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Cortical bone loss and measurements of the second metacarpal bone II. Hypodense bone in postwar Guamanian children

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AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 6357-63 (1984)
Cortical Bone Loss and Measurements of the Second Metacarpal
Bone: II. Hypodense Bone in Postwar Guamanian Children
C.C. PLATO, W.W. GREULICH, R.M. GARRUTO, AND R. YANAGIHARA
Gerontology Research Center, National Institute on Aging, Baltimore,
Maryland 21224 (C. C.P.), Department of Anatomy, Stanford University
School of Medicine, Stanford, California 94305 (w. W G.), and Laboratory of
Central Nervous System Studies, National Institutes of Health, Bethesda,
Maryland 20205 (R.M. G., R. Y)
KEY WORDS Bone measurements, Chamorro, Children, Second
metacarpal, Guam
ABSTRACT
Hand-wrist radiographs from 326 Guamanian children (180
boys and 146 girls) were evaluated for total width, medullary width, length,
and combined cortical thickness of the second metacarpal. Bone measurements
as well as standing height and weight were compared to similar published
data from U.S. mainland black, white, and Mexican-American children. The
results demonstrated that the second metacarpal bones of Guamanian boys
and girls of all age groups (5-17 years) have a narrower width and shorter
length with less combined cortical thickness than any of the other groups.
Guamanian children also weighed less and were of shorter stature than their
black, white, or Mexican-American counterparts. These results agree closely
with those comparisons between Guamanian and U S . mainland white adults
published earlier. It is not possible from the present data to ascertain whether
these differences were due to genetic variability or nutritional deficiency.
In 1947, one of us (W.W.G.)collected handwrist radiographs and anthropometric data
on 1800 children from Guam in a n attempt
to determine the physical growth and developmental status of the indigenous Chamorro
children who endured the hardships and nutritional deprivations during the Japanese
occupation of the island from 1941 to 1944
(Greulich, 1951). The objective of the present
investigation is to evaluate the width, length,
and cortical mass of the second metacarpal
bone from a subsample of Guamanian children studied in 1947, and to compare these
measurements with those of U.S. mainland
black, white, and Mexican-American children who participated in the ten-state nutritional survey conducted by Garn et al. (1976).
Previously, we demonstrated that the second metacarpal bones of Guamanian adults
of either sex were narrower in width and
shorter in length than whites of similar age
and sex (Plat0 et al., 1982). Despite the observed differences in length and width, Chamorro and white participants showed no
significant differences in combined cortical
0 1984 ALAN R. LISS, INC
thickness, suggesting that larger bones do
not necassarily have a greater cortical mass.
MATERIALS AND METHODS
Posterioanterior views of hand-wrist radiographs from 326 Guamanian Chamorro
children (180 boys and 146 girls) between the
ages of 5 and 17 years were evaluated for
total width (TW), medullary width (MW),and
length (LEN), which included the epiphyses,
of the second metacarpal bone. Combined
cortical thickness (CCT = TW - MW) and
percent cortical area (PCA = (TW12 - (MWP/
(TW)2)were calculated from measurements
of total and medullary widths. Cortical thickness has been utilized by a number of investigators as a n indicator of cortical bone
density or mass (Barnett and Nordin, 1960;
Dequeker, 1972; Exton-Smith et al., 1969;
Garn et al., 1964). The ratio CCTPTW offers a
simple measure of bone density, while the
ratio of cortical area over the total area (CA!
Received March 14, 1983; accepted August 25, 1983.
58
C.C. PLATO, W.W. GREULICH, R.M. GARRUTO, AND R. YANAGIHARA
TA) is a ratio of the physical density of the surements are established before adolescence
CA section of the bone to the total volume of (Plato and Norris, 1980).
For Guamanian boys, the mean TW, ME,
a cylinder with the same TW and LEN (Garn,
1970).Further descriptions of these measure- CCT, LEN, and PCA of the left second metaments and the methods for their derivation carpal bone for each age group are shown in
have been reported elsewhere (Garn et al., Figures 1-4, respectively. These figures also
illustrate the comparison between mean val1964; Garn, 1970; Plato and Norris, 1980).
Bone measurements for black, white, and ues of Guamanian boys with those of black,
Mexican-American children used in this white, and Mexican-American boys over the
study were those of the ten-state nutritional same age range. The plots for the right hands
survey reported by Garn et al. (1976). Stand- of Guamanian boys and for both hands of
ing heights and weights of the Guamanian Guamanian girls (not presented) showed simchildren were those obtained by Greulich ilar trends.
The age-specific means for TW and CCT of
during the 1947 survey.
male and female Guamanian children were
RESULTS A N D DISCUSSION
conspicuously lower than those of the other
The mean bone measurements and stand- three ethnic groups. The mean distributions
ard errors for each age group of male and of MW and LEN were very similar among all
female children are given in Tables 1 and 2, four ethnic groups a t all ages. Guamanian
respectively. For approximately 50% of the children of all ages have lower PCA than the
individuals, only x rays of the left hand were other three groups (Fig. 4). The lower PCA,
available. Paired bilateral comparisons were which corrects for bone size, suggests that
therefore computed only for individuals hav- the Chamorro children have less cortical bone
ing hand-wrist radiographs ofboth hands. in relation to their total subperiosteal enveThe mean bilateral difference (d = Right - lope than the other three groups. This is also
Left) is given in Table 3. Significant bilateral supported by the consistently lower ratio of
differences were found for TW (P < 0.01) and cortical volume (CA x LEN) to the total volCCT (P < 0.05), with right hands having ume (TA x LEN) of the second metacarpal of
higher values than the left. The absence of Guamanians when compared to those of the
significant differences in MW indicates that black, white, or Mexican-American children.
the observed bilateral differences in CCT re- It is not possible to ascertain from the presflect the differences in TW. Total width was ent data whether the narrower width and
also the measurement which provided the less dense second metacarpal bones of Gualargest degree of bilateral asymmetry among manian children are due to genetic variabilChamorro adults reported previously (Plato ity or to nutritional or cultural differences.
Greulich (1951) compared standing height,
et al., 1982) and in male and female white
Americans (Plato and Purifoy, 1982). The weight, and other growth indices of Guamanpresent results render further support to our ian Chamorro children with that of white
earlier conclusions that right hands have a n children in the continental United States and
inherent tendency for a larger second meta- found all growth parameters to be significarpal bone than left hands (Plato and Nor- cantly lower in the former. Comparisons between mean standing height and weight of
ris, 1980).
It is noteworthy that the average ages of Guamanian boys from Greulich’s 1947 data
boys and girls x-rayed in 1947 were 10.7 and and that of boys in the ten-state nutritional
11.1 years, respectively. The average ages of survey (Figs. 5 , 6) show strikingly similar
male and female Chamorro adults x-rayed in and parallel distributions to the comparisons
1981 were 48 and 45 years, respectively reported by Greulich (1951) between Guam
(Plato et al., 1982). The expected age range and the children of the continental United
of boys and girls from the 1947 study in 1981 States (Cleveland). The relative height and
(37 years later) would be between 45 and 51 weight distributions of girls (not shown) were
years of age. Thus, the 1947 and 1981 study very similar to those in Figures 5 and 6.
The age-specific ratios of TW to standing
samples are comprised of individuals selected from the same population pool but at height were much lower in Guamanians than
different times. The finding of similar bilat- in black, white, or Mexican-American chileral bone measurement differences in both dren, while the age specific ratios of LEN to
samples renders further support for our pre- height were similar in all four groups. These
vious suggestion that differential bone mea- results also indicate that the smaller TW
59
HYPODENSE BONE IN GUAMANIAN CHILDREN
2-
A MWX-AMERICAN
5
OGUAM
6
7
8
9 10 11 12 13 14 15 16 17
AGE lyeersl
.wm
1-
Fig. 3. Comparison between mean length of the left
Fig. 1. Comparison between mean total width (TW)
and medullary width (MW) of the left second metacarpal
bone of Guamanian, and black, white, and MexicanAmerican boys of similar ages. Non-Guamanian populations from Garn (1976).
A
BLACK
A MMICAN-AMERICAN
0 GUAM
t
WlTE
5 6
7
8
9 10 11 12 13 14 15 16
AGE lyearsl
Fig. 4. Percent cortical area (PCA) in Guamanian,
and black, white, and Mexican-American boys of similar
ages. Non-Guamanian populations from Garn (1976).
14
I
5 6 7 8 9 10 11 12 13 14 15 16 17
AGE lyeersl
Fig. 2. Comparison between mean combined cortical
thickness of the left second metacarpal bone of Guamanian, and black, white, and Mexican-American boys of
similar ages. Non-Guamanian populations from Garn
(1976).
values of Guamanians are not due to their
Greulich (1951) suggested that the reduced
heights and weights of Guamanian children
were due only in part to ethnic differences
between the two g o u p s and that much ofthe
differences could be attributed to nutritional
deprivation perhaps as a
of the Japanese occupation.
Right hand
5
6
7
8
9
10
11
12
13
14
15
16
Left hand
5
6
7
8
9
10
11
12
13
14
15
16
Age
(years)
10
7
9
4
13
6
8
10
9
3
5
6
6
9
18
18
18
14
22
15
21
18
13
16
Number
ofhands
4.63
5.14
5.37
5.57
5.80
5.90
6.39
6.35
6.73
7.15
7.67
6.90
4.53
5.12
5.31
5.48
5.79
6.06
6.24
6.23
6.62
7.15
7.34
7.39
Mean
0.26
0.09
0.14
0.15
0.21
0.42
0.11
0.22
0.12
0.15
0.22
0.47
0.22
0.08
0.08
0.12
0.16
0.20
0.09
0.22
0.14
0.16
0.19
0.24
S.E.
Total width
2.82
3.20
3.21
3.40
3.41
3.23
3.72
3.43
3.65
3.79
3.94
3.47
2.63
3.01
3.26
3.14
3.43
3.37
3.55
3.39
3.67
3.94
3.78
3.46
Mean
0.23
0.10
0.14
0.15
0.20
0.42
0.14
0.17
0.17
0.23
0.25
0.35
0.20
0.15
0.14
0.12
0.18
0.17
0.14
0.16
0.13
0.16
0.26
0.22
S.E.
Medullary width
1.82
1.94
2.16
2.17
2.39
2.68
2.68
2.92
3.08
3.36
3.72
3.43
~~
1.90
2.11
2.05
2.34
2.37
2.69
2.69
2.83
2.95
3.21
3.56
3.93
Mean
0.10
0.05
0.11
0.13
0.07
0.14
0.12
0.24
0.19
0.18
0.20
0.20
0.11
0.16
0.09
0.14
0.14
0.17
0.24
0.33
0.10
. ~.
0.19
0.18
0.12
S.E.
Combined
cortical
thickness
38.37
40.30
42.85
46.67
45.60
51.65
52.03
53.37
55.29
57.25
60.42
63.40
37.75
42.57
42.64
46.03
45.93
49.28
51.37
53.05
54.56
57.71
59.22
63.65
Mean
Length
1.94
0.61
1.17
0.87
1.26
2.43
0.92
2.60
1.24
1.07
1.83
3.22
1.69
2.19
0.66
0.47
0.70
0.06
0.71
1.42
0.64
0.90
1.40
1.42
S.E.
63.2
61.2
64.0
62.5
65.6
70.4
65.9
70.1
70.0
71.5
73.1
74.8
77.0
65.5
64.5
61.5
66.8
64.8
68.5
67.3
69.9
68.5
68.9
72.4
Mean
2.79
1.50
2.24
2.50
1.85
4.06
2.10
3.59
3.01
1.32
2.66
2.51
4.23
3.56
2.83
1.77
2.25
2.22
1.83
1.86
2.02
1.81
3.22
2.89
S.E.
Percent cortical
area
TABLE 1. Means and standard errors for total width, medullary width, combined cortical thickness, length and percent cortical area of the
second metacarpal bone i n Guamanian boys
P
U
“0
5
P
P
D
P
12
13
14
15
16
17
11
Right hand
5
6
7
8
9
10
Left hand
5
6
7
8
9
10
11
12
13
14
15
16
17
Age
(years)
5
6
5
2
2
1
10
4
5
8
8
6
9
7
2
11
17
17
14
20
12
15
~.
10
15
1
5
Number
ofhands
~~
5.30
5.20
5.59
5.70
5.72
5.96
6.14
6.65
6.71
7.04
7.03
6.72
7.35
~
4.46
5.30
5.37
5.43
5.55
5.89
6.18
6.56
6.59
6.95
6.86
6.73
7.15
0.23
0.36
0.22
0.36
0.24
0.13
0.17
0.25
0.16
0.12
0.25
0.20
0.21
0.14
0.10
0.17
0.17
0.16
0.15
0.15
0.19
0.20
0.10
0.23
Total width
Mean
S.E.
3.55
3.10
3.37
3.58
2.90
3.03
2.98
3.32
3.10
2.90
2.40
2.30
2.95
~
2.46
3.10
3.02
3.09
2.70
..
3.07
3.09
3.14
3.03
2.93
2.46
2.56
3.10
0.25
0.36
0.14
0.24
0.26
0.24
0.12
0.47
0.19
0.24
0.15
0.05
~~
0.27
0.13
0.16
.
0.18
0.14
0.15
0.15
0.21
0.18
0.30
0.10
0.37
Medullary width
Mean
S.E.
1.75
2.10
2.22
2.13
2.82
2.94
3.16
3.33
3.61
4.14
4.63
4.42
4.40
2.00
2.20
2.35
2.35
2.85
2.92
3.09
3.43
3.57
4.02
4.40
4.17
4.05
0.12
0.08
0.21
0.17
0.15
0.20
0.14
0.28
0.17
0.25
0.10
0.25
0.15
0.13
0.13
0.12
0.10
0.13
0.17
0.16
0.17
0.17
0.25
0.14
Combined
cortical
thickness
Mean
S.E.
39.80
41.30
44.00
46.43
47.18
50.45
52.93
55.05
59.02
63.36
63.08
61.38
64.55
38.66
40.40
43.90
46.29
47.61
50.66
52.50
55.36
57.94
61.50
62.17
61.63
64.85
1.07
0.54
1.06
2.01
1.30
1.75
1.70
1.33
1.18
1.85
1.15
0.20
1.04
0.35
0.68
1.12
0.91
1.25
0.96
0.92
0.81
1.24
0.65
0.56
Length
Mean
S.E.
54.8
64.5
63.7
61.0
73.9
74.3
76.4
74.8
78.5
52.3
88.1
87.8
83.9
69.5
65.8
68.1
67.1
75.7
73.5
74.8
76.8
77.8
81.7
86.7
85.1
81.1
2.89
3.44
2.44
1.69
2.68
3.04
1.30
4.42
1.59
2.19
0.54
4.67
3.84
2.21
2.25
1.73
1.65
1.76
2.34
2.08
1.75
2.77
2.00
5.80
Percent cortical
area
Mean
S.E.
TABLE 2. Means and standard errors for total width, medullary width, combined cortical thickness, length and percent cortical area o f the
second metacarpal bone i n Guamanian girls
0
m
62
C.C. PLATO, W.W. GREULICH, R.M. GARRUTO, AND R. YANAGIHARA
TABLE 3. Paired bilateral differences for measurements of the second metacarpal bone in Guamanian
children
Male
Total width
Medullary width
Combined cortical
thickness
Len&h
Percent cortical
area
Mgan
(d)
S.E.
Female
Mgan
(d)
S.E.
(Sd)
t
Value
0.111
0.032
0.79
0.030
0.042
0.037
3.75**
0.76
2.11*
0.183
0.082
0.101
0.041
0.042
0.047
4.43**
1.93
2.17*
0.008
0.832
0.230
0.675
0.03
1.23
0.308
0.123
0.125
0.736
2.46*
0.17
(SJ
t
Value
*0.05 > P > 0.01
**P < 0.01.
Fig, 5. Comparison between mean values for standing height of Guamanian, and black, white, and Mexican-American boys of similar ages. Non-Guamanian
populations from Garn (1976).
Fig. 6 . Comparison between mean values for weight
of Guamanian, and black, white, and Mexican-American
boys of similar ages. Non-Guamanian populations from
Garn (1976).
Our present results form hand-wrist radiographs of Guamanian children and adults
(Plato et al., 1982) support Greulich’s suggestion that nutritional deficiencies, in addition
to ethnic differences, contributed to retarded
height, weight, and skeletal development of
Guamanians (Greulich, 1951). This suggestion is further supported by results of a re-
cent elemental analysis of garden soil and
drinking water which indicated extremely
low levels of calcium in a number of Guamanian villages, particularly those in southern Guam, where little or no foodstuffs were
previously imported (Garruto et al., 1983).
However, conclusions regarding the extent of
genetic and nutritional effects on bone mea-
HYPODENSE BONE IN GUAMANIAN CHILDREN
surements of Guamanians cannot be made
until present day Guamanian children have
been evaluated.
ACKNOWLEDGMENTS
This study would not have been possible
without the cooperation and generous assistance of the officials of the Naval Government
of Guam in 1947, who made available the x
ray and other facilities during the collection
of the data. The authors also acknowledge
their indebtedness to the late Mrs. Mildred
L. Greulich who assisted in the collection of
the data on Guam and to Mrs. Kathleen Fox
who assisted with the evaluation of the x
rays and data.
LITERATURE CITED
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Exton-Smith,AN, Millard, PH, Payne, PR, and Wheeler,
E (1969) Pattern of development and loss of bone with
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Garn, SM (1970) The Earlier Gain and Later Loss of
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Cortical Bone. Springfield, Illinois: Charles C. Thomas.
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DM (1983) Environmental levels of trace and essential
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Greulich, WW (1951)The growth and developmental status of Guamanian school children in 1947. Am. J. Phys.
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Plato, CC, Garruto, RM, Yanagihara, RT, Chen, KM,
Wood, JL,Gajdusek, DC, and Norris, AH (1982)Corticai bone loss and measurements of the second rnetacarpal bone: 1. Comparisons between adult Guamanian
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Plato, CC, and Norris, AH (1980)Bone measurements of
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