Relationships between bone mineral density, body composition, and isokinetic strength in postmenopausal women

Increased response of postmenopausal bone to interval walking training depends on baseline bone mineral density

PURPOSE

To examine the hypothesis that an increase in response of postmenopausal bone to interval walking training (IWT) depends on baseline bone mineral densities (BMDs).

METHODS

Two hundred and thirty-four postmenopausal women (64±5 (SD) yr) with no medication for osteoporosis performed 5-month IWT, repeating fast and slow walking at ≥70% and ~40% peak aerobic capacity, respectively, for 3 minutes each per set, ≥5 sets/day, ≥4 days/week. They were recruited from those who had performed IWT ≥6 months before participating in the study so that their physical fitness and lifestyle-related disease symptoms had almost reached a steady state at the time of their participation. We measured BMDs for the lumbar spine (LS), bilateral femoral neck (FN), and bilateral total hip (TH) by dual-energy X-ray absorptiometry (DXA) before and after the intervention. We used a multiple regression analysis to identify significant independent factors for increasing BMDs after the intervention as baseline physical characteristics, exercise intensity, and exercise time during IWT were the candidates. For any bone site where the independent factor identified was singular, we analyzed the relationship between the identified factor vs increases in BMD after the intervention (ΔBMD) by the locally weighted scatterplot smoothing (LOWESS) method.

RESULTS

Almost all subjects completed the designated protocol with minimal adverse events. We found that significant determinants for increasing BMDs were the baseline BMDs for all bone sites, as well as age and body mass index for TH (all, P<0.02). Furthermore, the LOWESS trendline between ΔBMDs vs the baseline BMDs, divided equally into 10 bins for LS and FN, respectively, showed that ΔBMD responses (Y) were attenuated as the baseline BMDs (X) increased in the lower 4 bins and then showed a flat line (Y = ~0) in the remaining higher 6 bins for LS and FN. When the lower 4 bins and the higher 6 bins of the baseline BMD were pooled, respectively, BMDs significantly increased by 1.8% and 1.0% in the lower groups for LS and FN, respectively (both, P<0.001) while not in the higher groups after the intervention (both, P>0.3).

CONCLUSIONS

IWT may be of benefit with minimal adverse events to postmenopausal women, although the effects were greater in those with lower baseline BMDs.

TRIAL REGISTRATION

UMIN000047428. https://rctportal.niph.go.jp/s/detail/um?trial_id=UMIN000047428#.

Body fat distribution and bone mineral density in a multi-ethnic sample of postmenopausal women in The Malaysian Cohort

In this study of postmenopausal women in Malaysia, total adiposity was inversely associated with total BMD, while regional associations varied. No differences were detected across Malay, Chinese, and Indian ethnicities. Low BMD contributes substantially to morbidity and mortality, and increasing adiposity levels globally may be contributing to this.

PURPOSE

To investigate associations of total and regional adiposity with bone mineral density (BMD) among a multi-ethnic cohort of postmenopausal women.

METHODS

Dual X-ray absorptiometry (DXA) imaging was undertaken for 1990 postmenopausal women without prior chronic diseases (30% Malay, 53% Chinese, and 17% Indian) from The Malaysian Cohort (TMC). The strength of the associations between standardized total and regional body fat percentages with total and regional BMD was examined using linear regression models adjusted for age, height, lean mass, ethnicity, education, and diabetes. Effect modification was assessed for ethnicity.

RESULTS

Women with a higher total body fat percentage were more likely to be Indian or Malay. Mean (SD) BMD for the whole-body total, lumbar spine, leg, and arm were 1.08 (0.11), 0.96 (0.15), 2.21 (0.22), and 1.36 (0.12) g/cm2, respectively. Total body and visceral fat percentage were inversely associated with total BMD (- 0.02 [95% CI - 0.03, - 0.01] and - 0.01 [- 0.02, - 0.006] g/cm2 per 1 SD, respectively). In contrast, subcutaneous and gynoid fat percentages were positively associated with BMD (0.007 [0.002, 0.01] and 0.01 [0.006, 0.02] g/cm2, respectively). Total body fat percentage showed a weak positive association with lumbar BMD (0.01 [0.004, 0.02]) and inverse associations with leg (- 0.04 [- 0.06, - 0.03]) and arm (- 0.02 [- 0.03, - 0.02]) BMD in the highest four quintiles. There was no effect modification by ethnicity (phetero > 0.05).

CONCLUSION

Total adiposity was inversely associated with total BMD, although regional associations varied. There was no heterogeneity across ethnic groups suggesting adiposity may be a risk factor for low BMD across diverse populations.

Hand grip strength, vitamin D status, and diets as predictors of bone health in 6-12 years old school children

BACKGROUND

Vitamin D and calcium-rich foods, exposure to sunlight, and physical activities (PA) play a pivotal role in promoting the production of sufficient vitamin D and improving grip strength needed for better bone health among school children.

PURPOSE

This study aimed to determine the effects of hand grip muscle strength (HGS), vitamin D in addition to diets, and PA on bone health status among 6-12 years old schoolchildren.

METHODS

This study was based on a cross-sectional observational design, which was descriptive in nature. A diverse sample of 560 elementary school children aged 6-12 years old were invited to participate in this descriptive cross-sectional study. The Dual-Energy X-Ray Absorptiometry (DXA), QUS technique, and ACTi graph GT1M accelerometer were used respectively as a valid tools to identify BMD, BMC, and other parameters of bone health like c-BUA values and bone stiffness (SI), and physical activity (PA) of all individuals participated in this study. In addition, a hydraulic dynamometer was used to measure hand grip strength among the participants. Moreover, an immunoassay technique was used to measure the serum levels of vitamin 25(OH)D level, and bone metabolism markers; NTX, DPD, Ca, and sBAP in all participants. Bone loss (osteoporosis) was cross-sectionally predicted in 19.64% of the total population, most of whom were girls (14.3% vs. 5.4% for boys; P = 0.01). Compared to boys, the incidence of osteoporosis was higher and significantly correlated in girls with lower HGS, deficient vitamin D, inadequate vitamin D and Ca intake, greater adiposity, poor PA, and lower sun exposure. Also, in girls, lower vitamin 25(OH)D levels, and poor HGS were shown to be significantly associated with lower values of BMD, BMC, SI, and higher values of bone resorption markers; NTX, DPD, and sBAP and lower serum Ca than do in boys. The findings suggested that deficient vitamin D, lower HGS, adiposity, PA, and sun exposure as related risk factors to the pravelence of bone loss among school children, particularly in girls. In addition, these parameters might be considered diagnostic non-invasive predictors of bone health for clinical use in epidemiological contexts; however, more studies are required.

The effects of exercise training on body composition in postmenopausal women: a systematic review and meta-analysis

Introduction

We conducted a systematic review and meta-analysis to investigate the effect of exercise training on body composition outcomes in postmenopausal women.

Methods

PubMed, Web of Science, CINAHL, and Medline were searched to identify the randomized controlled trials which evaluated effect of exercise training versus control in postmenopausal women. Standardized mean differences (SMD), weighted mean differences (WMD) and 95% confidence intervals (95% CIs) were calculated using random effects model.

Results

One hundred and one studies involving 5,697 postmenopausal women were included in the meta-analysis. Results indicated that exercise training effectively increased muscle mass/ volume, muscle and fiber cross-sectional area and fat-free mass, and decreased fat mass, body fat percentage, waist circumference and visceral fat. Furthermore, subgroup analyses results revealed that aerobic and combined training had greater beneficial effects on fat mass outcomes, whereas resistance and combined training had greater beneficial effects on muscle mass outcomes.

Discussion

Overall, our results revealed that exercise training is effective for improving body composition in postmenopausal women. To be specific, aerobic training is effective on fat loss, whereas resistance training is effective on muscle gain. However, combination of aerobic and resistance trainings may be considered a viable strategy to improve body composition in postmenopausal women.

Systematic review registration

https://www.crd.york.ac.uk/prospero/, identifier CRD42021283425.

Association between muscle strength and mass and bone mineral density in the US general population: data from NHANES 1999-2002

PURPOSE

It is known that muscle strength and muscle mass play a crucial role in maintaining bone mineral density (BMD). Despite this, there are uncertainties about how muscle mass, lower extremity muscular strength, and BMD are related. We examined the impact of lower extremity muscle strength and mass on BMD in the general American population using cross-sectional analysis.

METHODS

In the study, we extracted 2165 individuals from the National Health and Nutrition Examination Survey 1999-2002. Multivariate logistic regression models were used to examine the association between muscle strength, muscle mass, and BMD. Fitted smoothing curves and generalized additive models were also performed. To ensure data stability and avoid confounding factors, subgroup analysis was also conducted on gender and race/ethnicity.

RESULTS

After full adjustment for potential confounders, significant positive associations were detected between peak force (PF) [0.167 (0.084, 0.249) P < 0.001], appendicular skeletal muscle index (ASMI) [0.029 (0.022, 0.036) P < 0.001], and lumbar spine BMD. A positive correlation was also found between PF, ASMI, and pelvis and total BMD. Following stratification by gender and race/ethnicity, our analyses illustrated a significant correlation between PF and lumbar spine BMD in both men [0.232 (0.130, 0.333) P < 0.001] and women [0.281 (0.142, 0.420) P < 0.001]. This was also seen in non-Hispanic white [0.178 (0.068, 0.288) P = 0.002], but not in non-Hispanic black, Mexican American and other race-ethnicity. Additionally, there was a positive link between ASMI and BMD in both genders in non-Hispanic whites, and non-Hispanic blacks, but not in any other racial group.

CONCLUSION

PF and ASMI were positively associated with BMD in American adults. In the future, the findings reported here may have profound implications for public health in terms of osteopenia and osteoporosis prevention, early diagnosis, and treatment.

Associations between bone mass, hormone levels, and body composition in postmenopausal women

OBJECTIVES

The aim of this study was to explore body composition parameters and hormone levels as risk factors for low bone mass (osteopenia/osteoporosis) in postmenopausal women.

METHODS

We analyzed biorepository samples from 139 postmenopausal women with no clinical evidence of cardiovascular disease. Inclusion criteria were menopause occurring after 40 years of age and no use of hormone therapy in the past 3 months. Bone mineral density and body composition were assessed by dual-energy x-ray absorptiometry. Sex hormone-binding globulin (SHBG) and follicle-stimulating hormone (FSH) levels were measured in all participants. Serum estradiol was measured by gas chromatography/tandem mass spectrometry in a subset of 57 participants. Free estrogen index was calculated by dividing estradiol by SHBG × 100.

RESULTS

Body mass index (25.0 [22.5-26.5] vs 27.7 [26.6-31.9] kg/m 2 , P < 0.001), estradiol (3.0 [2.7-4.5] vs 6.0 [2.7-15.0] pg/mL, P = 0.006), waist circumference (84 ± 9 vs 93 ± 12 cm, P < 0.001), appendicular lean mass (ALM) (15.739 ± 2.129 vs 17.184 ± 2.104 kg, P = 0.001), and fat mass index (9.36 [7.29-11.43] vs 11.38 [9.95-15.33] kg/m 2 , P < 0.001) were lower in women with low bone mass by dual-energy x-ray absorptiometry. Univariate analysis showed that free estrogen index, time since menopause, SHBG, and fat mass were significant predictors of low bone mass, and ALM was a significant predictor against low bone mass. Appendicular lean mass persisted as an independent predictor against low bone mass in multivariate models with fat mass and SHBG. In turn, fat mass was no longer significant in this multivariate model after inclusion of SHBG. No association of FSH with low bone mass was observed.

CONCLUSIONS

Appendicular lean mass was a significant independent predictor against low bone mass in postmenopausal women. Further prospective studies are needed to investigate whether lean mass, fat mass, and FSH have a direct effect on bone mass in postmenopausal women, adding to the consequences of hypoestrogenism in this group.

The Relationship Between Bone Mineral Density and Body Composition Among Qatari Women With High Rate of Obesity: Qatar Biobank Data

Studies have reported inconsistent results for the relationship between body composition and bone mineral density (BMD) among women, especially those with a high rate of obesity. This study aims to examine the association between BMD and body composition among Qatari women. A cross-sectional study, using data from the Qatar Biobank (QBB), was conducted on 2,000 Qatari women aged 18 and over. Measurements were taken by dual-energy X-ray absorptiometry (DEXA) for body composition [visceral fat and android fat (AF)], gynoid fat (GF), trunk fat, total fat mass (TFM), total lean mass (LM) and bone mineral density (BMD), including the lumber spine, neck, femur and total body. The participants were divided into groups of normal and low BMD, based on their T-score. Non-linear regression analysis using the restricted cubic spline method was performed according to the T-score of the total BMD for the fat mass variables. Women with a low BMD (T-score <-1) had significantly lower body composition indicators. LM was positively correlated with BMD at the spine (r = 0.29, p < 0.001), neck (r = 0.32, p < 0.001), and femur (r = 0.28, p < 0.001), as well as total BMD (r = 0.29, p < 0.001) and T-score (r = 0.31, p < 0.001), while the correlatio between TFM and BMD was negative and weak (r = -0.05, <0.017). Results of the non-linear regression indicated that components of fat distribution (TFM, AF, GF and trunk fat) were positively associated with total body T-score. In the adjusted non-liner regression, only a slight increase in T-score was recorded with an increase in FM. The association between FM and BMD was non-linear, suggesting that FM may not be a strong protector of bones among women with high rate of obesity.

The Relationship between Body Composition and Bone Mineral Density of Female Workers in A Unit of Tai’an

Objective. To explore the relationship between body composition and bone mineral density (BMD) of female workers in a university of Tai’an. Methods. This study randomly selected 90 female employees in a university of Tai’an. The body composition was monitored by body composition analyzer (inbody770), and the lumbar bone mineral density was monitored by dual energy X-ray absorptiometry (BMD model). The data were analyzed by SPSS 22.0 statistical software. Results. With the increasing of body mass index (BMI), BMD of female lumbar spines 1-4 (L1-4) increased gradually. Spearman correlation analysis showed that BMI, skeletal muscle mass, upper limb muscle mass, trunk muscle mass, lower limb muscle mass, and whole-body phase angle were positively correlated with L1-4BMD. Age was negatively correlated with L1-4BMD. Linear regression analysis showed that age was a negative factor of L1-4BMD, and skeletal muscle mass was a protective factor of abnormal bone mass, especially lower limb muscle mass. Conclusions. Lower limb muscle mass is a protective factor of female BMD. Strengthening physical exercise to improve lower limb muscle mass is conducive to the prevention of female osteoporosis.

Relationship between body composition and pulmonary function in healthy adolescents

BACKGROUND

It has been long established that body composition affects pulmonary function but little attention has been given to assessing lung function in healthy adolescents and determining the influence of body composition on these variables.

METHODS

We measured 399 boys (mean age 16.7 ± 1.2 years) and 46 girls (mean age 17.1 ± 1.2 years). We used multi-frequency segmental bioimpedance analyzer Tanita MC 980-MA Plus for body composition parameters and Micro Direct MicroGP Spirometer MS07 for spirometry parameters.

RESULTS

Mean body height was 179.5 cm and mean body mass index was 22.5 kg/m² in boys. In girls, mean body height was 166.9 cm and body mass index was 22.5 kg/m² . After adjusting for age, body height, bodyweight, and smoking status, we found a significant (P = 0.01) association (β = 0.35-0.43) between forced vital capacity and fat-free mass (FFM) or trunk fat-free mass only in boys. Similarly, body fat mass (BFM) showed significant (P = 0.01) negative association (β = -0.29 to -0.20) with spirometry parameters only in boys. In girls, the results showed a similar trend but it was not significant.

CONCLUSIONS

In conclusion, FFM or trunk FFM is more closely related to lung capacity than BFM or trunk BFM after adjustment for confounding variables in healthy adolescent boys. Body height explained up to 23% variability of forced vital capacity and fat-free mass explained up to 27% in a linear regression model.

Associations of Fat Mass and Fat Distribution With Bone Mineral Density in Non-Obese Postmenopausal Chinese Women Over 60 Years Old

BACKGROUND

Bone mineral density (BMD) loss is a major complication of menopause, and this loss is closely associated with Fat mass (FM). The relationship between FM, fat distribution (FD), and BMD in postmenopausal women, however, remains incompletely understood. The present study was thus developed to explore these associations between body fat accumulation, FD, and BMD among non-obese postmenopausal women over the age of 60.

METHODS

This was a cross-sectional analysis of 357 healthy postmenopausal women between the ages of 60.2 and 86.7 years. Dual-energy X-ray absorptiometry (DXA) was utilized to measure total and regional BMD as well as fat-related parameters including total FM, android and gynoid fat, body fat percentage (BF%), and total lean mass (LM) for all subjects. The android-to-gynoid fat ratio (AOI) was used to assess FD. Pearson's correlation testing and multiple regression analyses were used to explore relationships among AOI, LM, FM, and BMD.

RESULTS

Both LM and FM were positively correlated with total and regional BMD in univariate analysis (all P < 0.01), whereas BMD was not significantly associated with AOI in any analyzed site other than the head. Multivariate linear regression models corrected for age, height, and years post-menopause, revealed a sustained independent positive relationship between FM and BMD (standard β range: 0.141 - 0.343, P < 0.01). The relationship between FM and BMD was unaffected by adjustment for LM (standard β range: 0.132 - 0.258, P < 0.01), whereas AOI had an adverse impact on BMD at most analyzed skeletal sites (total body, hip, femoral neck, arm, leg, and head) (standard β range: -0.093 to -0.232, P < 0.05). These findings were unaffected by using BF% in place of FM (standard β range: -0.100 to -0.232, P < 0.05).

CONCLUSIONS

In this cohort of non-obese postmenopausal women over the age of 60 from China, total FM was positively associated with BMD, while AOI was negatively correlated with BMD. As such, a combination of proper weight gain and the control of central obesity may benefit the overall bone health of women after menopause.

Influence of the appendicular skeletal muscle mass index on the bone mineral density of postmenopausal women

BACKGROUND

The appendicular skeletal muscle mass index (ASMI) is an important risk indicator for osteoporosis because of the anatomical proximity and metabolic connection between muscle and bone mass. The present study investigated the relationship between ASMI and the bone mineral density (BMD) categories of postmenopausal women.

METHODS

In this cross-sectional study with a probabilistic sample, sociodemographic, lifestyle, menopause time, anthropometric, and physical activity variables were collected. ASMI and BMD were assessed by dual-energy X-ray absorptiometry (DXA). Participants were grouped according to BMD values into normal density, osteopenia, and osteoporosis. Multivariate logistic regression models were applied to verify the influence of ASMI on BMD. Data were analyzed using the SPSS statistical software, version 22. The significance level for all tests was set at 5%.

RESULTS

Of the 114 women analyzed, most were between 60 and 69.9 years of age (62.3%), on menopause for ≤19.0 (51.8%), self-declared brown race/color (49.1%), had < 4 years of education (41.2%), never smoked (69.0%) or drank alcohol (62.8%). Of these, 52.6% were classified as sufficiently active and 52.2% had regular sun exposure. Women with osteoporosis were older (p = 0.035), on menopause for a longer time (p = 0.011), underweight (p = 0.004), had adequate waist circumference (p = 0.017), and low ASMI values (p = 0.002). There was an association between the 1st tertile of ASMI and osteoporosis. However, after adjustments for age, race/color, and body mass index, the strength of association between BMD and ASMI was not maintained.

CONCLUSIONS

ASMI was not associated with the BMD of the postmenopausal women evaluated. Total body and muscle mass, in addition to bone mass, should be monitored during menopause treatment. Longitudinal studies must be conducted to elucidate the mechanisms and gaps in this relationship.

Bone mineral density in elite masters athletes: the effect of body composition and long-term exercise

BACKGROUND

The purpose of the study was to examine how bone mineral density (BMD) is related to body composition depending on the practiced sport (endurance, speed-power, throwing sports) in participants of the World Masters Athletics Championship.

METHODS

Dual-energy X-ray absorptiometry (DXA) was used to determine BMD and bone mass (BMC). Body composition was analyzed by means of the JAWON Medical X-scan analyzer using bioelectrical impedance methods. Percentage body fat (%BF), body fat mass (BFM), lean body mass (LBM), total body water (TBW), soft lean mass (SLM), intracellular water (ICW), and extracellular water (ECW) were evaluated.

RESULTS

Among men, the most important variables affecting the BMD norm were LBM (OR = 32.578; p = 0.023), ECW (OR = 0.003; p = 0.016) and ICW (OR = 0.011; p = 0.031), in the distal part and SLM (OR = 5.008; p = 0.020) and ICW (0.354, p = 0.008) in the proximal part. In women, the most important predictors of normal BMD were ICW (OR = 10.174; p = 0.003) and LBM (OR = 0.470; p = 0.020) in the distal part and ICW (OR = 5.254; p = 0.038) in the proximal part.

CONCLUSION

The representatives of strength based events had the most advantageous BMD levels. The condition of bone tissue evaluated by BMC and BMD of the forearm in masters athletes was strongly determined by the level of lean body components and the type of sports training associated with the track and field event. In the most important predictors of the BMD norm were also hydration components ECW and ICW. However, this relationship requires more research on the nature and mechanisms of these interactions.

Association between movement control during one-leg standing and femoral BMD in patients with hip fractures

INTRODUCTION

Prior studies have focused only on the temporal component of one-leg standing, no reports have examined the relationship between the qualitative components of one-leg standing and femoral BMD. Thus, this study investigated whether quality (i.e., movement control) of one-leg standing also associated femoral BMD.

MATERIALS AND METHODS

A total of 80 patients with unilateral hip fracture were included in a cross-sectional study. Basic and medical information and physical functions including movement control during one-leg standing were assessed at admission and 2 weeks after surgery, respectively. Hierarchical multiple regression analysis was performed to identify predictors of femoral BMDs on the non-fractured side. Dependent variables included femoral neck and total hip BMDs in models 1 and 2, respectively.

RESULTS

Hierarchical multiple regression analysis (standardized partial regression coefficients) in model 1 identified age (- 0.18), sex (0.38), body mass index (BMI) (0.41), movement control during one-leg standing on the non-fractured side (0.19), and life-space assessment (0.17) as factors associating femoral neck BMD. Meanwhile, hierarchical multiple regression analysis (standardized partial regression coefficients) in model 2 identified age (- 0.12), sex (0.36), BMI (0.37), and movement control during one-leg standing on the non-fractured side (0.25) as factors associating total hip BMD. The coefficients of determination adjusted for degrees of freedom (R²) were 0.529 and 0.470 for models 1 and 2, respectively.

CONCLUSION

Our results suggest that improving movement control during one-leg standing may be important for maintaining and improving femoral BMD on the non-fractured side.

Risk factors for femoral neck fracture in elderly population

OBJECTIVES

To explore the risk factors for femoral neck fracture in elderly population.

METHODS

A total of 124 elderly patients (≥60 years old) in hospital for trauma were enrolled, including 71 patients (57%) with femoral neck fracture and 53 non-femoral neck fracture patients (43%). All patients' age, gender, body mass index (BMI), bone mineral density (BMD), thigh length and average circumference were collected. Single factor analysis and multivariate logistic regression analysis were performed to explore whether the above factors were risk factors for femoral neck fracture.

RESULTS

Single factor analysis showed that the age, gender, BMI, BMD, thigh length, and average thigh circumference between the 2 groups were statistically different (all P<0.05), and multi-factor logistic regression analysis showed that age, gender, BMI, BMD, thigh length, and average thigh circumference were influencing factors for femoral neck fracture in elderly population (all P<0.05).

CONCLUSIONS

Older age, female, lower BMI index (low body weight), lower BMD (osteoporosis), longer thigh length, and lower average circumference are risk factors for femoral neck fracture in the elderly population.