Change in lean body mass is a major determinant of change in areal bone mineral density of the proximal femur: a 12-year observational study

A review of menopause nomenclature

Menopause nomenclature varies in the scholarly literature making synthesis and interpretation of research findings difficult. Therefore, the present study aimed to review and discuss critical developments in menopause nomenclature; determine the level of heterogeneity amongst menopause definitions and compare them with the Stages of Reproductive Aging Workshop criteria. Definitions/criteria used to characterise premenopausal and postmenopausal status were extracted from 210 studies and 128 of these studies were included in the final analyses. The main findings were that 39.84% of included studies were consistent with STRAW classification of premenopause, whereas 70.31% were consistent with STRAW classification of postmenopause. Surprisingly, major inconsistencies relating to premenopause definition were due to a total lack of reporting of any definitions/criteria for premenopause (39.84% of studies). In contrast, only 20.31% did not report definitions/criteria for postmenopause. The present findings indicate that there is a significant amount of heterogeneity associated with the definition of premenopause, compared with postmenopause. We propose three key suggestions/recommendations, which can be distilled from these findings. Firstly, premenopause should be transparently operationalised and reported. Secondly, as a minimum requirement, regular menstruation should be defined as the number of menstrual cycles in a period of at least 3 months. Finally, the utility of introducing normative age-ranges as supplementary criterion for defining stages of reproductive ageing should be considered. The use of consistent terminology in research will enhance our capacity to compare results from different studies and more effectively investigate issues related to women's health and ageing.

Early decrease in lean mass and bone mass in postmenopausal women: a cross-sectional study

OBJECTIVE

The effect of menopause transition in body composition was evaluated in a cross-sectional study.

METHOD

The study was carried out in an outpatient clinic of Brazil enrolling premenopausal (n = 64) and postmenopausal (n = 42) women aged between 44 and 52 years, with weight stability (±2 kg) for at least 6 months before evaluation. Participants answered a sociodemographic semi-structured questionnaire, the Menopause Rating Scale, the International Physical Activity Questionnaire, 24-h dietary recall and a visual analogue scale of appetite. Blood biochemical, anthropometry and densitometry measurements were used for body composition estimation.

RESULTS

Most participants were overweight (31.4%) or obese (45.7%) and categorized as 'high active' in physical activity (65.7%). Lean mass and bone mass decreased in the first few years of menopause. A metabolic turn to an increase of lipids was observed, represented by greater total cholesterol and high-density lipoprotein cholesterol levels. Menopause transition did not alter body fat distribution. Total body fat, android fat and gynoid fat were positively related to smoking habit, and android fat was also positively related to waist circumference.

CONCLUSION

Taken together, early postmenopause can be considered a time window of opportunity for preventing ailments such as atherogenic profile, obesity, increased cardiovascular risk and osteoporosis.

Long-term rates of change in musculoskeletal aging and body composition: findings from the Health, Aging and Body Composition Study

Musculoskeletal disorders are common among older people. Preventive strategies require understanding of age-related changes in strength, function and body composition, including how they interrelate. We have described, and examined associations between, 9-year changes in these parameters among 2917 Health, Aging and Body Composition Study participants (aged 70-79 years). Appendicular lean mass (ALM), whole body fat mass and total hip BMD were ascertained using DXA; muscle strength by grip dynamometry; and muscle function by gait speed. For each characteristic annualised percentage changes were calculated; measures of conditional change (independent of baseline) were derived and their interrelationships were examined using Pearson correlations; proportion of variance at 9-year follow-up explained by baseline level was estimated; and mean trajectories in relation to age were estimated using linear mixed models. Analyses were stratified by sex. Median [lower quartile, upper quartile] annual percentage declines were grip strength (1.5 [0.0, 2.9]), gait speed (2.0 [0.6, 3.7]), ALM (0.7 [0.1, 1.4]), fat mass (0.4 [- 1.1, 1.9]) and hip BMD (0.5 [0.0, 1.1]). Declines were linear for ALM and accelerated over time for other characteristics. Most conditional change measures were positively correlated, most strongly between ALM, fat mass and hip BMD (r > 0.28). Proportion of variation at follow-up explained by baseline was lower for grip strength and gait speed (39-52%) than other characteristics (69-86%). Strength and function declined more rapidly, and were less correlated between baseline and follow-up, than measures of body composition. Therefore, broader intervention strategies to prevent loss of strength and function in later life are required as those targeting body composition alone may be insufficient.

Muscle-Bone Interactions in Chinese Men and Women Aged 18-35 Years

To characterize bone mineral density (BMD), bone strength, muscle and fat mass, and muscle strength and power in Chinese women (n = 25) and men (n = 28) classified as in the bone accrual phase (18-25 years) or in the peak bone mass phase (26-35 years). Calcium intakes, physical activity levels, and serum vitamin D were measured. Dual-energy X-ray absorptiometry (DXA) assessed body composition, lumbar spine, and hip areal BMD (aBMD) variables and peripheral quantitative computed tomography (pQCT) assessed cortical and trabecular volumetric BMD (vBMD) and bone strength. Muscle strength and power were assessed by grip strength, leg press, and vertical jump tests. Calcium, serum vitamin D, and physical activity levels were similar across age and sex groups. Significant sex differences (p < 0.05) were found for most body composition variables, hip aBMD, tibia variables, and muscle strength and power. Adjusting for height and weight eliminated most of the significant sex differences. Women showed stronger positive correlations between body composition and bone variables (r = 0.44 to 0.78) than men. Also, correlations between muscle strength/power were stronger in women vs. men (r = 0.43 to 0.82). Bone traits were better related to body composition and muscle function in Chinese women compared to Chinese men aged 18 to 35 years, and peak bone mass seems to be achieved by 25 years of age in both Chinese men and women since there were no differences between the two age groups.

Fat mass changes during menopause: a metaanalysis

OBJECTIVE

Data: Fat mass has been shown to increase in aging women; however, the extent to which menopausal status mediates these changes remains unclear. The purpose of this review was to determine (1) how fat mass differs in quantity and distribution between premenopausal and postmenopausal women, (2) whether and how age and/or menopausal status moderates any observed differences, and (3) which type of fat mass measure is best suited to the detection of differences in fat mass between groups.

STUDY

This review with metaanalyses is reported according to Metaanalysis of Observational Studies in Epidemiology guidelines.

STUDY APPRAISAL AND SYNTHESIS METHODS

Studies (published up to May 2018) were identified via PubMed to provide fat mass measures in premenopausal and postmenopausal women. We included 201 cross-sectional studies in the metaanalysis, which provided a combined sample size of 1,049,919 individuals and consisted of 478,734 premenopausal women and 571,185 postmenopausal women. Eleven longitudinal studies were included in the metaanalyses, which provided a combined sample size of 2472 women who were premenopausal at baseline and postmenopausal at follow up.

RESULTS

The main findings of this review were that fat mass significantly increased between premenopausal and postmenopausal women across most measures, which included body mass index (1.14 kg/m²; 95% confidence interval, 0.95-1.32 kg/m²), bodyweight (1 kg; 95% confidence interval, 0.44-1.57 kg), body fat percentage (2.88%; 95% confidence interval, 2.13-3.63%), waist circumference (4.63 cm; 95% confidence interval, 3.90-5.35 cm), hip circumference (2.01 cm; 95% confidence interval, 1.36-2.65 cm), waist-hip ratio (0.04; 95% confidence interval, 0.03-0.05), visceral fat (26.90 cm²; 95% confidence interval, 13.12-40.68), and trunk fat percentage (5.49%; 95% confidence interval, 3.91-7.06 cm²). The exception was total leg fat percentage, which significantly decreased (-3.19%; 95% confidence interval, -5.98 to -0.41%). No interactive effects were observed between menopausal status and age across all fat mass measures.

CONCLUSION

The change in fat mass quantity between premenopausal and postmenopausal women was attributable predominantly to increasing age; menopause had no significant additional influence. However, the decrease in total leg fat percentage and increase in measures of central fat are indicative of a possible change in fat mass distribution after menopause. These changes are likely to, at least in part, be due to hormonal shifts that occur during midlife when women have a higher androgen (ie, testosterone) to estradiol ratio after menopause, which has been linked to enhanced central adiposity deposition. Evidently, these findings suggest attention should be paid to the accumulation of central fat after menopause, whereas increases in total fat mass should be monitored consistently across the lifespan.

Relationship between the changes over time of bone mass and muscle health in children and adults: a systematic review and meta-analysis

Background

Various cross-sectional studies provide an abundance of evidence that shows a relationship between bone quantity and muscle health. However, one question remains, less-often studied: is their development - or decline – associated? The aim of the research was to conduct a systematic review and meta-analysis to summarize the studies exploring the association between changes in bone mineral density (BMD) and changes in muscle parameters (registration CRD42018093813).

Methods

We searched for prospective studies, both in children and adults, by consulting electronic databases (Ovid-MEDLINE, Ovid-AMED, Scopus). Each review steps were performed by two independent reviewers. For outcomes reported by less of 3 studies, we synthetized the results narratively. In other cases, a meta-analysis was performed, giving an overall r coefficient and its 95% confidence interval (CI).

Results

Fifteen papers were included. In connection with the change of BMD, 10 studies concerned the parallel change of lean mass, 4 were about grip strength, and 1 was about physical performance. Children were the population of interest for 5 studies, while the aging population was the focus of the other studies. The correlation between hip BMD and lean mass was significant, with an overall coefficient r = 0.37 (95% CI 0.23–0.49). High heterogeneity was observed between studies but the length of follow-up, sex and study quality did not seem to significantly influence results. The systematic review allowed some other highlights: a significant link between changes in BMD and changes in muscle strength was observed (p-value < 0.05 in the 4 studies), in addition to changes in performance (1 study, r = 0.21, p-value = 0.004).

Conclusion

Despite the heterogeneity between studies, we highlighted a significant association between the change of BMD and the change of various muscle parameters. Future studies should investigate preventive and therapeutic strategies that are based on a single entity: the ‘muscle-bone unit’.

Association between fat mass and bone mineral density among Brazilian women differs by menopausal status: The Pró-Saúde Study

OBJECTIVE

The aim of this study was to investigate the association between bone mineral density (BMD) and fat mass (FM) in a multiethnic population of Brazilian women and to evaluate the influence of total body mass and lean mass on this association.

METHODS

This was a cross-sectional study nested within the Pro-Saúde Study, a prospective cohort of university civil servants in Rio de Janeiro. Participants were pre- (n = 100) and postmenopausal (n = 166) women. Total fat, lean mass, and BMD of total body, lumbar spine, and femoral neck were measured using dual energy x-ray absorptiometry. The association of BMD with FM was investigated after adjustment for total body mass (model 1) and lean mass (model 2) and potential confounding variables using multivariate linear regression models.

RESULTS

In model 1, FM was inversely associated with BMD for total body (B = -0.010; P < 0.01) and for femoral neck (B = -0.009 P < 0.05) in premenopausal women. No association between FM and BMD was observed in postmenopausal women. Model 2 yielded direct associations between FM and BMD (total and specific sites; B = 0.003-0.008; P < 0.01) in postmenopausal women only.

CONCLUSIONS

Independently of the adjustment used, the results of the present study suggest the absence of an inverse association between FM and BMD in postmenopausal women. Additionally, when adjusted for lean mass, a direct association between FM and bone mass can be observed, suggesting that for postmenopausal women being slightly obese does not confer excessive risk for bone loss and may even result in a bone density advantage.

Long-term Bone Mineral Density Changes in Antiretroviral-Treated HIV-Infected Individuals

We compared adjusted bone mineral density (BMD) changes between human immunodeficiency virus (HIV)-infected individuals during the first approximately 7.5 years after antiretroviral therapy (ART) initiation and HIV-uninfected controls. HIV-infected individuals (n = 97) had significantly greater adjusted BMD decline than controls (n = 614) during the first 96 weeks of ART. Subsequently, the rate of BMD decline slowed in HIV-infected individuals but remained greater than the rate of decline in HIV-uninfected individuals at the lumbar spine but not at the hip. In HIV-infected individuals after 96 weeks, no HIV- or treatment-related characteristic was associated with BMD loss, but lower lean body mass was associated with greater BMD loss at both lumbar spine and hip.

Associations of Bone Mineral Density with Lean Mass, Fat Mass, and Dietary Patterns in Postmenopausal Chinese Women: A 2-Year Prospective Study

Objective

To assess factors associated with bone mineral density (BMD) in postmenopausal women in a longitudinal study, and to examine the relative contribution of lean mass, fat mass, dietary patterns, and years since menopause to BMD.

Methods

Two hundred and eighty-two postmenopausal women were randomly selected from Hongqi Community Health Center, in Harbin City, China. All participants were followed up from 2009 to 2011. Dietary data were collected using a Food Frequency Questionnaire. BMD of the left hip, the lumbar spine, and the total body, and the body composition were measured by dual-energy X-ray absorptiometry at baseline and follow-up.

Results

Lean mass and fat mass were positively associated with BMD of the spine, hip, and the total body at both baseline and follow-up. The association between fat mass and BMD at the spine at baseline (P = 0.210) and at the spine (P = 0.116) and hip (P = 0.073) in the second year was not statistically significant when height was adjusted. Six dietary patterns were identified but only cereal grains-fruits pattern (P = 0.001 in the spine, P = 0.037 in hip) and milk-root vegetables pattern (P = 0.010 in hip) were associated with BMD of the spine and hip. The linear mixed model of follow-up data showed that lean mass, years since menopause, and age of menophania were the significant determinants of BMD of all sites. Moreover, lean mass was the best determinant of BMD (VIP = 1.936).

Conclusion

Lean mass, years since menopause, age of menophania and dietary patterns are the important determinants of BMD of the spine, hip, and the total body. Lean mass is the best determinant of BMD.

Body mass index at 11 years and bone mass at age 18: path analysis within the 1993 Pelotas (Brazil) birth cohort study

Background

We investigated whether Body Mass Index (BMI) at 11 years old has a direct effect on bone mass at age 18 operating through alterations to bone growth and development, or whether the association is mediated by concurrent BMI, fat mass (FM), and fat free mass (FFM).

Methods

Path analysis was used to explore the association between BMI at age 11 and whole-body bone mineral content (BMC) and bone mineral density (BMD) assessed by dual-energy x-ray absorptiometry (DXA) at age 18 in a prospective birth cohort study comprising 3,307 adolescents; we also evaluated the degree to which this association was mediated by BMI, FM (kg) and FFM (kg) assessed by plethysmography (BOD POD) at age 18.

Results

We found a positive association between BMI at age 11 and BMC (males [β = 179.7 g, 95% CI 161.4; 198.0]; females [β = 179.9 g, 95% CI 165.3; 194.6]) and BMD (males [β = 0.030 g/cm2, 95% CI 0.024; 0.035]; females [β = 0.029 g/cm2, 95% CI 0.025; 0.033]) at age 18. This association was largely mediated by BMI and FFM at age 18 in both female and male adolescents. FM at age 18 was not an important mediator.

Conclusions

Concurrent BMI and FFM were the main mediators of the association between BMC/BMD in late adolescence and BMI in early adolescence.

Electronic supplementary material

The online version of this article (doi:10.1186/s12891-015-0529-y) contains supplementary material, which is available to authorized users.

Physical activity from adolescence to young adulthood and bone mineral density in young adults from the 1982 Pelotas (Brazil) Birth Cohort

OBJECTIVE

To evaluate a prospective association between physical activity (PA) and bone mineral density (BMD) in young adults.

METHOD

Total body (TB), lumbar spine (LS) and femoral neck (FN) BMD were measured in participants from the 1982 Pelotas Birth Cohort by dual-energy X-ray absorptiometry at 30 y. PA was evaluated at 15, 18 (males) and 23 y.

RESULTS

3454 young adults were scanned (DXA) at least at one anatomical site. In males, PA at 15 y was associated with LS density (β=0.061 g/cm(2); 95% confidence interval (CI): 0.015; 0.108). A positive dose-response effect was found for the association between PA at 18 y and BMD. Males in the two highest quartiles of PA at 23 y had significantly greater BMD at all anatomical sites than males in the lowest quartile. We observed greater BMD at 30 y in boys who were active at least in one of the assessments (18 or 23 y) compared to inactive boys at both ages. Females in the highest quartile of PA at 23 y showed greater FN density at 30 y (β=0.020; 95%CI: 0.001; 0.039).

CONCLUSIONS

A physically active pattern is important to BMD across the first three decades of life. Potential beneficial effects of PA were not entirely lost with advancing age in male young adults.

Additive association of vitamin D insufficiency and sarcopenia with low femoral bone mineral density in noninstitutionalized elderly population: the Korea National Health and Nutrition Examination Surveys 2009-2010

Vitamin D insufficiency and sarcopenia are crucial risk factors for osteoporosis. In a study of noninstitutionalized elderly subjects, we investigated the simultaneous effect of vitamin D and sarcopenia on bone mineral density (BMD) and found that sarcopenia was associated with low BMD in the femur, especially in those with suboptimal vitamin D levels.

INTRODUCTION

Although vitamin D insufficiency and sarcopenia are prevalent in the elderly population worldwide, their possible influence on BMD has not been determined. We aimed to investigate the different effect of vitamin D insufficiency and sarcopenia on BMD in the elderly Korean population.

METHODS

Individuals aged 60 or older were selected from those who participated in the Fourth and Fifth Korea National Health and Nutrition Examination Surveys conducted in 2009 and 2010; 1,596 males and 1,886 females were analyzed. Appendicular skeletal muscle mass (ASM) and BMD were assessed by dual-energy X-ray absorptiometry; serum 25-hydroxyvitamin D [25(OH)D] and a panel of clinical and laboratory parameters were also measured.

RESULTS

The study population was divided into four groups according to their vitamin D and sarcopenic status. BMD in total femur and in the femoral neck but not the lumbar spine was markedly decreased in sarcopenic subjects with vitamin D insufficiency [25(OH)D < 20 ng/ml] comparing to other groups, regardless of gender. Multivariable linear regression models showed that BMD was significantly associated with ASM and high daily calcium intake as well as conventional risk factors such as age, body mass index (BMI), and history of fracture. Independent predictors for low femur BMD included sarcopenia, low daily calcium intake, low 25(OH)D levels, age, and BMI.

CONCLUSIONS

These data showed that an association between vitamin D insufficiency and low BMD was more prominent in elderly subjects with sarcopenia.

Weight and lean body mass change with antiretroviral initiation and impact on bone mineral density

OBJECTIVE

To compare the effect that initiating different antiretroviral therapy (ART) regimens has on weight, BMI, and lean body mass (LBM) and explore how changes in body composition are associated with bone mineral density (BMD).

METHODS

A5224s was a sub-study of A5202, a prospective trial of 1857 ART-naive participants randomized to blinded abacavir-lamivudine (ABC/3TC) or tenofovir DF-emtricitabine (TDF/FTC) with open-label efavirenz (EFV) or atazanavir-ritonavir (ATV/r). All participants underwent dual-energy absorptiometry (DXA) and abdominal computed tomography for body composition. Analyses used two-sample t-tests and linear regression.

RESULTS

A5224s included 269 participants: 85% men, 47% white non-Hispanic, median age 38 years, HIV-1 RNA 4.6 log10 copies/ml, and CD4 cell count 233 cells/μl. Overall, significant gains occurred in weight, BMI, and LBM at 96 weeks post-randomization (all P<0.001). Assignment to ATV/r (vs. EFV) resulted in significantly greater weight (mean difference 3.35 kg) and BMI gain (0.88 kg/m; both P=0.02), but not LBM (0.67 kg; P=0.15), whereas ABC/3TC and TDF/FTC were not significantly different (P≥0.10). In multivariable analysis, only lower baseline CD4 cell count and higher HIV-1 RNA were associated with greater increase in weight, BMI, or LBM. In multivariable analyses, increased LBM was associated with an increased hip BMD.

CONCLUSION

ABC/3TC vs. TDF/FTC did not differ in change in weight, BMI, or LBM; ATV/r vs. EFV resulted in greater weight and BMI gain but not LBM. A positive association between increased LBM and increased hip BMD should be further investigated through prospective interventional studies to verify the impact of increased LBM on hip BMD.

Physical activity during life course and bone mass: a systematic review of methods and findings from cohort studies with young adults

Background

The purpose of this paper was to review the literature of the cohort studies which evaluated the association between physical activity during the life course and bone mineral content or density in young adults.

Methods

Prospective cohort studies with bone mineral density or content measured in the whole body, lumbar spine and femoral neck by dual energy x-ray absorptiometry as outcome and physical activity as exposure were searched. Two independent reviewers selected studies retrieved from electronic databases (Medline, Lilacs, Web of Science and Scielo) and reviewed references of all selected full text articles. Downs & Black criterion was used in the quality assessment of these studies.

Results

Nineteen manuscripts met inclusion criteria. Lumbar spine was the skeletal site most studied (n = 15). Different questionnaires were used for physical activity evaluation. Peak strain score was also used to evaluate physical activity in 5 manuscripts. Lack of statistical power calculation was the main problem found in the quality assessment. Positive associations between physical activity and bone mass were found more in males than in females; in weight bearing anatomical sites (lumbar spine and femoral neck) than in total body and when physical activity measurements were done from adolescence to adulthood – than when evaluated in only one period. Physical activity during growth period was associated with greater bone mass in males. It was not possible to conduct pooled analyses due to the heterogeneity of the studies, considering mainly the different instruments used for physical activity measurements.

Conclusions

Physical activity seems to be important for bone mass in all periods of life, but especially the growth period should be taking into account due to its important direct effect on bone mass and its influence in physical activity practice in later life. Low participation in peak strain activities may also explain the lower number of associations found in females.

Lean soft tissue contributes more to bone health than fat mass independent of physical activity in women across the lifespan

OBJECTIVES

To investigate the association between lean soft tissue (LST) and fat mass (FM) on bone health variables in women across the lifespan, while taking into account the influence of objectively measured habitual physical activity (PA).

STUDY DESIGN

A total of 104 women, 37 young (23.3 ± 2.6 years), 28 middle-age (49.2 ± 5.4 years), and 39 old (68.3 ± 6.4 years) participated in this cross-sectional study. All underwent a DXA scan and wore a pedometer for 7 days.

MAIN OUTCOME MEASURES

Bone mineral content (BMC) and BMD of the whole body (WB), lumbar spine (LS) and proximal femur (PF), and body composition (FM and LST) were assessed with DXA and PA (steps/day) was assessed from 7 day pedometer counts.

RESULTS

LST was significantly and positively associated with PF and LS BMD (r = 0.34; 0.67, p < 0.05), and WB, PF and LS BMC (r range = 0.41-0.59, p < 0.05) in all age groups and WB BMD in the middle-age group (r = 0.72, p < 0.05) independent of PA, FM, and hormonal status. FM was not positively associated with any bone variable in any age group when adjusted for PA, LST, and hormonal status. PA was significantly associated with WB BMD in the middle-age group (r = 0.60, p < 0.05), independent of LST, FM, and hormonal status.

CONCLUSIONS

LST contributes more to bone health in women across the lifespan than FM, independent of PA and hormonal status.

Serum dickkopf-1 level in postmenopausal females: correlation with bone mineral density and serum biochemical markers

Objective. To assess serum level of Dickkopf-1 in postmenopausal females and its correlation with bone mineral density and serum biochemical markers. Methods. Bone densitometry, serum Dickkopf-1, calcium, phosphorus, and alkaline phosphatase were done in sixty postmenopausal females. Patients were divided according to T score into osteoporosis (group I), osteopenia (group II), and normal bone mineral density that served as controls. Results. There was highly significant increase in serum Dickkopf-1 levels in postmenopausal females with abnormal T score versus controls (P < 0.001). Serum DKK-1 levels correlated negatively with both lumbar T score (r = -0.69, P < 0.001) and femur T score (r = -0.64, P < 0.001) and correlated positively with duration of menopause (r = 0.61, P < 0.001), while there was no significant correlation between serum levels of either calcium, phosphorus or alkaline phosphatase, and both serum Dickkopf-1 levels and the level of bone mineral density (P > 0.05). Conclusion. Postmenopausal females may suffer from osteoporosis as evidenced by bone densitometry. Postmenopausal women with significantly increased serum Dickkopf-1 had more significant osteoporosis. Prolonged duration of menopause and increased serum Dickkopf-1 are important risk factors for the development and severity of osteoporosis.

Relationship between body composition and age, menopause and its effects on bone mineral density at segmental regions in Central Southern Chinese postmenopausal elderly women with and without osteoporosis

We aimed at evaluating the relationship between lean mass and fat mass with age, menopausal age (MA) and years since menopause (YSM) and their effects on bone mineral density (BMD) at segmental regions in postmenopausal elderly women with and without osteoporosis. After using a dual-energy X-ray absorptiometry (DXA) methodology to measure body composition and BMD at posteroanterior spine and hip in 244 postmenopausal elderly non-osteoporotic (Non-OP) women (65.5 ± 4.3 years) and 298 postmenopausal elderly osteoporotic (OP) women (67.1 ± 4.4 years), we found that in postmenopausal elderly Non-OP women, there was no correlation between lean mass with age, MA, and YSM, as well as no correlation between fat mass with age (all, p > 0.05); leg fat (LF) mass (r = 0.187; p<0.01), whole body fat (WF) mass (r = 0.151; p < 0.05), and trunk fat (TRF) mass (r = 0.141; p < 0.05) were positively correlated with MA; LF (r = -0.131; p < 0.05) and WF (r = -0.127; p < 0.05) were negatively associated with YSM; WF and whole body lean (WL) mass were the most important body composition components influencing BMD at the third lumbar spine (L3), total first to fourth lumbar spine (L1-4) and hip, respectively; TRF was the most significant determinant of BMD at both L2 and L4. In postmenopausal elderly OP women, there was no relationship between body composition with MA (p > 0.05); Trunk lean (TRL) mass (r = -0.183; p < 0.05), leg lean (LL) mass (r = -0.136; p < 0.01), and WL mass (r = -0.162; p < 0.01) were negatively correlated with age; TRL mass (r = -0.132; p < 0.05), LL mass (r = -0.152; p < 0.01), WL mass (r = -0.170; p < 0.01) were also negative with YSM; WF was the most important factor influencing BMD at lumbar spine and hip. These data suggest in postmenopausal elderly Non-OP women, fat mass (TRF, LF, and WF) was more related with MA; WF and WL mass were the most important body composition components influencing BMD at L1-4 and hip, respectively; in postmenopausal elderly OP women, body composition was not correlated with MA; lean mass (TRL, LL, and WL) was more age-related negatively; WF mass was the most significant factor affecting BMD at lumbar spine and hip.

Bone mass of overweight affluent Indian youth and its sex-specific association with body composition

SUMMARY: The study assessed whether overweight is associated with better bone densities in healthy youth. It was observed that overweight individuals had better BMDs at the hip but not at other sites after controlling for the bone area. Lean body mass was an important determinant of BMDs in men, but both lean and fat mass were important for BMDs in women. INTRODUCTION: The study assessed the relationship of overweight and obesity to the bone mass in young men and women consuming adequate calcium. METHODS: Bone and body composition parameters were measured using dual energy X-ray absorptiometry in overweight men (n = 74) and women (n = 77) in the age group of 20-35 years and compared with controls having normal body mass index (BMI). Biochemical parameters of bone metabolism were also assessed. RESULTS: After adjustment for whole body bone area, bone mineral densities (BMDs) at femoral neck and hip were significantly higher in overweight individuals when compared with controls. However, BMD at lumbar spine, forearm, and whole body were not significantly different in the two BMI groups. Overweight women had lower vitamin D and higher parathormone levels than controls. Regression analyses indicated that height was an important determinant of BMD at most of the skeletal sites in both men and women. Lean body mass was an important determinant of BMDs in men, but both lean and fat mass were important for BMDs in women. CONCLUSION: Overweight may be associated with better BMDs at the hip but not at other sites after controlling for the bone area. Body composition parameters may have sex-specific associations with BMD.

Natural history and risk factors for bone loss in postmenopausal Caucasian women: a 15-year follow-up population-based study

In this 15-year follow-up study, we found that the estimated rate of bone loss at the femoral neck (FN) for women aged 45-68 was linear at a rate of 1.67% per year, but quadratic for lumbar spine (LS) at a rate of 3.12% initially, and slowing down with age. We also confirmed the protective role of HRT, increasing weight, and lean mass in long-term bone loss.

INTRODUCTION

The objective was to describe the natural history of bone loss and explore the role of environmental factors in postmenopausal women over a 15-year period.

METHODS

Bone mineral density (BMD) at the FN and the LS were measured in postmenopausal women from the Chingford Study. Height, weight, HRT status, and calcium/vitamin D supplement were assessed at each visit. Osteoarthritis of hip and spine was assessed by X-ray at baseline and at year 8.

RESULTS

A total of 955 postmenopausal women with an average age of 54.7 at baseline were included. Both FN and LS BMD decreased significantly with age (p<0.0001). The decline was larger in the LS (-3.12% per year), which showed a quadratic relationship, than in the FN (-1.67% per year) with a linear relationship. The rate of bone loss was reduced by one third annually for the FN and LS respectively in current HRT users. Change in weight was positively associated with both DeltaFN and DeltaLS BMD (beta=0.16% and 0.09% change in DeltaFN and DeltaLS BMD per kilogramme change in weight respectively, p<0.0001 for both sites). Spine OA and progression were positively associated with DeltaLS BMD (beta=1.22% change in DeltaLS BMD per grade in spine OA and 0.45% change in DeltaLS BMD for patients who progressed, p<0.0001 for spine OA and p=0.002 for spine OA progression). Spine OA (beta=0.54% change in DeltaFN BMD per grade, p<0.0001), but not progression, and hip OA were positively associated with DeltaFN BMD. Furthermore, both age and body weight at baseline were positively associated with both DeltaFN and DeltaLS BMD (beta=0.02-0.04% change in DeltaFN and DeltaLS BMD per year increase in age at baseline and 0.004-0.007% change in DeltaFN and DeltaLS BMD per kilogramme increase in weight at baseline, all p<0.0001).

CONCLUSION

This large population-based longitudinal study demonstrated that the decline of BMD over 15 years is linear with age for the FN, but quadratic for the LS. The study confirmed the protective role of HRT, increased weight and lean mass in long-term bone loss.

Relationship between women's occupational work and bone health: a study from India

Physical activity is known to influence the bone mass of an individual. Few studies have examined the effect of occupational activities on bone health. The present study investigated the relationship between occupational activities and the bone parameters measured by dual-energy X-ray absorptiometry in 158 women from a low-income group in India. Women involved in three occupations with different bone-loading patterns (beedi (cigarette) makers, sweepers and construction workers) were included in the study. Anthropometric parameters, parity and percentage of menopausal women did not differ significantly between the three groups and dietary intake of Ca was low in all the groups. Bone mineral density (BMD) values of the overall group at all the sites were much lower than those reported from developed countries, possibly due to different body sizes in these regions. Femoral neck and hip BMD were not different in the three groups in spite of marked differences in activity patterns. However, bone area in the femoral neck was higher in the beedi makers compared with sweepers probably due to the squatting position adopted by beedi makers. Lumbar spine BMD was significantly lower among the sweepers when compared with the beedi makers and the groups performing walking and weight-bearing activities (sweepers and construction workers) had a higher prevalence of osteoporosis in the lumbar spine. However, weight-bearing effects of the upper body due to a squatting position were associated with better lumbar spine BMD in the beedi makers. The present study thus indicates that undernutrition might affect the relationship between occupational activities and bone parameters.

Linkage of genes to total lean body mass in normal women

BACKGROUND

Total lean body mass (LEAN-tot) is one of the three major components of body weight. Its deterioration is a risk factor for frailty. Despite this, there are few studies examining the contribution of genetic factors.

OBJECTIVE

Our objective was to examine the contribution of genetic factors for LEAN-tot variation, including a genome-wide search for the genes.

RESEARCH METHODS

Dual-energy x-ray absorptiometry measurements of LEAN-tot were obtained from each of the 3180 United Kingdom females (509 monozygotic and 1081 dizygotic twin pairs). Contribution of genetic factors was assessed using variance component analysis. A genome-wide linkage analysis was performed on the dizygotic twins using a modified version of the Haseman-Elston method.

RESULTS

Age, body height, total fat, and bone mass were correlated with LEAN-tot, and commonly explained 52% of the LEAN-tot variation. The crude heritability estimate was 74.0 +/- 4.0%, after adjustment for the aforementioned factors; 65.2 +/- 4.6% was attributable to independent genetic effects. Significant (P < 0.001) genetic correlations were found between LEAN-tot and bone mass, and LEAN-tot and total fat. Adjusted only for age, LEAN-tot showed no significant linkage. After adjustment for all covariates, significant linkage (LOD = 4.49 and 3.62) was observed at chromosome 12q24.3 and 14q22.3, respectively. Additional peaks of interest were on 7p15.3-15.1 (LOD = 2.86) and 8p22 (LOD = 2.83).

CONCLUSIONS

LEAN-tot measured by dual-energy x-ray absorptiometry is highly heritable, independent of other body measures. This first genomic search for genes associated with the lean component of body mass suggests significant linkage to quantitative trait loci on chromosomes 12 and 14.