The Brush Foundation studies on human growth and development, begun in 1931 and terminated in 1942, have been intensively reviewed and studied by Dr Greulich and Miss Pyle in the formulation of this Radiographic Atlas of Skeletal Development of the Hand and Wrist Serial radiographs of from 2 to 20 hand-films made at successive examinations of each of 1000 boys and girls made up the radiographic material Standards were selected that were judged to be the most representative of the central tendency or anatomic mode of each chronologic age group from birth through 18 years

Radiographic Atlas of Skeletal Development of the Hand and Wrist

The 2017 Hormone Therapy Position Statement of The North American Menopause Society (NAMS) updates the 2012 Hormone Therapy Position Statement of The North American Menopause Society and identifies future research needs. An Advisory Panel of clinicians and researchers expert in the field of women's health and menopause was recruited by NAMS to review the 2012 Position Statement, evaluate new literature, assess the evidence, and reach consensus on recommendations, using the level of evidence to identify the strength of recommendations and the quality of the evidence. The Panel's recommendations were reviewed and approved by the NAMS Board of Trustees. Hormone therapy (HT) remains the most effective treatment for vasomotor symptoms (VMS) and the genitourinary syndrome of menopause (GSM) and has been shown to prevent bone loss and fracture. The risks of HT differ depending on type, dose, duration of use, route of administration, timing of initiation, and whether a progestogen is used. Treatment should be individualized to identify the most appropriate HT type, dose, formulation, route of administration, and duration of use, using the best available evidence to maximize benefits and minimize risks, with periodic reevaluation of the benefits and risks of continuing or discontinuing HT. For women aged younger than 60 years or who are within 10 years of menopause onset and have no contraindications, the benefit-risk ratio is most favorable for treatment of bothersome VMS and for those at elevated risk for bone loss or fracture. For women who initiate HT more than 10 or 20 years from menopause onset or are aged 60 years or older, the benefit-risk ratio appears less favorable because of the greater absolute risks of coronary heart disease, stroke, venous thromboembolism, and dementia. Longer durations of therapy should be for documented indications such as persistent VMS or bone loss, with shared decision making and periodic reevaluation. For bothersome GSM symptoms not relieved with over-the-counter therapies and without indications for use of systemic HT, low-dose vaginal estrogen therapy or other therapies are recommended. This NAMS position statement has been endorsed by Academy of Women's Health, American Association of Clinical Endocrinologists, American Association of Nurse Practitioners, American Medical Women's Association, American Society for Reproductive Medicine, Asociacion Mexicana para el Estudio del Climaterio, Association of Reproductive Health Professionals, Australasian Menopause Society, Chinese Menopause Society, Colegio Mexicano de Especialistas en Ginecologia y Obstetricia, Czech Menopause and Andropause Society, Dominican Menopause Society, European Menopause and Andropause Society, German Menopause Society, Groupe d’etudes de la menopause et du vieillissement Hormonal, HealthyWomen, Indian Menopause Society, International Menopause Society, International Osteoporosis Foundation, International Society for the Study of Women's Sexual Health, Israeli Menopause Society, Japan Society of Menopause and Women's Health, Korean Society of Menopause, Menopause Research Society of Singapore, National Association of Nurse Practitioners in Women's Health, SOBRAC and FEBRASGO, SIGMA Canadian Menopause Society, Societa Italiana della Menopausa, Society of Obstetricians and Gynaecologists of Canada, South African Menopause Society, Taiwanese Menopause Society, and the Thai Menopause Society. The American College of Obstetricians and Gynecologists supports the value of this clinical document as an educational tool, June 2017. The British Menopause Society supports this Position Statement.

The 2017 hormone therapy position statement of The North American Menopause Society.

Lifestyle choices influence 20–40 % of adult peak bone mass. Therefore, optimization of lifestyle factors known to influence peak bone mass and strength is an important strategy aimed at reducing risk of osteoporosis or low bone mass later in life. The National Osteoporosis Foundation has issued this scientific statement to provide evidence-based guidance and a national implementation strategy for the purpose of helping individuals achieve maximal peak bone mass early in life. In this scientific statement, we (1) report the results of an evidence-based review of the literature since 2000 on factors that influence achieving the full genetic potential for skeletal mass; (2) recommend lifestyle choices that promote maximal bone health throughout the lifespan; (3) outline a research agenda to address current gaps; and (4) identify implementation strategies. We conducted a systematic review of the role of individual nutrients, food patterns, special issues, contraceptives, and physical activity on bone mass and strength development in youth. An evidence grading system was applied to describe the strength of available evidence on these individual modifiable lifestyle factors that may (or may not) influence the development of peak bone mass (Table 1). A summary of the grades for each of these factors is given below. We describe the underpinning biology of these relationships as well as other factors for which a systematic review approach was not possible. Articles published since 2000, all of which followed the report by Heaney et al. [1] published in that year, were considered for this scientific statement. This current review is a systematic update of the previous review conducted by the National Osteoporosis Foundation [1].
 Considering the evidence-based literature review, we recommend lifestyle choices that promote maximal bone health from childhood through young to late adolescence and outline a research agenda to address current gaps in knowledge. The best evidence (grade A) is available for positive effects of calcium intake and physical activity, especially during the late childhood and peripubertal years—a critical period for bone accretion. Good evidence is also available for a role of vitamin D and dairy consumption and a detriment of DMPA injections. However, more rigorous trial data on many other lifestyle choices are needed and this need is outlined in our research agenda. Implementation strategies for lifestyle modifications to promote development of peak bone mass and strength within one’s genetic potential require a multisectored (i.e., family, schools, healthcare systems) approach.

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The National Osteoporosis Foundation’s position statement on peak bone mass development and lifestyle factors: a systematic review and implementation recommendations

In seven strains of cultured normal human osteoblast-like cells, a mean of 1615 molecules of tritium-labeled 17 beta-estradiol per cell nucleus could be bound to specific nuclear sites. The nuclear binding of the labeled steroid was temperature-dependent, steroid-specific, saturable, and cell type-specific. These are characteristics of biologically active estrogen receptors. Pretreatment with 10 nanomolar estradiol in vitro increased the specific nuclear binding of progesterone in four of six cell strains, indicating an induction of functional progesterone receptors. RNA blot analysis demonstrated the presence of messenger RNA for the human estrogen receptor. The data suggest that estrogen acts directly on human bone cells through a classical estrogen receptor-mediated mechanism.

Evidence of estrogen receptors in normal human osteoblast-like cells

Height and weight at menarche were found for each subject in three longitudinal growth studies. Early and late maturing girls have menarche at the same mean weight, but late maturers are taller at menarche. Two other major events of adolescence, initiation of the weight growth spurt and maximum rate of weight gain, also occur at an invariant mean weight. The hypothesis is proposed that a critical body weight may trigger each of these adolescent events. Such an interaction would explain the secular trend to an earlier menarche.

Height and weight at menarche and a hypothesis of critical body weights and adolescent events

Considerations about the consequences of contraceptives use by adolescents, are made, based on National and international studies warn against early sexual life exposing adolescents to the risks of pregnancy and sexualy transmissible diseases including AIDS. For the most adolescents informations on contraceptives are offered, the pill and the condom being the most popular and used methods. However, a high inadequacy level of contraceptive methods was determined in addition to the lack of guidance and assistance services. Such a situation alerts to the need to have health and education professionals, family and community involved to warrant adolescents an improved life quality.

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Reflexões sobre a anticoncepção na adolescência no Brasil

A adolescencia e um periodo fundamental para a aquisicao da massa ossea. Em adolescentes atletas, o pico de massa ossea pode apresentar maior incremento, em virtude do estresse mecânico imposto aos ossos pelo exercicio fisico praticado. O objetivo desta revisao foi investigar o papel do treinamento esportivo vigoroso e precoce sobre a saude ossea de atletas adolescentes. Atraves da revisao da literatura cientifica, envolvendo adolescentes atletas de diferentes modalidades e de ambos os sexos, e possivel inferir que a densidade mineral ossea e potencializada pelos exercicios, quando grupos de atletas sao comparados com grupos de controle. Entretanto, muito se discute na literatura quanto a recomendacao da intensidade adequada da prescricao de exercicio fisico para populacao adolescente, uma vez que, caso o treinamento se torne muito extenuante, os beneficios gerados pela atividade sobre a saude dos ossos podem ser minimizados ou anulados. Embora muita controversia ainda envolva o tema, independente do tipo de esporte praticado, o aumento de intensidade do treinamento deve ser razoavel e coerente com as metas, sendo enfatizado treinamento seguro e eficaz para cada uma das faixas de idade e momentos da maturacao biologica, independente dos calendarios competitivos.

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O esporte e suas implicacoes na saude ossea de atletas adolescentes

Bone turnover is affected by exercise throughout the lifespan, especially during childhood and adolescence. The objective of this study was to investigate the impact of different sports on total and regional bone mineral density in male Brazilian adolescent athletes. Forty-six adolescents aged 10–18 years participated in the study: 12 swimmers, 10 tennis players, 10 soccer players, and 14 sedentary individuals. The athletes had engaged in physical activities for more than 10 h per week in the previous 6 months. Bone mineral density of the lumbar spine (L1–L4), left proximal femur region, and whole body was evaluated by dual-energy X-ray absorptiometry. Results showed higher mean values in the proximal femur region of tennis and soccer players (1.02 ± 0.18; 0.96 ± 0.16, respectively) than swimmers and controls (0.91 ± 0.14 and 0.87 ± 0.06, respectively) (P < 0.05). In relation to the impact of sporting activities based on bone age determination, we observed significant differences in bone mineral ...

The impact of different types of physical activity on total and regional bone mineral density in young Brazilian athletes

This study was conducted at the Santa Izabel Maternity Hospital in the town of Bauru, Sao Paulo State, Brazil, in order to investigate abortions and miscarriages in adolescence, comparing them to terminations among adult women. The indicators are used to draw up an epidemiological profile of hospitalized women through data collected from documents on women with diagnoses of abortion or miscarriage from 2000 to 2003, regardless of their clinical form. The total number of registered early terminations of pregnancy reached 2,286, with 459 (20.08%) during adolescence, with the complete form being significantly higher among teenagers than adults; a decrease in the occurrence among adolescents was noted, dropping from 30.5% in 2000 to 25.05% in 2001, 23.53% in 2002 and 20.92% in 2003; with adolescents tending to remain in hospital for two or more days. The implementation is stressed of policies and programs addressing sexual and reproductive health and its co-morbidities.

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Abortamento na adolescência: um estudo epidemiológico

OBJETIVO: Verificar o comportamento do conteudo mineral osseo e da densidade mineral ossea em adolescentes do sexo masculino em funcao da faixa etaria e do nivel maturacional dos caracteres sexuais secundarios. METODOS: 47 adolescentes saudaveis na faixa etaria de 10 a 19 anos foram avaliados quanto a ingestao de calcio, peso, estatura, indice de massa corporal, estagio puberal, densidade mineral ossea e conteudo mineral osseo na coluna e no femur proximal. A massa ossea foi mensurada atraves de densitometria ossea. A ingestao de calcio foi calculada atraves de registro dietetico de 3 dias. O indice de massa corporal foi calculado pelo Indice de Quetelet, e o estagio puberal foi definido segundo os criterios de Tanner. Foi utilizada estatistica descritiva, media e desvio padrao, analise de variância para comparacao entre os grupos etarios e teste de Tukey para localizar as diferencas significativas. RESULTADOS: A ingestao de calcio nao alcancou o valor minimo de 800 mg em varias faixas etarias estudadas. A densidade mineral ossea e o conteudo mineral osseo demonstraram incrementos com o avancar da idade, indicando diferencas significativas a partir dos 14 anos, bem como quando os adolescentes atingiam os estagios de maturacao sexual G4. Os parâmetros de mineralizacao revelaram aumento pronunciado quando os adolescentes atingiam G3, porem sem significado estatistico. CONCLUSAO: Os resultados apontam um aumento importante na mineralizacao ossea durante a adolescencia. A evidencia de aumento na mineralizacao dos adolescentes foi percebida em niveis maturacionais superiores a G3. Os anos criticos para a aquisicao da massa ossea neste estudo evidenciaram-se a partir dos 14-15 anos de idade.

Tamara Beres Lederer Goldberg

Papers

Reflexões sobre a anticoncepção na adolescência no Brasil

O esporte e suas implicacoes na saude ossea de atletas adolescentes

The impact of different types of physical activity on total and regional bone mineral density in young Brazilian athletes

Abortamento na adolescência: um estudo epidemiológico

Mineralização óssea em adolescentes do sexo masculino: anos críticos para a aquisição da massa óssea