Yonsei Med J.  2010 Nov;51(6):857-863. 10.3349/ymj.2010.51.6.857.

Relation between Obesity and Bone Mineral Density and Vertebral Fractures in Korean Postmenopausal Women

Affiliations
  • 1Department of Family Medicine, Mizmedi Hospital, Seoul, Korea.
  • 2Graduate Program in Science for Aging, The Graduate School, Yonsei University College of Medicine, Seoul, Korea.
  • 3Sports and Medicine Research Center, INTOTO Inc., Seoul, Korea.
  • 4Department of Family Medicine, Yonsei University College of Medicine, Seoul, Korea. faith@yuhs.ac

Abstract

PURPOSE
The traditional belief that obesity is protective against osteoporosis has been questioned. Recent epidemiologic studies show that body fat itself may be a risk factor for osteoporosis and bone fractures. Accumulating evidence suggests that metabolic syndrome and the individual components of metabolic syndrome such as hypertension, increased triglycerides, and reduced high-density lipoprotein cholesterol are also risk factors for low bone mineral density. Using a cross sectional study design, we evaluated the associations between obesity or metabolic syndrome and bone mineral density (BMD) or vertebral fracture.
MATERIALS AND METHODS
A total of 907 postmenopausal healthy female subjects, aged 60-79 years, were recruited from woman hospitals in Seoul, South Korea. BMD, vetebral fracture, bone markers, and body composition including body weight, body mass index (BMI), percentage body fat, and waist circumference were measured.
RESULTS
After adjusting for age, smoking status, alcohol consumption, total calcium intake, and total energy intake, waist circumference was negatively related to BMD of all sites (lumbar BMD p = 0.037, all sites of femur BMD p < 0.001) whereas body weight was still positively related to BMD of all sites (p < 0.001). Percentage body fat and waist circumference were much higher in the fracture group than the non-fracture group (p = 0.0383, 0.082 respectively). Serum glucose levels were postively correlated to lumbar BMD (p = 0.016), femoral neck BMD (p = 0.0335), and femoral trochanter BMD (p = 0.0082). Serum high density lipoprotein cholesterol (HDLC) was positively related to femoral trochanter BMD (p = 0.0366) and was lower in the control group than the fracture group (p = 0.011).
CONCLUSION
In contrast to the effect favorable body weight on bone mineral density, high percentage body fat and waist circumference are related to low BMD and a vertebral fracture. Some components of metabolic syndrome were related to BMD and a vertebral fracture.

Keyword

Obesity; metabolic syndrome; bone mineral density; vertebral fracture

MeSH Terms

Aged
Blood Glucose/metabolism
Body Composition
Body Mass Index
Body Weight
*Bone Density
Female
Humans
Middle Aged
Obesity/*complications/diagnosis
Overweight
*Postmenopause
Republic of Korea
Risk Factors
Spinal Fractures/*complications/diagnosis

Figure

  • Fig. 1 Odds ratios of vertebral fractures according to adiposity variables. All variables are adjusted for age, smoking status, alcohol consumption, total calcium intake, total energy expenditure, and total calorie intake and variable of Wt (kg) and BMI are additionally adjusted by body fat (%), whereas variable of body fat (%) and waist (cm) are adjusted by Wt (kg), respectively. BMI: body mass indices.


Cited by  4 articles

Effect of Childbirth Age on Bone Mineral Density in Postmenopausal Women
Ji Sun We, Kyungdo Han, Hyuk-Sang Kwon, Kicheol Kil
J Korean Med Sci. 2018;33(48):.    doi: 10.3346/jkms.2018.33.e311.

The Positive Association between Peripheral Blood Cell Counts and Bone Mineral Density in Postmenopausal Women
Hack-Lyoung Kim, Hwa Young Cho, In Young Park, Jin Man Choi, Min Kim, Ho Jin Jang, Se-Min Hwang
Yonsei Med J. 2011;52(5):739-745.    doi: 10.3349/ymj.2011.52.5.739.

Osteoporosis Risk Prediction for Bone Mineral Density Assessment of Postmenopausal Women Using Machine Learning
Tae Keun Yoo, Sung Kean Kim, Deok Won Kim, Joon Yul Choi, Wan Hyung Lee, Ein Oh, Eun-Cheol Park
Yonsei Med J. 2013;54(6):1321-1330.    doi: 10.3349/ymj.2013.54.6.1321.

Association Between Osteoporotic Vertebral Fracture and Body Mass Index
Hyun Tae Kim, Hyeong Yeon Seo
J Korean Soc Spine Surg. 2016;23(3):160-165.    doi: 10.4184/jkss.2016.23.3.160.


Reference

1. Douchi T, Yamamoto S, Oki T, Maruta K, Kuwahata R, Yamasaki H, et al. Difference in the effect of adiposity on bone density between pre- and postmenopausal women. Maturitas. 2000. 34:261–266.
Article
2. Guney E, Kisakol G, Ozgen G, Yilmaz C, Yilmaz R, Kabalak T. Effect of weight loss on bone metabolism: comparison of vertical banded gastroplasty and medical intervention. Obes Surg. 2003. 13:383–388.
3. Radak TL. Caloric restriction and calcium's effect on bone metabolism and body composition in overweight and obese premenopausal women. Nutr Rev. 2004. 62:468–481.
Article
4. Filip R, Raszewski G. Bone mineral density and bone turnover in relation to serum leptin, alpha-ketoglutarate and sex steroids in overweight and obese postmenopausal women. Clinical Endocrinol (Oxf). 2009. 70:214–220.
Article
5. Reid IR. Relationships among body mass, its components, and bone. Bone. 2002. 31:547–555.
Article
6. Zhao LJ, Liu YJ, Liu PY, Hamilton J, Recker RR, Deng HW. Relationship of obesity with osteoporosis. J Clin Endocrinol Metab. 2007. 92:1640–1646.
Article
7. Hsu YH, Venners SA, Terwedow HA, Feng Y, Niu T, Li Z, et al. Relation of body composition, fat mass, and serum lipids to osteoporotic fractures and bone mineral density in Chinese men and women. Am J Clin Nutr. 2006. 83:146–154.
8. Janicka A, Wren TA, Sanchez MM, Dorey F, Kim PS, Mittelman SD, et al. Fat mass is not beneficial to bone in adolescents and young adults. J Clin Endocrinol Metab. 2007. 92:143–147.
9. Rosen CJ, Bouxsein ML. Mechanisms of disease: is osteoporosis the obesity of bone? Nat Clin Pract Rheumatol. 2006. 2:35–43.
Article
10. Meunier P, Aaron J, Edouard C, Vignon G. Osteoporosis and the replacement of cell populations of the marrow by adipose tissue. A quantitative study of 84 iliac bone biopsies. Clin Orthop Relat Res. 1971. 80:147–154.
Article
11. Lecka-Czernik B, Moerman EJ, Grant DF, Lehmann JM, Manolagas SC, Jilka RL. Divergent effects of selective peroxisome proliferator-activated receptor-gamma 2 ligands on adipocyte versus osteoblast differentiation. Endocrinology. 2002. 143:2376–2384.
Article
12. Akune T, Ohba S, Kamekura S, Yamaguchi M, Chung UI, Kubota N, et al. PPARgamma insufficiency enhances osteogenesis through osteoblast formation from bone marrow progenitors. J Clin Invest. 2004. 113:846–855.
Article
13. Cornish J, Callon KE, Bava U, Lin C, Naot D, Hill BL, et al. Leptin directly regulates bone cell function in vitro and reduces bone fragility in vivo. J Endocrinol. 2002. 175:405–415.
Article
14. Luo XH, Guo LJ, Xie H, Yuan LQ, Wu XP, Zhou HD, et al. Adiponectin stimulates RANKL and inhibits OPG expression in human osteoblasts through the MAPK signaling pathway. J Bone Miner Res. 2006. 21:1648–1656.
Article
15. Luo XH, Guo LJ, Yuan LQ, Xie H, Zhou HD, Wu XP, et al. Adiponectin stimulates human osteoblasts proliferation and differentiation via the MAPK signaling pathway. Exp Cell Res. 2005. 309:99–109.
Article
16. Steppan CM, Crawford DT, Chidsey-Frink KL, Ke H, Swick AG. Leptin is a potent stimulator of bone growth in ob/ob mice. Regul Pept. 2000. 92:73–78.
17. Tong PC, Kong AP, So WY, Yang X, Ho CS, Ma RC, et al. The usefulness of the International Diabetes Federation and the National Cholesterol Education Program's Adult Treatment Panel III definitions of the metabolic syndrome in predicting coronary heart disease in sub-jects with type 2 diabetes. Diabetes Care. 2007. 30:1206–1211.
18. Ferrar L, Jiang G, Adams J, Eastell R. Identification of vertebral fractures: an update. Osteoporos Int. 2005. 16:717–728.
Article
19. Ribas-Barba L, Serra-Majem L, Román-Viñas B, Ngo J, García-Alvarez A. Effects of dietary assessment methods on assessing risk of nutrient intake adequacy at the population level: from theory to practice. Br J Nutr. 2009. 101:Suppl 2. S64–S72.
20. Kim WY, Kim JE, Choi YJ, Huh KB. Nutritional risk and metabolic syndrome in Korean type 2 diabetes mellitus. Asia Pac J Clin Nutr. 2008. 17:Suppl 1. 47–51.
21. Holecki M, Zahorska-Markiewicz B, Wiecek A, Nieszporek T, Zak-Golab A. [Obesity and bone metabolism]. Endokrynol Pol. 2008. 59:218–223.
22. Cui LH, Shin MH, Kweon SS, Park KS, Lee YH, Chung EK, et al. Relative contribution of body composition to bone mineral density at different sites in men and women of South Korea. J Bone Miner Metab. 2007. 25:165–171.
Article
23. El Hage RP, Courteix D, Benhamou CL, Jacob C, Jaffré C. Relative importance of lean and fat mass on bone mineral density in a group of adolescent girls and boys. Eur J Appl Physiol. 2009. 105:759–764.
Article
24. Lekamwasam S, Weerarathna T, Rodrigo M, Arachchi WK, Munidasa D. Association between bone mineral density, lean mass, and fat mass among healthy middle-aged premenopausal women: a cross-sectional study in southern Sri Lanka. J Bone Miner Metab. 2009. 27:83–88.
Article
25. Leslie WD, Miller N, Rogala L, Bernstein CN. Body mass and composition affect bone density in recently diagnosed inflammatory bowel disease: the Manitoba IBD Cohort Study. Inflamm Bowel Dis. 2009. 15:39–46.
Article
26. Tarquini B, Navari N, Perfetto F, Piluso A, Romano S, Tarquini R. Evidence for bone mass and body fat distribution relationship in postmenopausal obese women. Arch Gerontol Geriatr. 1997. 24:15–21.
Article
27. Carrasco F, Ruz M, Rojas P, Csendes A, Rebolledo A, Codoceo J, et al. Changes in bone mineral density, body composition and adiponectin levels in morbidly obese patients after bariatric surgery. Obes Surg. 2009. 19:41–46.
28. von Muhlen D, Safii S, Jassal SK, Svartberg J, Barrett-Connor E. Associations between the metabolic syndrome and bone health in older men and women: the Rancho Bernardo Study. Osteoporos Int. 2007. 18:1337–1344.
29. McFarlane SI. Bone metabolism and the cardiometabolic syndrome: pathophysiologic insights. J Cardiometab Syndr. 2006. 1:53–57.
Article
30. Cui LH, Shin MH, Chung EK, Lee YH, Kweon SS, Park KS, et al. Association between bone mineral densities and serum lipid profiles of pre- and post-menopausal rural women in South Korea. Osteoporos Int. 2005. 16:1975–1981.
Article
31. Yamaguchi T, Sugimoto T, Yano S, Yamauchi M, Sowa H, Chen Q, et al. Plasma lipids and osteoporosis in postmenopausal women. Endocr J. 2002. 49:211–217.
Article
32. Pinheiro MM, Ciconelli RM, Martini LA, Ferraz MB. Clinical risk factors for osteoporotic fractures in Brazilian women and men: the Brazilian Osteoporosis Study (BRAZOS). Osteoporos Int. 2009. 20:399–408.
Article
33. Melton LJ 3rd, Leibson CL, Achenbach SJ, Therneau TM, Khosla S. Fracture risk in type 2 diabetes: update of a population-based study. J Bone Miner Res. 2008. 23:1334–1342.
Article
34. Hisa I, Kaji H, Inoue Y, Sugimoto T, Chihara K. Fasting plasma glucose levels are related to bone mineral density in postmenopausal women with primary hyperparathyroidism. Int J Clin Exp Med. 2008. 1:319–326.
35. Sivas F, Alemdaroğlu E, Elverici E, Kuluğ T, Ozoran K. Serum lipid profile: its relationship with osteoporotic vertebrae fractures and bone mineral density in Turkish postmenopausal women. Rheumatol Int. 2009. 29:885–890.
Article
36. Brownbill RA, Ilich JZ. Lipid profile and bone paradox: higher serum lipids are associated with higher bone mineral density in postmenopausal women. J Womens Health (Larchmt). 2006. 15:261–270.
Article
37. D'Amelio P, Di Bella S, Tamone C, Ravazzoli MG, Cristofaro MA, Di Stefano M, et al. HDL cholesterol and bone mineral density in normal-weight postmenopausal women: is there any possible association? Panminerva Med. 2008. 50:89–96.
38. Dennison EM, Syddall HE, Aihie Sayer A, Martin HJ, Cooper C. Hertfordshire Cohort Study Group. Lipid profile, obesity and bone mineral density: the Hertfordshire Cohort Study. QJM. 2007. 100:297–303.
Article
39. Makovey J, Chen JS, Hayward C, Williams FM, Sambrook PN. Association between serum cholesterol and bone mineral density. Bone. 2009. 44:208–213.
Article
40. Kuwahata A, Kawamura Y, Yonehara Y, Matsuo T, Iwamoto I, Douchi T. Non-weight-bearing effect of trunk and peripheral fat mass on bone mineral density in pre- and post-menopausal women. Maturitas. 2008. 60:244–247.
Article
41. Chen C, Tong N, Ran X, Yang D. [The relationship between obesity, intra-abdominal fat area and bone mineral density and bone strength]. Sheng Wu Yi Xue Gong Cheng Xue Za Zhi. 2002. 19:471–472. 475
42. Farrell TJ, Webber CE. The error due to fat inhomogeneity in lumbar spine bone mineral measurements. Clin Phys Physiol Meas. 1989. 10:57–64.
Article
Full Text Links
  • YMJ
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr