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Body mass index is positively associated with bone mineral density in US older adults

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Abstract

Summary

Literature has been conflicting as to whether obesity is protective against osteoporosis. Understanding the relationship is particularly important in light of the increasing prevalence of obesity among older adults. Study results confirm a protective association between obesity and osteoporosis in a recent, nationally representative sample of US older adults.

Purpose

Currently, the majority of US older adults are either overweight or obese. Evidence regarding the relationship between body composition measures and bone mass is conflicting, possibly because different measures of obesity reflect multiple mechanisms. Additionally, there are important age, gender, and racial differences in a risk of osteoporosis and fat mass composition. The objective of this study was to examine the association between body mass index (BMI) and bone mineral density (BMD) in a recent, nationally representative sample of US older adults as well as to see if this relationship differs by age, sex, and race.

Methods

Data for this study were obtained from the National Health and Nutrition Examination Survey (2005–2008) for adults ages 50 and older (n = 3,296). Linear regression models were used to predict BMD of the femoral neck (measured by dual-energy X-ray absorptiometry (DXA)) as a function of BMI (measured height and weight) and a range of study covariates.

Results

Every unit increase in BMI was associated with an increase of 0.0082 g/cm2 in BMD (p < 0.001). Interaction terms for BMI and age (p = 0.345), BMI and sex (p = 0.413), and BMI and race (p = 0.725) were not statistically significant.

Conclusions

Study results confirm the positive association between BMI and BMD, and this relationship does not differ by age, sex, or race. A 10-unit increase in BMI (e.g., from normal BMI to obese) would result in moving an individual from an osteoporotic BMD level to a normal BMD level. Results demonstrate a protective, cross-sectional association between obesity and osteoporosis in a recent sample of US older adults.

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References

  1. Wang Y, Beydoun MA (2007) The obesity epidemic in the United States—gender, age, socioeconomic, racial/ethnic, and geographic characteristics: a systematic review and meta-regression analysis. Epidemiol Rev 29:6–28. doi:10.1093/epirev/mxm007

    Article  CAS  PubMed  Google Scholar 

  2. Wang Y, Beydoun MA, Liang L, Caballero B, Kumanyika SK (2008) Will all Americans become overweight or obese? Estimating the progression and cost of the US obesity epidemic. Obesity (Silver Spring) 16:2323–2330. doi:10.1038/oby.2008.351

    Article  Google Scholar 

  3. Zhao LJ, Liu YJ, Liu PY, Hamilton J, Recker RR, Deng HW (2007) Relationship of obesity with osteoporosis. J Clin Endocrinol Metab 92:1640–1646. doi:10.1210/jc.2006-0572

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  4. Nunez NP, Carpenter CL, Perkins SN, Berrigan D, Jaque SV, Ingles SA, Bernstein L, Forman MR, Barrett JC, Hursting SD (2007) Extreme obesity reduces bone mineral density: complementary evidence from mice and women. Obesity (Silver Spring) 15:1980–1987. doi:10.1038/oby.2007.236

    Article  CAS  Google Scholar 

  5. Lin H, Luo Q, He C, Yang L, He H, Wu Y, Lan Q, Xie W, Xiong E (2010) On correlation between body mass index and lumbar spine average bone mineral density: a study in male patients with osteopenia and those with osteoporosis. Sheng Wu Yi Xue Gong Cheng Xue Za Zhi 27:138–141

    PubMed  Google Scholar 

  6. Greco EA, Fornari R, Rossi F, Santiemma V, Prossomariti G, Annoscia C, Aversa A, Brama M, Marini M, Donini LM, Spera G, Lenzi A, Lubrano C, Migliaccio S (2010) Is obesity protective for osteoporosis? Evaluation of bone mineral density in individuals with high body mass index. Int J Clin Pract 64:817–820. doi:10.1111/j.1742-1241.2009.02301.x

    Article  CAS  PubMed  Google Scholar 

  7. Beck TJ, Petit MA, Wu G, LeBoff MS, Cauley JA, Chen Z (2009) Does obesity really make the femur stronger? BMD, geometry, and fracture incidence in the women’s health initiative-observational study. J Bone Miner Res 24:1369–1379. doi:10.1359/jbmr.090307

    Article  PubMed Central  PubMed  Google Scholar 

  8. Albala C, Yanez M, Devoto E, Sostin C, Zeballos L, Santos JL (1996) Obesity as a protective factor for postmenopausal osteoporosis. Int J Obes Relat Metab Disord 20:1027–1032

    CAS  PubMed  Google Scholar 

  9. Asomaning K, Bertone-Johnson ER, Nasca PC, Hooven F, Pekow PS (2006) The association between body mass index and osteoporosis in patients referred for a bone mineral density examination. J Womens Health (Larchmt) 15:1028–1034. doi:10.1089/jwh.2006.15.1028

    Article  Google Scholar 

  10. Siris ES, Miller PD, Barrett-Connor E, Faulkner KG, Wehren LE, Abbott TA, Berger ML, Santora AC, Sherwood LM (2001) Identification and fracture outcomes of undiagnosed low bone mineral density in postmenopausal women: results from the National Osteoporosis Risk Assessment. JAMA 286:2815–2822

    Article  CAS  PubMed  Google Scholar 

  11. Hsu YH, Venners SA, Terwedow HA, Feng Y, Niu T, Li Z, Laird N, Brain JD, Cummings SR, Bouxsein ML, Rosen CJ, Xu X (2006) 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 83:146–154

    CAS  PubMed  Google Scholar 

  12. Bredella MA, Torriani M, Ghomi RH, Thomas BJ, Brick DJ, Gerweck AV, Harrington LM, Breggia A, Rosen CJ, Miller KK (2010) Determinants of bone mineral density in obese premenopausal women. Bone. doi:10.1016/j.bone.2010.12.011

    Google Scholar 

  13. Nielson CM, Marshall LM, Adams AL, Leblanc ES, Cawthon PM, Ensrud K, Stefanick ML, Barrett-Connor E, Orwoll ES, Osteoporotic Fractures in Men (MrOS) Research Group (2010) BMI and fracture risk in older men: the osteoporotic fractures in men (MrOS) study. J Bone Miner Res. doi:10.1002/jbmr.235

    PubMed Central  Google Scholar 

  14. Lips P (1997) Epidemiology and predictors of fractures associated with osteoporosis. Am J Med 103:3S–8S, discussion 8S-11S

    Article  CAS  PubMed  Google Scholar 

  15. Albrand G, Munoz F, Sornay-Rendu E, DuBoeuf F, Delmas PD (2003) Independent predictors of all osteoporosis-related fractures in healthy postmenopausal women: the OFELY study. Bone 32:78–85

    Article  CAS  PubMed  Google Scholar 

  16. Looker AC, Orwoll ES, Johnston CC Jr, Lindsay RL, Wahner HW, Dunn WL, Calvo MS, Harris TB, Heyse SP (1997) Prevalence of low femoral bone density in older U.S. adults from NHANES III. J Bone Miner Res 12:1761–1768. doi:10.1359/jbmr.1997.12.11.1761

    Article  CAS  PubMed  Google Scholar 

  17. Kessenich CR (2000) Osteoporosis and African-American women. Womens Health Issues 10:300–304

    Article  CAS  PubMed  Google Scholar 

  18. Peacock M, Buckwalter KA, Persohn S, Hangartner TN, Econs MJ, Hui S (2009) Race and sex differences in bone mineral density and geometry at the femur. Bone 45:218–225. doi:10.1016/j.bone.2009.04.236

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  19. Hughes VA, Frontera WR, Roubenoff R, Evans WJ, Singh MA (2002) Longitudinal changes in body composition in older men and women: role of body weight change and physical activity. Am J Clin Nutr 76:473–481

    CAS  PubMed  Google Scholar 

  20. Kyle UG, Genton L, Hans D, Karsegard L, Slosman DO, Pichard C (2001) Age-related differences in fat-free mass, skeletal muscle, body cell mass and fat mass between 18 and 94 years. Eur J Clin Nutr 55:663–672. doi:10.1038/sj.ejcn.1601198

    Article  CAS  PubMed  Google Scholar 

  21. Blaak E (2001) Gender differences in fat metabolism. Curr Opin Clin Nutr Metab Care 4:499–502

    Article  CAS  PubMed  Google Scholar 

  22. Katzmarzyk PT, Bray GA, Greenway FL, Johnson WD, Newton RL Jr, Ravussin E, Ryan DH, Smith SR, Bouchard C (2010) Racial differences in abdominal depot-specific adiposity in white and African American adults. Am J Clin Nutr 91:7–15. doi:10.3945/ajcn.2009.28136

    Article  CAS  PubMed  Google Scholar 

  23. National Center for Health Statistics (2007) National Health and Nutrition Examination Survey, 2007–2008: overview

  24. Wardlaw GM (1996) Putting body weight and osteoporosis into perspective. Am J Clin Nutr 63:433S–436S

    CAS  PubMed  Google Scholar 

  25. Ravn P, Cizza G, Bjarnason NH, Thompson D, Daley M, Wasnich RD, McClung M, Hosking D, Yates AJ, Christiansen C (1999) Low body mass index is an important risk factor for low bone mass and increased bone loss in early postmenopausal women. Early Postmenopausal Intervention Cohort (EPIC) study group. J Bone Miner Res 14:1622–1627. doi:10.1359/jbmr.1999.14.9.1622

    Article  CAS  PubMed  Google Scholar 

  26. Shardell MD, Alley DE, Hicks GE, El-Kamary SS, Miller RR, Semba RD, Ferrucci L (2011) Low-serum carotenoid concentrations and carotenoid interactions predict mortality in US adults: the Third National Health and Nutrition Examination Survey. Nutr Res 31:178–189. doi:10.1016/j.nutres.2011.03.003

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  27. De Laet C, Kanis JA, Oden A, Johanson H, Johnell O, Delmas P, Eisman JA, Kroger H, Fujiwara S, Garnero P, McCloskey EV, Mellstrom D, Melton LJ 3rd, Meunier PJ, Pols HA, Reeve J, Silman A, Tenenhouse A (2005) Body mass index as a predictor of fracture risk: a meta-analysis. Osteoporos Int 16:1330–1338. doi:10.1007/s00198-005-1863-y

    Article  PubMed  Google Scholar 

  28. Kanis JA, Borgstrom F, De Laet C, Johansson H, Johnell O, Jonsson B, Oden A, Zethraeus N, Pfleger B, Khaltaev N (2005) Assessment of fracture risk. Osteoporos Int 16:581–589. doi:10.1007/s00198-004-1780-5

    Article  PubMed  Google Scholar 

  29. Kanis JA, Reginster JY (2008) European guidance for the diagnosis and management of osteoporosis in postmenopausal women—what is the current message for clinical practice? Pol Arch Med Wewn 118:538–540

    PubMed  Google Scholar 

  30. Compston J, Cooper A, Cooper C, Francis R, Kanis JA, Marsh D, McCloskey EV, Reid DM, Selby P, Wilkins M, National Osteoporosis Guideline Group (NOGG) (2009) Guidelines for the diagnosis and management of osteoporosis in postmenopausal women and men from the age of 50 years in the UK. Maturitas 62:105–108. doi:10.1016/j.maturitas.2008.11.022

    Article  CAS  PubMed  Google Scholar 

  31. Reid IR, Ames R, Evans MC, Sharpe S, Gamble G, France JT, Lim TM, Cundy TF (1992) Determinants of total body and regional bone mineral density in normal postmenopausal women—a key role for fat mass. J Clin Endocrinol Metab 75:45–51

    CAS  PubMed  Google Scholar 

  32. Reid IR, Ames RW, Evans MC, Sharpe SJ, Gamble GD (1994) Determinants of the rate of bone loss in normal postmenopausal women. J Clin Endocrinol Metab 79:950–954

    CAS  PubMed  Google Scholar 

  33. Sheu Y, Cauley JA (2011) The role of bone marrow and visceral fat on bone metabolism. Curr Osteoporos Rep 9:67–75. doi:10.1007/s11914-011-0051-6

    Article  PubMed Central  PubMed  Google Scholar 

  34. Looker AC, Flegal KM, Melton LJ 3rd (2007) Impact of increased overweight on the projected prevalence of osteoporosis in older women. Osteoporos Int 18:307–313. doi:10.1007/s00198-006-0241-8

    Article  CAS  PubMed  Google Scholar 

  35. Khosla S, Amin S, Orwoll E (2008) Osteoporosis in men. Endocr Rev 29:441–464. doi:10.1210/er.2008-0002

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  36. Castro JP, Joseph LA, Shin JJ, Arora SK, Nicasio J, Shatzkes J, Raklyar I, Erlikh I, Pantone V, Bahtiyar G, Chandler L, Pabon L, Choudhry S, Ghadiri N, Gosukonda P, Muniyappa R, von-Gicyzki H, McFarlane SI (2005) Differential effect of obesity on bone mineral density in White, Hispanic and African American women: a cross sectional study. Nutr Metab (Lond) 2:9. doi:10.1186/1743-7075-2-9

    Article  Google Scholar 

  37. Himes CL, Reynolds SL (2011) Effect of obesity on falls, injury, and disability. J Am Geriatr Soc. doi:10.1111/j.1532-5415.2011.03767.x

    PubMed  Google Scholar 

  38. Premaor MO, Pilbrow L, Tonkin C, Parker RA, Compston J (2010) Obesity and fractures in postmenopausal women. J Bone Miner Res 25:292–297. doi:10.1359/jbmr.091004

    Article  PubMed  Google Scholar 

  39. Robbins J, Schott AM, Azari R, Kronmal R (2006) Body mass index is not a good predictor of bone density: results from WHI, CHS, and EPIDOS. J Clin Densitom 9:329–334. doi:10.1016/j.jocd.2006.02.005

    Article  PubMed  Google Scholar 

  40. National Center for Health Statistics (2007) National Health and Nutrition Examination Survey (NHANES), dual energy X-ray absorptiometry (DXA) procedures manual

  41. Tataranni PA, Ravussin E (1995) Use of dual-energy X-ray absorptiometry in obese individuals. Am J Clin Nutr 62:730–734

    CAS  PubMed  Google Scholar 

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Acknowledgments

Analysis was supported by grants from the National Institutes of Health (T32 4G000262 and R01AG028556).

Conflicts of interest

None.

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Authors and Affiliations

  1. Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, USA

    Dawn E. Alley, William G. Hawkes, Marc C. Hochberg & Denise L. Orwig

  2. Doctoral Program in Gerontology, University of Maryland, Baltimore and Baltimore County, USA

    Jennifer T. Lloyd, Dawn E. Alley, William G. Hawkes, Shari R. Waldstein & Denise L. Orwig

  3. Department of Psychology, University of Maryland, Baltimore, USA

    Shari R. Waldstein

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  1. Jennifer T. Lloyd
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  2. Dawn E. Alley
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Correspondence to Jennifer T. Lloyd.

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Lloyd, J.T., Alley, D.E., Hawkes, W.G. et al. Body mass index is positively associated with bone mineral density in US older adults. Arch Osteoporos 9, 175 (2014). https://doi.org/10.1007/s11657-014-0175-2

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