A shared biomechanical environment for bone and posture development in children

Fábio A. Araújo*, Ana Martins, Nuno Alegrete, Laura D. Howe, Raquel Lucas

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

11 Citations (Scopus)
262 Downloads (Pure)


Background Context In each specific habitual standing posture, gravitational forces determine the mechanical setting provided to skeletal structures. Bone quality and resistance to physical stress is highly determined by habitual mechanical stimulation. However, the relationship between bone properties and sagittal posture has never been studied in children. Purpose This study aimed to investigate the association between bone physical properties and sagittal standing postural patterns in 7-year-old children. We also analyzed the relationship between fat or fat-free mass and postural patterns. Study Design Cross-sectional evaluation. Patient Sample This study was performed in a sample of 1,138 girls and 1,260 boys at 7 years of age participating in the Generation XXI study, a population-based cohort of children followed since birth (2005–2006) and recruited in Porto, Portugal. Outcome Measures Sagittal standing posture was measured through photographs of the sagittal right view of children in the standing position. Three angles were considered to quantify the magnitude of major curves of the spine and an overall balance measure (trunk, lumbar, and sway angles). Postural patterns were identified using latent profile analysis in Mplus. Methods Weight and height were measured. Total body less head fat or fat-free mass and bone properties were estimated from whole-body dual-energy X-ray absorptiometry scans. The associations of fat or fat-free mass and bone physical properties with postural patterns were jointly estimated in latent profile analysis using multinomial logistic regressions. Results The identified patterns were labeled as Sway, Flat, and “Neutral to Hyperlordotic” (in girls), and “Sway to Neutral,” Flat, and Hyperlordotic (in boys). In both genders, children in the Flat pattern showed the lowest body mass index, and children with a rounded posture presented the highest: mean differences varying from −0.86 kg/m2 to 0.60 kg/m2 in girls and from −0.70 kg/m2 to 0.62 kg/m2 in boys (vs. Sway or “Sway to Neutral”). Fat and fat-free mass were inversely associated with a Flat pattern and positively associated with a rounded posture: odds ratio (OR) of 0.23 per standard deviation (SD) fat and 0.70 per SD fat-free mass for the Flat pattern, and 1.85 (fat) and 1.43 (fat-free) for the Hyperlordotic pattern in boys, with similar findings in girls. The same direction of relationships was observed between bone physical properties and postural patterns. A positive association between bone (especially bone mineral density) and a rounded posture was robust to adjustment for age, height, and body composition (girls: OR=1.79, p=.006 fat-adjusted, OR=2.00, p=.014 fat-free mass adjusted; boys: OR=2.02, p=.002 fat-adjusted, OR=2.42, p<.001 fat-free mass adjusted). Conclusions In this population-based pediatric setting, there was an inverse association between bone physical properties and a Flat posture. Bone and posture were more strongly positively linked in a rounded posture. Our results support that both bone properties and posture mature in a shared and interrelated mechanical environment, probably modulated by pattern-specific anthropometrics and body composition.

Original languageEnglish
Pages (from-to)1426-1434
Number of pages9
JournalSpine Journal
Issue number10
Early online date4 May 2017
Publication statusPublished - 1 Oct 2017


  • Sagittal standing posture
  • Spine
  • Bone density
  • Body composition
  • Body size
  • Child


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