Bone mineral density in older non-Hispanic Caucasian and Mexican-American women: relationship to lean and fat mass

PRIMARY OBJECTIVE: The prevalence of osteoporotic fracture is higher in non-Hispanic Caucasian (NHC) than Mexican-American (MA) women in the USA. The present study examined bone mineral density (BMD) in these two ethnic groups and the association between BMD and body composition. RESEARCH DESIGN: Cross-sectional. SUBJECTS: Sixty-two NHC and 54 MA women, aged 60-86 years, with a body mass index (kgm(-2)) of <30. METHODS: BMD (gcm(-2)) of the spine (L2-4), hip (femoral neck, trochanter, Ward's triangle) and whole body was determined by dual-energy X-ray absorptiometry (DXA). Bone mineral-free lean mass (LM) and fat mass (FM) and several ratios of body fat distribution were also assessed by DXA. RESULTS: There was no difference in age (NHC, 69.5+/-0.7; MA 69.5+/-0.9 years; mean +/- SEM) or body mass, but MA women were shorter with a higher truncal adiposity (p < 0.001). There was no significant difference in BMD between groups, however, adjusting for height resulted in higher hip and whole body BMD in MA women (p < 0.01). When volumetric bone density was calculated (bone mineral apparent density; BMAD, gcm(-3)), a trend for higher values in MA women was observed at the femoral neck (p = 0.018). LM contributed independently to BMD at the spine and hip in NHC women, with FM also contributing at the femoral neck. In MA women, LM was an independent contributor to lumbar spine and trochanter BMD, and both LM and FM contributed to whole body BMD. However, the effects of LM and FM were removed in both groups when BMD was adjusted for body or bone size, the only exception being at the trochanter in NHC women. CONCLUSIONS: These results indicate that MA women have higher bone density at the proximal femur than NHC women, which may partially account for their lower rate of hip fracture. Further, differences in bone density between the two ethnic groups do not appear to be dependent on soft-tissue composition.     

Impact of lean mass and fat mass on bone mineral density: The Hordaland Health Study

OBJECTIVES: To examine the relationship between soft tissue composition and bone mineral density (BMD) of the hip and whether these relationships differ by gender and age. METHODS: Femoral neck BMD and total body soft tissue composition were measured by dual X-ray absorptiometry in a population-based sample of 5205 men and women 47-50 and 71-75 years old. Analysis of covariance was used to explore possible modifying effects of sex and gender on the impact of fat and lean mass on BMD. RESULTS: The difference in BMD per kilo lean mass (LM) was larger than the difference per kilo fat mass (FM). The effect of FM on BMD was significantly greater among women than among men. In multivariate adjusted analyses, 10kg increase in LM was associated with a 0.083 (95% confidence interval [CI]: 0.075, 0.092)g/cm(2) increase in BMD. A 10kg increase in FM was associated with 0.013 (0.007, 0.019)g/cm(2) increase in BMD among men and 0.021 (0.017, 0.026)g/cm(2) among women. There was indication of a steeper dose-response relationship at lower levels of FM among women. CONCLUSIONS: Compared to FM, LM was generally more strongly related to BMD of the femoral neck in middle-aged and elderly men and women. FM was a significantly stronger predictor of BMD among women than among men, particularly at lower levels of FM.     

Bone mineral density,bone turnover markers,lean mass,and fat mass in Egyptian children with congenital adrenal hyperplasia

Introduction

Aim of this paper is to assess bone mineral density (BMD) and body composition, by dual energy X-ray absorptiometry (DXA), and various markers of bone growth, in a group of children with congenital adrenal hyperplasia (CAH) on long-term glucocorticoid therapy.

Material and methods

A case-control study included thirty patients with CAH with different states of metabolic control. Their mean age was 7.5 ±4.2 years. All patients are subjected to BMD using DXA at the neck of the femur and lumbar spine. A blood sample was taken for assessment of osteocalcin, osteoprotegerin, and procollagen type 1, as markers of bone formation, as well as RANKL and urinary deoxypyridinoline (DPD), as markers of bone resorption.

Results

We found no difference in BMD in patients and control subjects; however, patients showed significantly lower serum osteocalcin (p = 0.008) and osteoprotegerin (p = 0.0001) and significantly higher serum RANKL levels (p = 0.0001). Our results show that patients had significantly lower lean body mass (p = 0.005) and fat/lean ratio (p = 0.008) compared to matched controls. The duration of treatment showed a significant negative correlation with procollagen type 1 (r = –0.49, p = 0.02) and lean mass % (r = –0.43, p = 0.04); however, it showed a significant positive correlation with total fat mass % (r = 0.6, p = 0.0006), and fat/lean ratio (r = 0.43, p = 0.04). Dose of steroid had a significant positive correlation with BMI SDS (r = 0.4, p = 0.02).

Conclusions

Bone mineral density is normal but bone turnover is low in patients with CAH. There is an increase in fat/lean mass in patients with CAH.     

Relationship of head lean mass to regional bone mineral density in elderly postmenopausal women

OBJECTIVES: This study investigated the relationship of head lean mass to bone mineral density (BMD). METHOD: Subjects were 102 elderly women (> or =65-years-old) and 123 middle-aged postmenopausal women (<65-years-old) with right-side dominance. Age, height, weight, and years since menopause (YSM) were recorded. Lean mass of the head, arm, trunk, leg, and total body were measured by dual-energy X-ray absorptiometry (DEXA). BMD of the same regions were measured by DEXA. RESULTS: In elderly women, head lean mass was positively correlated with BMD of the head (r=0.389, P<0.01), left arm (r=0.235, P<0.05), right arm (r=0.280, P<0.05), lumbar spine (L2-4) (r=0.411, P<0.001), pelvis (r=0.490, P<0.001), left leg (r=0.572, P<0.001), right leg (r=0.558, P<0.001), and total body (r=0.529, P<0.001). These relationships remained significant after adjusting for age, height, and YSM. In addition, the strength of correlation of head lean mass with BMD was higher than those of other regional lean mass with respective BMD. In middle-aged women, strength of correlation of head lean mass with BMD was loose (r< or =0.238), while regional lean mass was more correlated with respective regional BMD. CONCLUSION: Factors related to lifestyle associated with higher (lower) head lean mass may contribute to higher (lower) BMD in elderly postmenopausal women.     

Bone mineral density in healthy Tunisian women

Interpretation of densitometric results requires a comparison with reference bone mineral density (BMD) values of normal age and sex-matched persons. Thus the aim of this study was to determine these values for healthy Tunisian women, to estimate the prevalence of osteoporosis and to compare our findings with other populations. A cross-sectional study of 1378 Tunisian women aged between 20 and 96 years was carried out using DXA (GE-Lunar Prodigy). Subjects with suspected conditions affecting bone metabolism were excluded. Measurements were taken at the lumbar spine and femoral neck. These values were expressed at T-scores, with reference to the mean BMD values of the group aged 20–40 years. The peak bone mass, estimated in this age group was 1.174 + 0.127 g/cm² at the lumbar spine and 1.016 ± 0.118 g/cm² at the femoral site. It was attained respectively within the age of 25 years and 36 years. For both sites, the expected decline in BMD was shown when the successive age groups [40–49 years] and [50–59 years] were compared. Bone loss was rapid during the first 5 years after menopause. Thereafter BMD declined slowly but continually. The prevalence of osteoporosis in the women over 50 years of age, taking account of peak bone mass observed in our cohort, was 23.3% at the spine and 17.3% at the femoral neck with a combined prevalence of 23.4%. These rates attained respectively 30.4%, 11.8% and 32.9% when we considered the Italian values, which demonstrate the variability of osteodensitometric depending to the reference population adopted.     

Bone mineral density of American Indian and Alaska Native women compared with non-Hispanic white women: results from the Women's Health Initiative Study

OBJECTIVE: To compare bone mineral density (BMD) of American Indian/Alaska Native (AI/AN) women with that of non-Hispanic white women. DESIGN: This cross-sectional study compared mean BMD between AI/AN women and a random sample of non-Hispanic white women matched on geographic region in the Women's Health Initiative Study, a prospective study of postmenopausal women. We analyzed baseline BMD measurements for the total hip, spine, and whole body from 139 AI/AN women and 1,431 non-Hispanic white women. RESULTS: Unadjusted mean spine and whole body BMDs were not significantly different between the two races. Controlling for age, education, and hormone therapy use, adjusted mean BMD was similar by race among women who were underweight, normal, or obese. We found a significant interaction of race by body mass index on spine (P = 0.003) and whole body (P = 0.0003) BMD; thus, analyses were stratified by body mass index. Overweight AI/AN women had slightly lower adjusted mean whole body and spine BMD than overweight non-Hispanic white women (whole body: 0.97 vs 1.03 g/cm, P = 0.02; spine: 0.96 versus 1.03 g/cm, P = 0.001). Among extremely obese (body mass index: > or =40.0 kg/m) women, adjusted mean total hip BMD was higher in the AI/AN women (1.07 vs 0.97 g/cm, respectively, P = 0.03). CONCLUSIONS: Overall, AI/AN and non-Hispanic white women had similar BMDs. This study suggests that extremely obese AI/AN women may have higher BMD at certain skeletal sites compared with extremely obese non-Hispanic white women. However, these results need to be confirmed by additional research.     

Relative importance of lean and fat mass on bone mineral density in a group of adolescent girls and boys

The aim of this study was to determine the relative importance of lean mass (LM) and fat mass (FM) on bone mineral density (BMD) in a group of adolescent girls and boys. A total of 65 adolescent boys and 35 adolescent girls participated in this study. Whole body (WB) and lumbar spine (L1–L4) BMD were measured by dual-energy X-ray absorptiometry (DXA). Body composition was assessed using the same technique. In boys, LM was strongly related to WBBMD (r = 0.68; p < 0.001) and to L1–L4 BMD (r = 0.61; p < 0.001), whereas FM was not positively related to BMD and was negatively associated with WB bone mineral apparent density (WBBMAD). In girls, both LM and FM were positively related to WBBMD (r = 0.41; p < 0.05 and r = 0.49; p < 0.01, respectively), whereas only FM was correlated to L1–L4 BMD (r = 0.33; p < 0.05). Finally, in a multiple regression analysis, FM was found to be a better positive determinant of WBBMD than LM in girls, whereas in boys, FM was found to be a negative determinant of WBBMD and L1–L4 BMD. This study suggests that LM is a strong determinant of WBBMD and L1–L4 BMD in boys, and that FM is a stronger determinant of WBBMD than LM in girls.     

Bone mineral density in postmenopausal women with endometrial cancer

OBJECTIVE: The aim of the study was to investigate the relationship between endometrial cancer and bone mineral density (BMD). MATERIALS AND METHODS: A total of 55 postmenopausal Japanese women with well-differentiated adenocarcinoma and 284 age-matched healthy women were studied. Baseline characteristics including age, age at menopause, years since menopause (YSM), weight, height, body mass index (BMI), prior menstrual history, parity, and fertility were recorded for each subject. Lumbar spine BMD (L2-4), and body fat indices including body fat mass amount and percent body fat were measured by dual-energy X-ray absorptiometry. These variables were compared between the two groups. In all subjects (n = 339), correlations of BMD with the presence of endometrial cancer, baseline characteristics, and body fat indices were investigated, using univariate and multiple regression analyses. RESULTS: BMD, weight, BMI, body fat mass amount, and percent body fat were significantly higher in women with endometrial cancer. Other baseline characteristics did not differ between the two groups. Age at menopause, height, weight, BMI, percent body fat, and body fat mass amount were positively correlated with BMD, while age and YSM were inversely correlated with BMD. After adjusting for age, YSM, and height, the presence of endometrial cancer was still correlated with BMD (P < 0.05). However, after adding body fat mass amount to these three adjusted variables, there was no correlation between the presence of endometrial cancer and BMD. CONCLUSION: Women with endometrial cancer have a high BMD. This is attributable to high body fat mass amount in this disease.     

Bone mineral density of visually handicapped women.

While physical activity is an essential factor for muscle performance and development and also for the maintenance of bone mass in the loaded bones, apparently low intensity of physical activity of blind persons may compromise the muscle performance and bone mineral density (BMD). Therefore, the aim was to study whether there are differences in BMD of the weight-bearing or non-weight-bearing bones between visually handicapped persons and those with normal sight. Nineteen visually handicapped premenopausal women and their matched pairs were recruited to the study. The mean age of the visually handicapped women was 39.9 years (SD 8.1) and that of the women with normal vision 39.7 years (6.5). BMD of the distal radius, femoral neck and trochanter was measured with dual energy X-ray absorptiometry (DXA), and isometric muscle strength of the extremities and trunk with a dynamometer. Between-group differences were compared with paired Student's t-test. The BMD at the femur was 8% higher in favour of the group with normal sight, whereas radial BMD was similar in the two groups. The t-score was -1.0 (95% confidence interval -1.5 to -0.5) for the femoral neck BMD and -0.7 (-1.1 to -0.2) for the trochanter BMD in the group with impaired vision. The respective t-scores for the group with normal sight were -0.3 (-0.9 to 0.3) for the femoral neck and 0 (-0.7 to 0.7) for the trochanter. Visual handicap seems to be a risk for lower BMD of the weight-bearing proximal femur, but not for lower BMD of the non-weight-bearing distal radius.     

Non-weight-bearing effect of trunk and peripheral fat mass on bone mineral density in pre- and post-menopausal women

ObjectiveTo investigate the non-weight-bearing effect of trunk fat mass (composed of visceral and subcutaneous fat mass) and peripheral fat mass (subcutaneous fat mass alone) on bone mineral density (BMD) in pre- and post-menopausal women.MethodsThe subjects were 412 pre-menopausal women, 20–50 years of age and 228 post-menopausal women, 50–75 years of age. Age, years since menopause (YSM), height, body weight, and body mass index were recorded. Trunk, peripheral (extremities), left arm (non-weight-bearing site), lean mass, and BMD were measured by dual-energy X-ray absorptiometry.ResultsIn pre-menopausal women, the amount of trunk fat mass was 6.8 ± 4.1 kg, which was significantly lower than the amount of peripheral fat mass (11.6 ± 3.8 kg, p < 0.001). Although trunk fat mass was positively correlated with arm BMD on Pearson's correlation test, arm lean mass was the only significant predictor of BMD on multiple regression analysis. In post-menopausal women, the amount of trunk fat mass (8.7 ± 3.6 kg) was also significantly lower than the peripheral fat mass (10.3 ± 3.4 kg, p < 0.001). On multiple regression analysis, however, trunk fat mass, but not arm lean mass, was the significant predictor of BMD. In both groups, peripheral fat mass was not correlated with left arm BMD.ConclusionThe effect of adipocyte-derived biochemical factors on BMD may differ with menopausal status and the sites of adipocyte deposition.     

Difference in segmental lean and fat mass components between pre- and postmenopausal women

OBJECTIVE: To investigate the differences in segmental body composition (lean and fat mass components) between pre- and postmenopausal women. DESIGN: Participants were 413 premenopausal women aged 20 to 53 years old and 229 postmenopausal women aged 50 to 75 years old with right-side dominance. Age, height, weight, body mass index, age at menopause, and years since menopause were recorded. The percentages of fat mass in the arms, trunk, legs, and total body were measured by dual-energy x-ray absorptiometry. The ratio of trunk to leg fat mass (trunk-leg fat mass ratio) was also measured by dual-energy x-ray absorptiometry. RESULTS: The percentage of trunk fat mass and the trunk-leg fat mass ratio were significantly higher in postmenopausal women, but the percentages of leg fat mass did not differ. In the two groups, percentage of trunk fat mass and trunk-leg fat mass ratio were similarly and positively correlated with age. However, percentage of leg fat mass did not correlate with age. The percentage of fat mass at each segmental site and the trunk-leg fat mass ratio did not differ between premenopausal women aged 50 to 53 years old (n=52) and age-matched postmenopausal women (n=43, years since menopause=2.8+/-1.8). CONCLUSIONS: Aging rather than menopause contributes to the increase in the percentage of trunk fat mass. However, the percentage of leg fat mass does not change with aging. Upper body fat distribution in postmenopausal women may be more attributable to aging than to menopause.     

Bone turnover and its relationship with bone mineral density in pre- and postmenopausal women with or without fractures

Objective: This work was carried out in order to investigate possible relationships between bone turnover rate, as evaluated by bone biomarkers and skeletal mass, as evaluated by bone mineral density (BMD). Method: Fifty-eight normal women and 30 female patients with osteoporotic fractures were enrolled. Three groups were defined: (1) fertile subjects (n=24), mean age 33.7±8.1 years; (2) postmenopausal women (n=32, including 11 patients with fractures) whose BMD values, in terms of T score, were less than −2.5 S.D. below the young adult mean obtained in our laboratory (mean age 61.7±7.9 years; and years since menopause (ysm), 12.6±8.3); (3) postmenopausal women (n=32, including 19 patients with fractures) whose BMD values in terms of T score, were below −2.5 S.D. (mean age 62.9±8.6 years; and ysm 15.9±9.0). Groups II and III characterised, by inclusion criteria, by significant different mean BMD values, were similar as far as chronological and menopausal age were considered. Metabolic tests included a short urine collection to determine calcium, hydroxyproline, cross-linked N-telopeptides of type I collagen (NTx) and creatinine (Cr); half-way through this collection, a blood sample was taken for the measurement of total alkaline phosphatase activity (ALP) and tartrate-resistant acid phosphatase activity (TRAP). BMD at lumbar spine was evaluated. Results: There were significant differences amongst the three groups in mean ALP (P<0.001, by analysis of variance) TRAP (P<0.006) and NTx/Cr (P<0.001) values, but not as far as mean values of calcium/Cr or hydroxyproline/Cr ratios were concerned. Considering the group as a whole, there were significant inverse correlations between NTx/Cr, ALP, TRAP and BMD controlling for both age (r=−0.392, P<0.001; r=−0.447, P<0.001 and r=−0.327, P<0.002, respectively) and ysm (r=−0.374, P<0.001; r=−0.474, P<0.001 and r=−0.333, P<0.002). Conclusions: Our results indicate, that, even after controlling for both ageing and oestrogen status, there is an inverse relationship between bone mass (that at a given time represents the balance of all previous metabolic events) and a biochemical marker (which reflects bone turnover at the time of examination). These findings are in line with the belief that increased bone turnover should be regarded as a risk factor for osteoporosis. Furthermore, our results indicate that, unless there is no increase of hepatic isozyme, total ALP still maintains a possible role as a first analysis to evaluate bone turnover before requesting markers with greater specificity, sensitivity but also more expensive and whose analysis is sometimes time-consuming.     

Bone metabolism and bone mineral density in premenopausal women with mild depression

This study was undertaken to investigate the bone metabolism and bone mineral density (BMD) in female patients suffering from depression. Forty-two female patients diagnosed with depression and 42 healthy women, all in the premenopausal age, were enrolled. A clinical evaluation, measurements of the biochemical markers of bone metabolism and BMD measurements were performed. The BMD values were found to be similar in all measured sites. It was concluded that a low BMD was not a prominent feature of premenopausal women with mild depression, even though an increase in bone resorption was found.     

Soy protein and bone mineral density in older men and women: a randomized trial

OBJECTIVE: Test the hypothesis that soy isoflavone supplementation preserves bone mineral density (BMD) in men and women. METHODS: We conducted a controlled, parallel-arm, double-blinded trial with 145 participants, 50-80 years, with random assignment to soy beverage daily for 12 months. Active treatment (+ISO) received soy protein containing 83 mg isoflavones (45.6 mg genistein, 31.7 mg daidzein), aglycone units; the comparison group (-ISO) received soy protein containing 3mg isoflavones. We measured BMD using dual-energy X-ray absorptiometry at the total hip and posterior-anterior spine (L1-L4) at baseline in 22 women and 123 men, and at 12 months in 13 women and 98 men. We used linear mixed models to test for an isoflavone effect on percentage BMD change from baseline in spine and hip. RESULTS: Among all participants, mean percent change in spine BMD (+/-S.E.) was 0.16+/-0.44 in -ISO (P=0.10) at 12 months. Treatment effects on spine BMD were significantly greater in women than men (P=0.01). At 12 months, in women, mean percent change was 0.58+/-0.70 in +ISO and -1.84+/-0.86 in -ISO (P=0.05); among men it was 1.32+/-0.53 in +ISO and 0.31+/-0.48 in -ISO (P=0.16). By comparison, percent change in hip BMD was similar in the treatment groups, and was not different between men and women. Mean percent change in hip BMD from baseline to 12 months was 0.54+/-0.38 in +ISO and -0.13+/-0.36 in -ISO (P=0.20) among all participants. CONCLUSIONS: Soy protein containing isoflavones showed a modest benefit in preserving spine, but not hip BMD in older women.     

Bone turnover markers and bone mineral density in hypertensive postmenopausal women on treatment

Objective

To evaluate bone mineral density (BMD) and bone metabolism in hypertensive postmenopausal women, and to differentiate the effect of thiazides from that of other antihypertensive agents.

Subjects and methods

A community-based population of 636 postmenopausal women, 293 with hypertension (160 receiving thiazides, and 133 receiving other antihypertensive treatments), and 343 control women, were evaluated. Serum levels of aminoterminal propeptide of type I collagen (P1NP), C-terminal telopeptide of type I collagen (β-CTX), 25-hydroxivitamin D, and intact parathyroid hormone were measured by electrochemiluminiscence. BMD was determined by DXA, and heel quantitative ultrasound measurements (QUS) with a gel-coupled device.

Results

BMD expressed as Z-score was higher in both groups of hypertensive women at all locations. Expressed as g/cm², it was also higher in patients on thiazides at femoral neck and lumbar spine. Only in the latter site, differences remained significant after adjusting for potential confounding variables, including BMI. Bone turnover markers were lower in both groups of hypertensive women, although the difference was greater in those on thiazides. After adjusting for potential confounders, differences remained significant only in the thiazide group.

Conclusions

Our results add evidence to the idea that thiazides are beneficial to prevent bone loss.     

Lean body mass and bone mineral density in physically exercising postmenopausal women

OBJECTIVES: To investigate whether the relative contribution of body composition (lean and fat mass component) to postmenopausal bone mineral density (BMD) differs between women participating in physical exercise and sedentary women. METHODS: Subjects were 45 postmenopausal women participating in regular physical exercise and 89 sedentary controls aged 50-60 years. Baseline characteristics included age, height, weight, body mass index (BMI, Wt/Ht(2)), age at menopause, and years since menopause (YSM). Body fat mass, percentage of body fat, lean body mass, and lumbar spine BMD (L2-4) were measured by dual-energy X-ray absorptiometry. RESULTS: Although age, height, weight, BMI, and YSM did not differ between the two groups, lean body mass and lumbar spine BMD were significantly higher (P<0.05 and <0.001, respectively), while body fat mass and percentage of body fat mass were significantly lower in exercising women than in sedentary controls (P<0.05 and <0.05, respectively). In exercising women, BMD was positively correlated with lean body mass (r=0.415, P<0.01) but not with body fat mass (r=0.155, NS). Conversely, in sedentary controls, BMD was correlated with body fat mass (r=0.251, P<0.05) and lean body mass (r=0.228, P<0.05). CONCLUSIONS: Lean body mass is a more significant determinant of postmenopausal BMD in physically exercising women than in sedentary women.     

Menopause,fat and lean distribution in obese women

Objectives: Whether menopause per se influences fat distribution independently of the effect of aging remains controversial. The lack of consistency in the menopause related changes in body fat distribution may be the result of differences in the methods for measuring fat distribution or in the characteristics of the women studied. The aim of this cross sectional study in obese women was to compare total body composition and regional fat and lean distribution, in premenopausal, perimenopausal and postmenopausal women. Methods: Body composition was assessed by dual energy X-ray absorptiometry (DEXA) in premenopausal (n = 26), perimenopausal (n = 24) and postmenopausal (n = 73) obese women with no intercurrent diseases. Results: It was shown that postmenopausal obese (n = 73) women had a higher proportion of total fat mass in the trunk and a lower proportion of total fat and lean mass in the femoral and leg regions than premenopausal women after adjustment for age and total fat mass. In the same analysis, perimenopausal women had a lower proportion of total fat in the leg and femoral regions and of total lean in the femoral region than premenopausal women; they had a regional body composition similar to that of postmenopausal women. Conclusion: The present data indicate that in obese women, post menopause and perimenopause are associated with differences in fat and lean distribution, independently of age and total fat.