Significant Determinant Of Bone Mineral Density Research Articles

B-vitamin status in relation to bone mineral density in treated celiac disease patients

Objectives. Patients with celiac disease (CD) are at increased risk of osteoporosis and compromised B-vitamin status. Emerging evidence supports a beneficial role of folate and the metabolically related B-vitamins in bone health in generally healthy adults, but no previous study has investigated this in CD patients. The aim of the current study was to examine the relationship of folate, vitamins B12, B6 and B2 (riboflavin), and the related metabolite homocysteine, with bone mineral density (BMD) in CD patients. Materials and methods. Of the 400 treated adult CD patients invited to participate, 110 responded and met the eligibility criteria for study participation. BMD was measured using dual energy X-ray absorptiometry scanning at the lumbar spine (L1–L4), femoral neck, and total hip sites. Biomarker status of the relevant B-vitamins and homocysteine, and dietary B-vitamin intakes, were measured. Results. The significant predictors of low BMD were increasing age (B = 0.080, p < 0.001) and decreasing weight (B = 0.072, p = 0.004), whereas no significant relationship with serum 25-hydroxyvitamin D (B = 0.093, p = 0.928) was observed. Following adjustment for these predictors, serum vitamin B12 (but no other B-vitamin biomarker) was found to be a significant determinant of BMD at the femoral neck (β = 0.416, p = 0.011) and total hip (β = 0.327, p = 0.049) in men only. No significant relationships were found between any of the B-vitamin biomarkers investigated and BMD (at any measured site) in women. Conclusion. These findings add to current evidence suggesting a potential role of vitamin B12 in BMD, particularly in men, and show such a relationship for the first time in CD patients.

Fibroblast growth factor 23 contributes to diminished bone mineral density in childhood inflammatory bowel disease

BackgroundDiminished bone mineral density (BMD) is of significant concern in pediatric inflammatory bowel disease (IBD). Exact etiology is debatable. The recognition of fibroblast growth factor 23 (FGF23), a phosphaturic hormone related to tumor necrosis factor alpha (TNF-α) makes it plausible to hypothesize its possible relation to this pathology.MethodsIn this follow up case control study, BMD as well as serum levels of FGF23, calcium, phosphorus, alkaline phosphatase, creatinine, parathyroid hormone, 25 hydroxy vitamin D3 and 1, 25 dihydroxy vitamin D3 were measured in 47 children with IBD during flare and reassessed in the next remission.ResultsLow BMD was frequent during IBD flare (87.2%) with significant improvement after remission (44.7%). During disease flare, only 21.3% of patients had vitamin D deficiency, which was severe in 12.8%. During remission, all patients had normal vitamin D except for two patients with Crohn’s disease (CD) who remained vitamin D deficient. Mean value of serum FGF23 was significantly higher among patients with IBD during flare compared to controls. It showed significant improvement during remission but not to the control values. 1, 25 dihydroxy vitamin D3, FGF23, serum calcium and urinary phosphorus were significant determinants of BMD in IBD patients.ConclusionsWe can conclude that diminished BMD in childhood IBD is a common multifactorial problem. Elevated FGF23 would be a novel addition to the list of factors affecting bone mineral density in this context. Further molecular studies are warranted to display the exact interplay of these factors.

Relationship of body composition with prevalence of osteoporosis in central south Chinese postmenopausal women

To elucidate the relationship between body composition and bone mineral density (BMD) and the prevalence of osteoporosis in central south Chinese postmenopausal women. A cross-sectional study was conducted on 954 healthy central southern Chinese postmenopausal women, aged 50-82. Total body, lumbar spine and left femur BMD and total body soft tissue composition were measured by dual X-ray absorptiometry. Among the study population, 578 (60.5%) subjects were without osteoporosis and 376 (39.4%) subjects were osteoporotic. The osteoporotic women were older, shorter and thinner, had an earlier age at menopause, a lower BMD and bone mineral content (BMC) of the total body and at different sites, and had lower body mass and body mass components than the women without osteoporosis. Both fat mass and lean mass were positively correlated with age at menopause, height, weight, body mass index (BMI) and BMD at all sites. Fat mass and lean mass were also inversely correlated with age and years since menopause (P<0.05). After controlling for age, age at menopause and height, both fat mass and lean mass were positively correlated with BMD at the lumbar(1-4) spine, the femoral neck and the total hip. Fat mass was the most significant determinant of BMD at the lumbar(1-4) spine with a higher R(2) change and a partial R(2) compared with that of lean mass, while lean mass had more impact on the total hip values. Either a fat mass below 18.4 kg or a lean mass below 33.9 kg was correlated with a higher prevalence of osteoporosis at the lumbar spine or total hip. In central south Chinese postmenopausal women, both fat mass and lean mass are correlated with BMD at the lumbar spine and hip. Fat mass was the most significant determinant of BMD at the lumbar spine, while lean mass had more impact on the total hip value. Both lower values of fat mass and lean mass are related to a higher prevalence of osteoporosis at either the lumbar spine or the total hip. Thus, it is important to maintain a reasonable body weight to balance bone health and other metabolic disorders.

Adiponectin is associated with low bone mineral density in elderly men

Recent evidence suggests that adiponectin may play a role in bone metabolism. Previous studies demonstrated that the adiponectin levels had a negative correlation with bone mineral density (BMD) in women. However, little is known about the relationship between adiponectin and BMD in men. The aim of this study was to determinate the relationship between the adiponectin levels and BMD in elderly men. Cross-sectional study including 92 healthy men aged 60-80 years. Main outcome measures were the adiponectin levels estimated by RIA and BMD at lumbar spine and femoral neck using dual energy X-ray absorptiometry. Results The negative correlation between adiponectin and BMD at the spine was r=-0.209, (P<0.05) and at the femoral neck was r=-0.237, (P<0.001). These correlations disappeared after adjustment for body mass index (BMI). When stratified by BMI, the relationship between BMD and adiponectin remained significant in the subgroup of participants with BMI >27 kg/m(2), but disappeared in men with BMI <or=27 kg/m(2). In multiple regression analysis, adiponectin was a significant determinant of BMD at the spine, not at the femoral neck, in those with BMI >27. BMD is negatively associated with the adiponectin levels in men older than 60 years and this relationship is greater in those men with BMI >27, which suggests a plausible connection between bone and fat tissue.

Influence of birth size and body composition on bone mineral density in early adulthood: the PROGRAM study

Low bone mineral density (BMD) may lead to osteoporosis and is associated with increased fracture risk. Associations between BMD and various factors have been reported. Our objective was to investigate whether birth size, lean body mass (LBM) and fat mass (FM) are determinants of BMD of the total body (BMD(TB)) and the lumbar spine (BMD(LS)). In the PROgramming factors for GRowth And Metabolism (PROGRAM) study of a cohort of 312 young adults aged 18-24 years, BMD(TB) and BMD(LS) were determined by dual-energy X-ray absorptiometry (DXA). Subsequently, differences in BMD(TB) and BMD(LS) were analysed in four subgroups: young adults born small for gestational age with short stature (SGA-S) or with catch-up growth (SGA-CU), or born appropriate for gestational age (AGA) with idiopathic short stature (ISS) or with normal stature (controls). Adult weight, LBM, FM and weight gain during childhood were the main positive determinants for BMD(TB) in early adulthood, whereas birth size had no influence (adjusted R(2) = 0.50). Gender, adult weight, LBM, FM and weight gain were the significant determinants of BMD(LS). In the subgroups, after correction for age, gender and adult body size, the ISS group had a significantly lower BMD(TB) than controls but there was no difference in BMD(LS) between the subgroups. Prenatal growth has no significant influence on BMD(TB) and BMD(LS) in early adulthood. Gender and postnatal growth, particularly weight gain, are the main positive determinants. To achieve a normal BMD in adulthood, healthcare workers should aim for a normal weight gain in children.

Impact of seafood and fruit consumption on bone mineral density

Objectives Over the past decade, dietary choices and nutrition have proven to be major modulators of bone mineral density (BMD) in men and women. We investigated environmental determinants, specifically dietary habits, of BMD by using multiple regression models in a rural Chinese population. Methods BMDs were measured at the hip and total body in 5848 men and 6207 women, aged 25–64. Dietary and supplemental intakes were assessed by a simple, one-page questionnaire tailored to collect nutritional information from large rural populations. Another questionnaire was used to collect information on the subjects’ age, disease history, smoking, alcohol consumption, physical activity as well as women's menstrual status and reproductive history. Multiple regression models were used to assess the relationships among dietary variables and BMD, after adjusting for age, BMI (body mass index), weight, occupation, smoking status, and alcohol consumption. Results Increasing seafood consumption was significantly associated with greater BMD in women ( p < 0.001), especially those consuming more than 250 g per week of seafood. One thousand and three hundred and twenty-four men and 1479 women consumed >250 g of fruit per week. Higher fruit intake was found to be significantly associated with higher BMD in both sexes ( p < 0.05). High vegetable consumption, however, did not positively impact BMD. Conclusions This study with its large population size has identified preventive measures, as well as some risk factors, involved in bone loss and osteoporosis. Our results highlight the importance of several dietary variables as significant determinants of BMD. It also emphasizes the role of dietary intake in general and shows that specific foods, such as fruits and seafood, can positively impact BMD.

Determinants of bone mass and bone size in a large cohort of physically active young adult men

The determinants of bone mineral density (BMD) at multiple sites were examined in a fit college population. Subjects were 755 males (mean age = 18.7 years) entering the United States Military Academy. A questionnaire assessed exercise frequency and milk, caffeine, and alcohol consumption and tobacco use. Academy staff measured height, weight, and fitness. Calcaneal BMD was measured by peripheral dual-energy x-ray absorptiometry (pDXA). Peripheral-quantitative computed tomography (pQCT) was used to measure tibial mineral content, circumference and cortical thickness. Spine and hip BMD were measured by DXA in a subset (n = 159). Mean BMD at all sites was approximately one standard deviation above young normal (p < 0.05). African Americans had significantly higher hip, spine and heel BMD and greater tibial mineral content and cortical thickness than Caucasians and Asians. In Caucasians (n = 653), weight was a significant determinant of BMD at every skeletal site. Prior exercise levels and milk intake positively related to bone density and size, while caffeine had a negative impact. There was an apparent interaction between milk and exercise in BMD at the heel, spine, hip and tibial mineral content and cortical thickness. Our data confirm the importance of race, body size, milk intake and duration of weekly exercise as determinants of BMD and bone size.

Determinants Of Bone Mineral Density In Premenopausal Women

In premenopausal women, osteoporosis may be diagnosed by low bone mineral density (BMD) in conjunction with secondary causes of bone loss or with risk factors for fracture. Therefore, it is important to identify determinants of low bone mass and/or risk for bone loss in this age group of women. PURPOSE The purpose of this study was to examine the influence of body composition, calcium intake, physical activity and menstrual characteristics on BMD in women, 18–30 years of age. METHODS All subjects (n=65) completed questionnaires to assess physical activity levels (Baecke), menstrual status, and calcium intakes. 36 of the women recruited for the study were taking oral contraceptives (OC). BMD and bone mineral content (BMC) at the AP lumbar spine, left proximal femur, and total body sites was measured by a pencil beam DXA. In this laboratory, in vivo precision for the spine and total body is 1.0% and ranges from 0.7% to 1.3% for the proximal femur regions of interest. Body composition variables were analyzed from the total body scans. RESULTS There were no significant differences in BMD or B between women taking OC and those not taking OC. Significant (p<.05) moderate correlations were found between BMD variables and bone-free lean body mass (r=.41−.55), whereas low correlations existed between physical activity scores and BMD (r=.27−.29). Stepwise multiple regression analyses determined that bone-free lean body mass was a significant (p<.05) predictor for each BMD site, accounting for 19.1% (spine) to 32.3% (total hip) of the variance. Fat mass and the Baecke work index score were also significant predictors of total body BMD. None of the other independent variables (calcium intake, OC use, sport index, leisure index) used in the regression analyses were significant predictors for the BMD variables. CONCLUSION Lean body mass had the strongest influence on BMD at the lumbar spine, proximal femur and total body sites. Generally, OC use, calcium intake, and physical activity scores were not significant determinants of BMD in these young women.

Increased risk of falls and increased bone resorption in elderly men with partial androgen deficiency: the MINOS study.

The goal of this study was to identify the clinical and biological patterns of hypogonadism in a cohort of 1040 elderly men. Residual androgenic activity was estimated by total testosterone as well as the apparent free testosterone concentration (AFTC) and free testosterone index (FTI) calculated on the basis of concentrations of SHBG and total testosterone using appropriate formulae. The lower limit of the normal range defined by 2 SD below the mean in 150 healthy, nonobese, and nonsmoking men, aged 19-40 yr, was calculated for total testosterone (9.26 nmol/liter), AFTC (146 pmol/liter), and FTI (0.14 nmol/nmol). The prevalence of hypogonadism increased with ageing. Hypogonadal men were older and heavier (due to a higher fat body mass) and had lower concentrations of 17 beta-estradiol and androstenedione than men with normal androgenic activity. Men with decreased AFTC had a slightly lower bone mineral density (BMD) at certain sites. Men with decreased FTI had lower appendicular skeletal muscle mass and relative skeletal muscle index. For all three measures of androgenic activity, hypogonadal men had increased levels of the markers of bone resorption. In the multiple regression models including both 17 beta-estradiol and testosterone (total, AFTC, or FTI), 17 beta-estradiol was the only significant determinant of BMD. In the multiple regression models including 17 beta-estradiol and AFTC or FTI, only testosterone was a significant determinant of the variability in bone formation markers, whereas both 17 beta-estradiol and testosterone were significant determinants of the variability of the markers of bone resorption. Hypogonadism was associated with an increase in the risk of falls, an impairment of static and dynamic balance, as well as the inability to stand up from a chair and to perform the tandem walk. Decreased AFTC (<146 pmol/liter) discriminated best men with functional disabilities (odds ratio, 1.54-7.95; P < 0.05-0.0001). Hypogonadal elderly men had increased bone resorption that was not adequately matched by an increase in bone formation, lower muscle strength, impaired static and dynamic balance, a higher risk of falls, and, in men with low AFTC, a slightly lower BMD. Low AFTC seems to have the best discriminative power for densitometric, biochemical, and functional parameters, followed by FTI, whereas total testosterone was the least discriminative. In multiple regression models, 17 beta-estradiol was the strongest determinant of BMD, and AFTC and FTI were significant determinants of the variability in bone formation markers, whereas both 17 beta-estradiol and testosterone determined the variability in bone resorption markers.

Risk factors for osteoporosis in men.

We evaluated the risk factors for osteoporosis in men. The subjects of this study consisted of 686 healthy middle-aged (40-59 years) men who had undergone bone mineral density (BMD) measurement and medical examination, including physical strength. BMD of L2-4 was measured at the anterior-posterior position, using dual X-ray absorptiometry. Physical investigations, such as height, weight, and physical strength, were carried out on the examination day. Details of tobacco and alcohol consumption, exercise, and food intake were described on a questionnaire completed by the subjects. Sixty-five (9.5%) of the 686 subjects had a BMD less than 2.5 SD below the peak bone mass (PBM), 182 (26.5%) had a BMD between 1 SD and 2.5 SD below the PBM; and 439 (64.0%) had a BMD no less than 1 SD below the PBM. Body mass index (BMI) and leg strength were significant positive determinants of BMD, and smoking was a significant negative determinant on multiple regression analysis, with a coefficient of determination of 9.5%. Calcium intake, exercise, and alcohol consumption were not significant determinants of BMD. These results suggest that poor lifestyle behaviors (i.e., smoking) accelerate the reduction of bone density.

Difference in the effects of body composition on bone mineral density between pre- and postmenopausal women

Objective: This study was to investigate whether the effect of lean and fat mass component on bone mineral density (BMD) differs between pre- and postmenopausal women. Materials and methods: Subjects were 360 pre- and 193 postmenopausal Japanese women with right side dominance. Age, height, and years since menopause (YSM, in postmenopausal women) were recorded. Body fat and lean body mass were measured by whole body scanning with dual-energy X-ray absorptiometry (DEXA). BMD of the vertical axis (L2-4 of the lumbar spine, pelvis, bilateral legs, and total body) and horizontal axis (arms) were also measured by DEXA. Results: In premenopausal women, lean body mass was independently correlated with BMD of the left arm (partial correlation coefficient=0.417), right arm (0.430), L2-4 (0.285), pelvis (0.276), left leg (0.403), right leg (0.412), and total body (0.377) ( P<0.001). However, body fat mass was not correlated with several BMD sites except for pelvis BMD (0.187, P<0.01). In postmenopausal women, body fat mass was independently correlated with BMD of the left arm (0.248, P<0.01), L2-4 (0.188, P<0.05), pelvis (0.263, P<0.01), left leg (0.228, P<0.01), right leg (0.319, P<0.001), and total body (0.188, P<0.01)). However, lean body mass was correlated with BMD in only three segmental regions including left arm (0.175), right arm (0.217), and left leg (0.210; P<0.05). Conclusion: Lean body mass is a significant determinant of BMD in premenopausal women, while body fat mass is a significant determinant in postmenopausal women.

AED Effects on Bone Density.

AED Effects on Bone Density.

Difference in the effect of adiposity on bone density between pre- and postmenopausal women

Objectives: Elevated bone mineral density (BMD) in obese women is partially attributable to the higher circulating estrogen levels derived from extraglandular aromatization in adipose tissue. However, it remains unclear whether there is an effect of overall adiposity on BMD in both pre- and postmenopausal women. The difference in the effect of overall adiposity on BMD between pre- and postmenopausal women was investigated. Materials and methods: Subjects were 296 premenopausal women with regular menstruation and 233 postmenopausal women. Age, age at menarche, years since menopause (YSM, in postmenopausal women), weight, height, and body mass index were recorded. Total fat mass amount, lean mass amount, and percentage of body fat were measured by whole body scanning with dual-energy X-ray absorptiometry (DEXA). Lumbar spine BMD (L2–L4) was measured by DEXA. In each group, significant determinants of BMD were investigated using univariate and stepwise multiple regression analysis. Results: In postmenopausal women, YSM, lean mass amount, total fat mass amount, and height were significant determinants of BMD ( R 2=0.273, P<0.001). In premenopausal women, only two variables including lean mass amount and age at menarche were significant determinants of lumbar spine BMD ( R 2=0.110, P<0.001), but total fat mass amount and percentage of body fat were not significant determinants of BMD. Conclusion: The effect of overall adiposity on BMD is more prominent in postmenopausal women than in premenopausal women.

The effect of body composition on bone density in pre- and postmenopausal women.

To investigate the relative contribution of body composition (lean and fat) to bone mineral density (BMD), 196 premenopausal and 128 postmenopausal Japanese women were enrolled. Total fat mass, total lean mass, lumbar BMD (L2-L4), and total body BMD were measured by dual-energy X-ray absorptiometry (DEXA, Hologic QDR 2000, MA. USA). Physical characteristics were also recorded for each subject. Correlation between BMD and variables were calculated for each of the two groups in single and stepwise regression analyses. Total lean mass was significantly higher in premenopausal women than postmenopausal women (P < 0.0001), while body weight, body mass index, and total fat mass were not different between the two groups. In stepwise regression analysis, total lean mass was the most powerful determinant of lumbar BMD and total body BMD in premenopausal women. In postmenopausal women, total fat mass was the most significant determinant of lumbar BMD, while total lean mass was the most significant determinant of total body BMD. These findings suggest that there is a difference between pre- and postmenopausal women in the relative contribution of lean and fat mass. Total lean mass is the most significant determinant of BMD in premenopausal women. On the other hand, total fat mass may have some advantages in maintaining BMD in postmenopausal women.

Determinants of premenopausal bone mineral density: the interplay of genetic and lifestyle factors.

Bone mineral density (BMD) is a reflection of both genetic and lifestyle factors. The interplay of genetic (vitamin D receptor [VDR] gene polymorphisms) and lifestyle factors on BMD at the lumbar spine and proximal femur was examined in 470 healthy premenopausal women, aged 44-50 years, using a Hologic QDR 2000 densitometer. The objective of this study was to examine the genetic and lifestyle determinants of premenopausal BMD. Each participant was genotyped for BsmI polymorphism at the VDR gene locus. The presence of a restriction site within VDR, specified as bb (189, 40.2%) (n, %) was associated with reduced spinal BMD, whereas absence of this site in BB (97, 20.6%) conferred greater spinal BMD, as did the genotype Bb (184, 39.1%). Associations between smoking, alcohol use, oral contraceptives, education level, multivitamins, number of children, degree of obesity, body weight, physical activity, dietary calcium intake, and VDR genotype to BMDs were examined. VDR genotype, body weight, degree of obesity, physical activity, and dietary calcium intake were all significant determinants of BMD. The association of VDR genotype with BMD at the femoral neck appeared to be modified by calcium intake (BB and Bb: 0.797 +/- 0.11 g/cm2 vs. 0.844 +/- 0.11 g/cm2, interaction term, p = 0.06) for low (< 1036 mg/day) and high (> or = 1036 mg/day; upper quartile) calcium intakes, respectively. A similar trend was demonstrated for physical activity. These findings suggest that prophylactic interventions aimed at achieving and maintaining optimal BMD, such as greater calcium intake or physical activity, may be important in maximizing one's genetic potential for BMD.

Bone density of the radius, spine, and hip in relation to percent of ideal body weight in postmenopausal women

Bone mineral content (BMC) and bone mineral density (BMD) of the spine (L2-L4) and hip (at femoral neck, Ward's triangle, and greater trochanter sites) were determined by dual-photon absorptiometry (DPA), and of the radius by single-photon absorptiometry (SPA) in healthy postmenopausal women aged 40-70 years. The relationships of BMC and BMD to years since menopause were examined separately in 97 women who were above 115% of ideal body weight (IBW) and in 128 women below. The heavier women had significantly greater mean BMC and BMD at each site than did the normal-weight women. In the normal-weight women, there was a significant negative correlation between BMD and years since menopause at each measurement site except the greater trochanter. In the obese women, BMD decreased with increasing years since menopause at the radius site only and BMC declined with increasing years after menopause at the hip (femoral neck and Ward's triangle region) as well as the radius. Thus, body size is a significant determinant of BMD in this population. The pattern of loss of BMD from Ward's triangle and femoral neck regions of hip are similar to that of the spine. The BMC and BMD findings in the hip suggest that remodeling occurs at this weight-bearing site which has a favorable effect on bone strength.