Bone Miner Res 2003 Jan; 18 (1): 156–62

    Article  Google Scholar 

Download references

Acknowledgements

Funding was provided during the writing of this review from the Douglas Conley Memorial Scholarship and the North American Society for Pediatric Exercise medicine student research grant. The authors have no conflicts of interest that are directly relevant to the content of this review.

Author information

Authors and Affiliations

  1. Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, 209 Fetzer Gymnasium, CB# 8700, Chapel Hill, North Carolina, 27599-8700, USA

    Kristin S. Ondrak

  2. Middle Tennessee State University, Murfreesboro, Tennessee, USA

    Don W. Morgan

Authors
  1. Kristin S. Ondrak
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Don W. Morgan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kristin S. Ondrak.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ondrak, K.S., Morgan, D.W. Physical Activity, Calcium Intake and Bone Health in Children and Adolescents. Sports Med 37, 587–600 (2007). https://doi.org/10.2165/00007256-200737070-00003

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00007256-200737070-00003

Keywords

Search

Navigation