The positive association between maternal age and risk of fractures is difficult to interpret. Our original hypothesis was that children of adolescent mothers

might have been at greater risk due to inadequate child care, but the results came out in the opposite direction. It is possible that older mothers have faced increased demands on calcium and vitamin D stores through repeated pregnancies, which could explain the positive association between maternal age and risk of fractures. However, adjustment for parity did not influence such an association. We found no other studies reporting such an association and confirmation by other researchers is essential. A previous study in the same city reported that adults in

the lowest socioeconomic position Apoptosis inhibitor category—based on household assets—were 3.2 times more likely than those in the highest category to have experienced a fracture within the 12 months prior to the interview [17]. Because the socioeconomic classification is based on assets acquired over several years rather than concurrent income, reverse causality is unlikely to explain this finding. Data from the ALSPAC cohort in the United Kingdom showed that social position is directly related to bone mineral content of adolescents [18], which may reduce Eltanexor purchase their risk of fractures. These trends were not confirmed in our study with Brazilian adolescents. In the Poisson models, the association was actually in the opposite direction. A limitation of our study is that, so far, we have no data on bone mineral density for cohort members. We are planning to collect such data in the next follow-up visit, which will take place in 2011, when subjects will be aged 18 years. An advantage of our study is that two multivariable techniques provided consistent results in terms of the risk factors for fractures, reducing the possibility of type 1 error. Also, the prospective nature of the data reduces the possibility of recall

bias. Our findings are in agreement with the literature regarding an increased risk of fractures among boys and among children who were longer at birth [8, 18, 19]. The finding on higher risk among children born to older mothers needs to be Amino acid replicated. Our results suggest that, in accordance with the hypothesis of developmental origins of diseases, fractures seem to be, at least in part, programmed in early life. Acknowledgements This analysis was supported by the Wellcome Trust initiative entitled Major Awards for Latin America on Health Consequences of Population Change. Earlier phases of the 1993 cohort study were funded by the European Union, the 3-MA order National Program for Centers of Excellence (Brazil), the National Research Council (Brazil) and the Ministry of Health (Brazil). Conflicts of interest None.