Associations of ethnicity, skin tone, and genome-wide sequencing with bone mineral density in adolescents

Authors

Catherine M. Gordon
Abby F. Fleisch, Center for Interdisciplinary Population and Health Research, MaineHealth Institute for Research, Portland, ME, USA.
Marie-France Hivert, Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA.
Lisa B. Rokoff, Center for Interdisciplinary Population and Health Research, MaineHealth Institute for Research, Portland, ME, USA.
Sheryl L. Rifas-Shiman, Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA.
Jean L. Raphael, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA.
Emily Oken, Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA.

Document Type

Article

Publication Date

10-17-2024

Institution/Department

Center for Interdisciplinary Population and Health Research; Pediatrics; Endocrinology & Diabetes

Journal Title

Pediatric research

Abstract

BACKGROUND: Dual-energy x-ray absorptiometry reference data designate Black and non-Black categories, as higher BMD has been documented among Black youth. We examined associations of race, skin tone, and genetic factors with bone mineral density (BMD). METHODS: 557 adolescents were followed longitudinally. Exposures included race, skin tone, and principal components (PC) from genome-wide arrays. Total body BMD Z-score (BMD-Z) was the primary outcome using linear regression. RESULTS: 359 adolescents identified as non-Hispanic White (NHW) and 75, non-Hispanic Black (NHB). BMD-Z was higher in NHB vs. NHW (β: 0.92 units, 95% CI: 0.64, 1.19) or those with darker skin (0.79, 95% CI: 0.49, 1.08 for brown vs. medium). The first genetic PC (PC1) correlated with identification as NHB. PC1 was associated with higher BMD-Z (0.09, 95% CI: 0.06, 0.12), even after including race (0.07, 95% CI: 0.00, 0.14) or skin tone (0.10, 95% CI: 0.05, 0.15); both race (0.26, 95% CI: -0.49, 1.01 for NHB vs. NHW) and skin tone (-0.08, 95% CI: -0.59, 0.44 for brown vs. medium) no longer predicted BMD-Z after adjustment for PC1. CONCLUSION: Genetic similarity was robustly associated with BMD, prompting a reevaluation of adolescent BMD reference data to exclude the consideration of race. IMPACT: Current bone density reference databases include a binary assignment of patients into "Black" and "non-Black" categories, as a higher BMD has been documented among those identifying as Black compared with individuals of other racial and ethnic backgrounds. This study found genetic similarity to be more strongly associated with bone density by dual-energy x-ray absorptiometry than race or skin tone. These data emphasize a need to reevaluate how bone density measurements are interpreted, including exploring reference data that exclude the consideration of race.

Recommended Citation

Gordon, Catherine M.; Fleisch, Abby F.; Hivert, Marie-France; Rokoff, Lisa B.; Rifas-Shiman, Sheryl L.; Raphael, Jean L.; and Oken, Emily, "Associations of ethnicity, skin tone, and genome-wide sequencing with bone mineral density in adolescents" (2024). MaineHealth Maine Medical Center. 3823.
https://knowledgeconnection.mainehealth.org/mmc/3823