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Robert R. Recker, MD; K. Michael Davies, PhD; Sharilyn M. Hinders, MSN; Robert P. Heaney, MD; Mary Ruth Stegman, PhD; Donald B. Kimmel, DDS, PhD

JAMA. 1992;268(17):2403-2408.

Abstract
Objective.
—To test whether bone mass increases in healthy nonpregnant white women during early adult life after cessation of linear growth; and to test whether various self-chosen levels of physical activity and nutrient intake or use of oral contraceptives influences this increase in bone mass.

Design.
—Longitudinal prospective study of up to 5 years of 156 healthy college-aged women full-time students attending professional schools in universities in the Omaha, Neb, area.

Setting.
—University medical center.

Participants.
—A convenience sample of healthy women students from Omahaarea professional schools. Any candidate with an illness, condition, or medication (except oral contraceptives) thought to affect general health or bone mass was excluded.

Interventions.
—None.

Outcome Measures.
—Clinical and family histories of disease, particularly osteoporosis; oral contraceptive use; bone mineral densities of the spine, forearm, and total body by dual- and single-photon absorptiometry; estimates of nutrient intake by repeated 7-day diet diaries; and measures of physical activity using a physical activity monitor.

Results.
—The median gain in bone mass for the third decade of life, expressed as a percentage per decade, was 4.8% for the forearm, 5.9% for lumbar bone mineral content, 6.8% for lumbar bone mineral density, and 12.5% for total body bone mass (P<.0001 in all cases). By both bivariate and multiple regression analysis the rate of gain in bone density of the spine was negatively correlated with age and positively correlated with calcium/protein intake ratio and physical activity (multiple r=.31 P=.004). Bivariate analysis showed that use of oral contraceptives was associated with greater gain in total body bone mass (r=.31, P=.01). The estimated age when mineral acquisition ceased ranged from 28.3 years to 29.5 years at the several study sites.

Conclusions.
—Gain in bone mass occurs in healthy young women during the third decade of life. Physical activity and dietary calcium intake both exert a positive effect on this bone gain. Use of oral contraceptives exerts a further independent positive effect. Changes in life-style among college-aged women, involving relatively modest increases in physical activity and calcium intake, may significantly reduce the risk of osteoporosis late in life.

(JAMA. 1992;268:2403-2408)

Author Affiliations
From the Center for Hard Tissue Research, Creighton University School of Medicine, Omaha, Neb.

Footnotes
Reprint requests to Center for Hard Tissue Research, Creighton University School of Medicine, 601 N 30th St, Omaha, NE 68131 (Dr Recker).

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