Osteoporosis in survivors of early life starvation
George M. Weisz A B C and William R. Albury BA School of Humanities (Program in History of Medicine), University of New South Wales, Sydney, NSW 2052, Australia.
B School of Humanities, University of New England, Armidale, NSW 2351, Australia.
C Corresponding author. Email: gmweisz1@aol.com
Australian Journal of Primary Health 19(1) 3-6 https://doi.org/10.1071/PY12004
Submitted: 23 January 2012 Accepted: 6 March 2012 Published: 5 April 2012
Abstract
The objective of this study was to provide evidence for the association of early life nutritional deprivation and adult osteoporosis, in order to suggest that a history of such deprivation may be an indicator of increased risk of osteoporosis in later life. The ‘fetal programming’ of a range of metabolic and cardiovascular disorders in adults was first proposed in the 1990s and more recently extended to disorders of bone metabolism. Localised famines during World War II left populations in whom the long-term effects of maternal, fetal and infantile nutritional deprivation were studied. These studies supported the original concept of ‘fetal programming’ but did not consider bone metabolism. The present paper offers clinical data from another cohort of World War II famine survivors – those from the Holocaust. The data presented here, specifically addressing the issue of osteoporosis, report on 11 Holocaust survivors in Australia (five females, six males) who were exposed to starvation in early life. The cases show, in addition to other metabolic disorders associated with early life starvation, various levels of osteoporosis, often with premature onset. The cohort studied is too small to support firm conclusions, but the evidence suggests that the risk of adult osteoporosis in both males and females is increased by severe starvation early in life – not just in the period from gestation to infancy but also in childhood and young adulthood. It is recommended that epidemiological research on this issue be undertaken, to assist planning for the future health needs of immigrants to Australia coming from famine affected backgrounds. Pending such research, it would be prudent for primary care health workers to be alert to the prima facie association between early life starvation and adult osteoporosis, and to take this factor into account along with other indicators when assessing a patient’s risk of osteoporosis in later life.
Additional keyword: metabolism.
References
Barker DJ, Winter PD, Osmond C, Margetts B, Simmonds SJ (1992) Weight in infancy and death from ischemic heart disease. In ‘Fetal and infant origins of adult disease’. (Ed. DJ Barker) pp. 141–148. (BMJ Publications: London)Ben-Shlomo Y, Kuh D (2002) A life course approach to chronic disease epidemiology: conceptual models, empirical challenges and interdisciplinary perspectives. International Journal of Epidemiology 31, 285–293.
| A life course approach to chronic disease epidemiology: conceptual models, empirical challenges and interdisciplinary perspectives.Crossref | GoogleScholarGoogle Scholar | 11980781PubMed |
Cole ZA, Gale CR, Javaid MK, Robinson SM, Law C, Boucher BJ, Crozier SR, Godfrey KM, Dennison EM, Cooper C (2009) Maternal dietary patterns during pregnancy and childhood bone mass: a longitudinal study. Journal of Bone and Mineral Research 24, 663–668.
| Maternal dietary patterns during pregnancy and childhood bone mass: a longitudinal study.Crossref | GoogleScholarGoogle Scholar | 19049331PubMed |
Cooper C, Walker-Bone K, Arden N (2000) Novel insights into the pathogenesis of osteoporosis: the role of intrauterine programming. Rheumatology 39, 1312–1315.
| Novel insights into the pathogenesis of osteoporosis: the role of intrauterine programming.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD3MXoslGiuw%3D%3D&md5=19d22c448b8e801cf6199dd98172c4dfCAS | 11136871PubMed |
Cooper C, Javaid MK, Taylor P, Walker-Bone K, Dennison E, Arden N (2002) The fetal origins of osteoporotic fracture. Calcified Tissue International 70, 391–394.
| The fetal origins of osteoporotic fracture.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD38Xlt1Knt70%3D&md5=7c0ecf095aabfe9543fa1e8e32735bbdCAS | 11960204PubMed |
Cooper C, Javaid K, Westlake S, Harvey N, Dennison E (2005) Developmental origins of osteoporotic fracture: the role of maternal Vitamin D insufficiency. The Journal of Nutrition 135, 2728S–2734S.
Dennison EM, Arden NK, Keen RW, Syddall H, Day INM, Spector TD, Cooper C (2001) Birthweight, vitamin D receptor genotype and the programming of osteoporosis. Paediatric and Perinatal Epidemiology 15, 211–219.
| Birthweight, vitamin D receptor genotype and the programming of osteoporosis.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3Mvlsl2ktA%3D%3D&md5=c3f3e7081a5a1af84ca042f5c2f1902bCAS | 11489147PubMed |
Dennison EM, Hindmarsch PC, Kellingray S, Fall CDH, Cooper C (2003) Growth hormone predicts bone density in elderly women. Bone 32, 434–440.
| Growth hormone predicts bone density in elderly women.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD3sXislemsrc%3D&md5=fa7420ae538d7346a18df65fdc2c190eCAS | 12689688PubMed |
Dirx MJM, van den Brandt PA, Goldbohm RA, Lumey LH (2003) Energy restriction early in life and colon carcinoma risk. Cancer 97, 46–55.
| Energy restriction early in life and colon carcinoma risk.Crossref | GoogleScholarGoogle Scholar |
Elias SG, Peeters PHM, Grobbee DE, van Noord PAH (2004) Breast cancer risk after caloric restriction during the 1944–1945 Dutch famine. Journal of the National Cancer Institute 96, 539–546.
| Breast cancer risk after caloric restriction during the 1944–1945 Dutch famine.Crossref | GoogleScholarGoogle Scholar | 15069116PubMed |
Fentiman IS, Allen DS, Ellison GTH (2007) The impact of the occupation of Guernsey 1940–1945 on breast cancer risk. International Journal of Clinical Practice 61, 937–943.
| The impact of the occupation of Guernsey 1940–1945 on breast cancer risk.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD2s3ptlKjsQ%3D%3D&md5=e22dfecc20299989fdeeaf7601f078deCAS | 17504356PubMed |
Gale CR, Martyn CN, Kellingray S, Eastell R, Cooper C (2001) Intrauterine programming of adult body composition. The Journal of Clinical Endocrinology and Metabolism 86, 267–272.
| Intrauterine programming of adult body composition.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD3MXhtVGnsbw%3D&md5=ffea21347e74ef3cc915616f865f5ffaCAS | 11232011PubMed |
Head RF, Gilthorpe MS, Byrom A, Ellison GTH (2008) Cardiovascular disease in a cohort exposed to the 1940–45 Channel Islands occupation. BMC Public Health 8, 303–307.
| Cardiovascular disease in a cohort exposed to the 1940–45 Channel Islands occupation.Crossref | GoogleScholarGoogle Scholar | 18764932PubMed |
Kimber C, Grimmer-Somers K (2011) A novel primary care clinical prediction rule for early detection of osteoporosis. Australian Journal of Primary Health 17, 175–180.
| A novel primary care clinical prediction rule for early detection of osteoporosis.Crossref | GoogleScholarGoogle Scholar | 21645474PubMed |
Koupil I, Shestov DB, Sparén P, Plavinskaja S, Parfenova N, Vågerö D (2007) Blood pressure, hypertension and mortality from circulatory disease in men and women who survived the siege of Leningrad. European Journal of Epidemiology 22, 223–234.
| Blood pressure, hypertension and mortality from circulatory disease in men and women who survived the siege of Leningrad.Crossref | GoogleScholarGoogle Scholar | 17436055PubMed |
Lucas A (1991) Programming by early nutrition in man. In ‘The childhood environment and adult disease (Ciba Foundation Symposium 156)’. (Ed. GR Bock, J Whelan) pp. 38–55. (John Wiley: Chichester)
Marcus E-L, Menczel J (2007) Higher prevalence of osteoporosis among female Holocaust survivors. Osteoporosis International 18, 1501–1506.
| Higher prevalence of osteoporosis among female Holocaust survivors.Crossref | GoogleScholarGoogle Scholar | 17492392PubMed |
Ophir E, Oettinger M (2000) Fetal intrauterine life – a window to adult disease? The Israel Medical Association Journal 2, 43–47.
Paratz ED, Katz B (2011) Ageing Holocaust survivors in Australia. The Medical Journal of Australia 194, 194–197.
Roseboom T, de Rooij S, Painter R (2006) The Dutch famine and its long-term consequences for adult health. Early Human Development 82, 485–491.
| The Dutch famine and its long-term consequences for adult health.Crossref | GoogleScholarGoogle Scholar | 16876341PubMed |
Sayer AA, Cooper C (2005) Fetal programming of body composition and musculoskeletal development. Early Human Development 81, 735–744.
| Fetal programming of body composition and musculoskeletal development.Crossref | GoogleScholarGoogle Scholar | 16081228PubMed |
Winick MD (Ed) (1979) ‘Hunger disease: studies by the Jewish physicians in the Warsaw Ghetto.’ p. 219. (Wiley Interscience: New York)
