Prenatal influences on bone health in children

ABSTRACT

Introduction: Optimising bone health might reduce the burden of both fractures in childhood and fragility fractures in later life. A number of maternal dietary and non-dietary factors have been identified that might influence offspring bone health and represent targets for intervention.

Areas covered: This article will outline the accrual of bone mineral throughout the life course and how observational and intervention studies have shown that maternal diet, in particular maternal calcium and 25-hydroxyvitamin D [25(OH)D] status, and lifestyle are associated with offspring bone mineralization. Studies examining the effects of maternal micronutrient supplementation on offspring bone mineral density (BMD) will also be discussed.

Expert commentary: There is a wealth of observational evidence relating maternal diet to offspring BMD. However, high quality randomized controlled trials, such as the ongoing MAVIDOS study, are needed before these findings can be definitively translated into public health advice.

KEYWORDS:

• Bone mineral density
• calcium
• fetal origins
• osteoporosis
• pregnancy
• vitamin D

Article Highlights

• Fractures are common in childhood and later adult life and represent a significant healthcare burden.

• Birthweight has been associated with bone mineral density (BMD) in adulthood, and a number of studies have demonstrated associations between maternal dietary quality or components and lifestyle and offspring bone health.

• Observational studies relating maternal calcium status to offspring bone health are inconclusive, and the few studies of calcium supplementation have not consistently demonstrated a positive effect on offspring BMD; one study in the Gambia has shown mixed long-term effects on maternal BMD and offspring growth.

• Many observational studies have identified positive relationships between maternal 25-hydroxyvitamin D status and offspring BMD. The MAVIDOS randomized controlled trial of cholecalciferol supplementation in pregnancy demonstrated that maternal vitamin D supplementation led to greater offspring neonatal BMD amongst winter born infants.

This box summarises key points contained in the article.

Declaration of interest

NC Harvey has received personal fees, consultancy, lecture fees and honoraria from Alliance for Better Bone Health, AMGEN, MSD, Eli Lilly, Servier, Shire, UCB, Radius Health, Consilient Healthcare, and Internis Pharma, outside the submitted work. C Cooper has received personal fees from ABBH, Amgen, Eli Lilly, GSK, Medtronic, Merck, Novartis, Pfizer, Roche, Servier, and Takeda, outside the submitted work. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

Our work reported in this review article was supported by grants from Arthritis Research UK, Medical Research Council (MRC) [4050502589 (MRC LEU)], Bupa Foundation, National Institute for Health Research (NIHR) Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, and NIHR Oxford Biomedical Research Centre, University of Oxford, European Union’s Seventh Framework Programme (FP7/2007–2013), projects EarlyNutrition and ODIN under grant agreements numbers 289346 and 613977, and by the BBSRC (HDHL-Biomarkers, BB/P028179/1), as part of the ALPHABET project, supported by an award made through the ERA-Net on Biomarkers for Nutrition and Health (ERA HDHL), Horizon 2020 grant agreement number 696295.