Skip to main content

Advertisement

SpringerLink
Log in

Risk factors for low bone mineral density and the 6-year rate of bone loss among premenopausal and perimenopausal women

  • Original Article
  • Published:
Osteoporosis International Aims and scope Submit manuscript

Abstract

Risk factors that are associated with lower bone mineral density (BMD) may not necessarily be associated with increased bone loss among premenopausal and perimenopausal women. We determined risk factors for lower premenopausal and perimenopausal BMD while simultaneously determining risk factors for increased 6-year rate of bone loss among women aged 24–50 years within a population-based prospective cohort study. BMD of the lumbar spine and femoral neck, reported as t scores, were measured five times within the 6-year study among 614 women who were between the ages of 24 and 44 in 1992/1993. Rates of bone loss were calculated from the repeated BMD measurements. Risk factors for lower BMD over time at the lumbar spine included history of any fracture (P=0.005). The major risk factor for lower BMD over time at the femoral neck was family history of osteoporosis (P<0.002). The major protective factor for greater BMD over time at both skeletal sites was additional body weight (P<0.0001). Other protective factors for greater BMD over time at the femoral neck were modest alcohol consumption (P=0.0002) and high-school sports participation (P=0.002). Risk factors for greater bone loss at either skeletal site included postmenopausal status (P<0.0001 at the lumbar spine; P=0.01 at the femoral neck), and the reporting of a reproductive cancer (P<0.0001 at the lumbar spine; P=0.0008 at the femoral neck). Body weight was protective against bone loss at both skeletal sites (P<0.0001). Baseline age, calcium intake, smoking, and current physical activity were not associated with BMD or bone loss. The understanding of the relative importance of risk factors for both low BMD and bone loss may assist in the identification of women at greater risk for subsequent low postmenopausal BMD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Sowers MF (2000) Lower peak bone mass and its decline. Baillieres Clin Endocrinol Metab 14:317–329

    Article  CAS  Google Scholar 

  2. Bainbridge KE, Sowers MF, Crutchfield M, et al (2002) Natural history of bone loss over 6 years among premenopausal and early postmenopausal women. Am J Epidemiol 156:410–417

    Article  CAS  PubMed  Google Scholar 

  3. Melton LJ, Atkinson EJ, O’Connor MK, et al (2000) Determinants of bone loss from the femoral neck in women of different ages. J Bone Miner Res 15:24–31

    PubMed  Google Scholar 

  4. Sowers MF, Crutchfield M, Bandekar R, et al (1998) Bone mineral density and its change in pre- and perimenopausal white women: The Michigan Bone Health Study. J Bone Miner Res 13:1124–1140

    Google Scholar 

  5. Revilla M, Villa LF, Hernandez ER, et al (1997) Influence of weight and gonadal status on total and regional bone mineral content and on weight-bearing and non-weight bearing bones, measured by dual-energy X-ray absorptiometry. Maturitas 28:69–74

    Article  CAS  PubMed  Google Scholar 

  6. Sowers MF, Kshirsagar A, Crutchfield MM, et al (1992) Joint influence of fat and lean body composition compartments on femoral bone mineral density in premenopausal women. Am J Epidemiol 136:257–265

    CAS  PubMed  Google Scholar 

  7. Snow-Harter CM (1994) Bone health and prevention of osteoporosis in active and athletic women. Clin Sports Med 13:389–404

    CAS  PubMed  Google Scholar 

  8. Sowers MFR, Galuska DA (1993) Epidemiology of bone mass in premenopausal women. Epidemiol Rev 15:374–398

    CAS  PubMed  Google Scholar 

  9. Sowers MF (1996) Pregnancy and lactation as risk factors for subsequent bone loss and osteoporosis. J Bone Miner Res 11:1052–1060

    CAS  PubMed  Google Scholar 

  10. Lloyd T, Taylor DS (2001) Calcium intake and peak bone mass. J Am Med Womens Assoc 56:49–52

    CAS  PubMed  Google Scholar 

  11. Tudor-Locke C, McColl RS (2000) Factors related to variation in premenopausal bone mineral status: a health promotion approach. Osteoporos Int 11:1–24

    Article  CAS  PubMed  Google Scholar 

  12. Hall SL, Greendale GA (1998) The relation of dietary vitamin C intake to bone mineral density: results from the PEPI study. Calcif Tissue Int 63:183–189

    Article  CAS  PubMed  Google Scholar 

  13. Leveille SG, LaCroix AZ, Koepsell TD, et al (1997) Dietary vitamin C and bone mineral density in postmenopausal women in Washington State, USA. J Epidemiol Community Health 51:479–485

    CAS  PubMed  Google Scholar 

  14. Sowers MFR, Wallace RB (1990) Retinol, supplemental vitamin A and bone status. J Clin Epidemiol 43:693–699

    CAS  PubMed  Google Scholar 

  15. Laitinen K, Valimaki M (1991) Alcohol and bone. Calcif Tissue Int 49[Suppl]:S70–S73

  16. Law MR, Hackshaw AK (1997) A meta-analysis of cigarette smoking, bone mineral density and risk of hip fracture: recognition of a major effect. BMJ 315:841–846

    CAS  PubMed  Google Scholar 

  17. Snow CM (1996) Exercise and bone mass in young and premenopausal women. Bone 18:51S–55S

    Article  CAS  PubMed  Google Scholar 

  18. Laatikainen AK, Kroger HP, Tukiainen HO, et al (1999) Bone mineral density in perimenopausal women with asthma: a population-based cross-sectional study. Am J Respir Crit Care Med 159:1179–1185

    CAS  PubMed  Google Scholar 

  19. Pfeilschifter J, Diel IJ (2000) Osteoporosis due to cancer treatment: pathogenesis and management. J Clin Oncol 18:1570–1593

    CAS  PubMed  Google Scholar 

  20. Pollitzer WS, Anderson JJB (1989) Ethnic and genetic differences in bone mass: a review with a hereditary vs environmental perspective. Am J Clin Nutr 50:1244–1259

    CAS  PubMed  Google Scholar 

  21. Hunter DJ, de Lange M, Andrew T, et al (2001) Genetic variation in bone mineral density and calcaneal ultrasound: a study of the influence of menopause using female twins. Osteoporos Int 12:406–411

    Article  CAS  PubMed  Google Scholar 

  22. Lips P (1997) Epidemiology and predictors of fractures associated with osteoporosis. Am J Med 103:20S–26S

    CAS  PubMed  Google Scholar 

  23. Gilfillan C, Silberberg S, Scrivenor P, et al (1994) Determinants of forearm mineral density and its correlation with fracture history in women. Maturitas 20:199–208

    CAS  PubMed  Google Scholar 

  24. Honkanen R, Kroger H, Tuppurainen M, et al (1995) Fractures and low axial bone density in perimenopausal women. J Clin Epidemiol 48:881–888

    Article  CAS  PubMed  Google Scholar 

  25. Mazess RB, Barden HS (1991) Bone density in premenopausal women: effects of age, dietary intake, physical activity, smoking, and birth control pills. Am J Clin Nutr 53:132–142

    Google Scholar 

  26. Bray GA (1987) Overweight is risking fate: definition, classification, prevalence and risks. Ann N Y Acad Sci 499:14–28

    Google Scholar 

  27. Block G, Hartman AM, Dresser CM, et al (1986) A data-based approach to diet questionnaire design and testing. Am J Epidemiol 124:453–469

    CAS  PubMed  Google Scholar 

  28. National Cancer Institute (1993) HHHQ-DIETSYS Analysis software, version 3.0

  29. Bowes and Church’s food values of portions commonly used (1980) In: Pennington JAT, Church HN (eds). Harper and Row, New York, NY, USA

  30. Sallis JF, Haskell WL, Wood PD, et al (1985) Physical activity assessment methodology in the five-city project. Am J Epidemiol 121:91–106

    CAS  PubMed  Google Scholar 

  31. SAS proprietary software, release 6.12; SAS Institute, Cary, NC, USA

  32. Diggle PJ, Liang K-Y, Zeger S (1994) Analysis of longitudinal data. Clarendon Press, Oxford

  33. Sowers MF, Kshirsagar A, Crutchfield M, et al (1991) Body composition, age and femoral bone mass of young adult women. Ann Epidemiol 1:245–254

    CAS  PubMed  Google Scholar 

  34. Torgerson DJ, Campbell MK, Reid DM (1995) Life-style, environmental and medical factors influencing peak bone mass in women. Br J Rheumatol 34:620–624

    CAS  PubMed  Google Scholar 

  35. New SA, Bolton-Smith C, Grubb DA, et al (1997) Nutritional influences on bone mineral density: a cross-sectional study in premenopausal women. Am J Clin Nutr 65:1831–1839

    CAS  PubMed  Google Scholar 

  36. Harris S, Dallal GE, Dawson-Hughes B (1992) Influence of body weight on rates of change in bone density of the spine, hip, and radius in postmenopausal women. Calcif Tissue Int 50:19–23

    CAS  PubMed  Google Scholar 

  37. Tremollieres FA, Pouilles J-M, Ribot C (1993) Vertebral postmenopausal bone loss is reduced in overweight women: a longitudinal study in 155 early postmenopausal women. J Clin Endocrinol Metab 77:683–696

    PubMed  Google Scholar 

  38. Ravn P, Cizza G, Bjarnason NH, et al (1999) Low body mass index is an important risk factor for low bone mass and increased bone loss in early postmenopausal women. J Bone Miner Res 14:1622–1627

    CAS  PubMed  Google Scholar 

  39. Brot C, Jensen LB, Sorensen OH (1997) Bone mass and risk factors for bone loss in perimenopausal Danish women. J Int Med 242:505–511

    CAS  Google Scholar 

  40. Rubin CT, Lanyon LE (1985) Regulation of bone mass by mechanical strain magnitude. Calcif Tissue Int 37:411–417

    CAS  PubMed  Google Scholar 

  41. Reid IR, Plank LD, Evans MC (1992) Fat mass is an important determinant of whole body bone density in premenopausal women but not in men. J Clin Endocrinol Metab 75:779–782

    Google Scholar 

  42. Reid IR (2002) Relationships among body mass, its components, and bone. Bone 31:547–555

    Article  CAS  PubMed  Google Scholar 

  43. Zmuda JM, Cauley JA, Ljung B-M, Bauer DC, Cummings SR, Kuller LH (2001) Bone mass and breast cancer risk in older women: differences by stage at diagnosis. J Natl Cancer Inst 93:930–936

    Article  CAS  PubMed  Google Scholar 

  44. Zhang Y, Kiel DP, Kreger BE, Cupples LA, Ellison C, Dorgan JF, Schatzkin, A, Levy D, Felson DT (1997) Bone mass and the risk of breast cancer among postmenopausal women. N Engl J Med 336:611–617

    Article  CAS  PubMed  Google Scholar 

  45. Danielson ME, Cauley JA, Baker CE, et al (1999) Familial resemblance of bone mineral density (BMD) and calcaneal ultrasound attenuation: the BMD in mothers and daughters study. J Bone Miner Res 14:102–110

    Google Scholar 

  46. Cox ML, Khan SA, Gau DW, et al (1991) Determinants of forearm bone density in premenopausal women: a study in one general practice. Br J Gen Pract 41:194–196

    CAS  PubMed  Google Scholar 

  47. Goulding A, Gold E, Walker R, et al (1997) Women with past history of bone fracture have low spinal bone density before menopause. N Z Med J 110:232–233

    Google Scholar 

  48. Honkanen R, Kroger H, Tuppurainen M, et al (1995) Fractures and low axial bone density in perimenopausal women. J Clin Epidemiol 48:881–888

    Article  CAS  PubMed  Google Scholar 

  49. Sabatier JP, Guaydier-Souquieres G, Benmalek A, et al (1999) Evolution of lumbar bone mineral content during adolescence and adulthood: a longitudinal study in 395 healthy females 10–24 years of age and 206 premenopausal women. Osteoporos Int 9:476–482

    Article  CAS  PubMed  Google Scholar 

  50. Lloyd T, Chinchilli VM, Johnson-Rollings N, et al (2000) Adult female hip bone density reflects teenage sports–exercise patterns but not teenage calcium intake. Pediatrics 106:40–44

    CAS  PubMed  Google Scholar 

  51. Feskanich D, Korrick SA, Greenspan SL, et al (1999) Moderate alcohol consumption and bone density among postmenopausal women. J Womens Health 8:65–73

    CAS  PubMed  Google Scholar 

  52. Holbrook TL, Barrett-Connor E (1993) A prospective study of alcohol consumption and bone mineral density. BMJ 306:1506–1509

    CAS  PubMed  Google Scholar 

  53. Clark K, Sowers MF (1996) Alcohol dependence, smoking status, reproductive characteristics, and bone mineral density in premenopausal women. Res Nurs Health 19:399–408

    Article  CAS  PubMed  Google Scholar 

  54. Reichman ME, Judd JT, Longcope C, et al (1993) Effects of alcohol consumption on plasma and urinary hormone concentrations in premenopausal women. J Natl Cancer Inst 85:722–727

    CAS  PubMed  Google Scholar 

  55. Rico H (1990) Alcohol and bone disease. Alcohol Alcohol 25:345–352

    CAS  PubMed  Google Scholar 

  56. Laitinen K, Lamberg-Allardt C, Tunninen R, et al (1991) Transient hypoparathyroidism during acute alcohol intoxication. N Engl J Med 324:721–727

    CAS  PubMed  Google Scholar 

  57. Daniell HW (1976) Osteoporosis of the slender smoker. Vertebral compression fractures and loss of metacarpal cortex in relation to postmenopausal cigarette smoking and lack of obesity. Arch Intern Med 136:298–304

    PubMed  Google Scholar 

  58. Ortego-Centeno N, Munoz-Torres M, Hernandez-Quero J, et al (1994) Bone mineral density, sex steroids, and mineral metabolism in premenopausal smokers. Calcif Tissue Int 55:403–407

    CAS  PubMed  Google Scholar 

  59. Michnovicz JJ, Hershcopf RJ, Naganuma H, et al (1986) Increased 2-hydroxylation of estradiol as a possible mechanism for the anti-estrogenic effect of cigarette smoking. N Engl J Med 315:1305–1309

    PubMed  Google Scholar 

  60. Jensen GF (1986) Osteoporosis of the slender smoker revisited by epidemiologic approach. Eur J Clin Invest 16:239–242

    CAS  PubMed  Google Scholar 

  61. LaPorte RE, Montoye HJ, Casperson CJ (1985) Assessment of physical activity in epidemiologic research: problems and prospects. Public Health Rep 100:131–146

    CAS  PubMed  Google Scholar 

  62. Todd KS, Hudes M, Calloway DH (1983) Food intake measurement: problems and approaches. Am J Clin Nutr 37:139–146

    CAS  PubMed  Google Scholar 

Download references

Acknowledgement

Funding was obtained by AR R01–40888 (Sowers, PI) and AR P60–20557 (Sowers, PI). We acknowledge Mary Crutchfield and Mary Jannausch for their contributions to data collection and management.

Author information

Authors and Affiliations

  1. Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA

    Kathleen E. Bainbridge, MaryFran Sowers & Sioban D. Harlow

  2. Suite 310, 339 East Liberty, Ann Arbor, Michigan, 48104, USA

    MaryFran Sowers

  3. Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA

    Xihong Lin

Authors
  1. Kathleen E. Bainbridge
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. MaryFran Sowers
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Xihong Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sioban D. Harlow
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to MaryFran Sowers.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bainbridge, K.E., Sowers, M., Lin, X. et al. Risk factors for low bone mineral density and the 6-year rate of bone loss among premenopausal and perimenopausal women. Osteoporos Int 15, 439–446 (2004). https://doi.org/10.1007/s00198-003-1562-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00198-003-1562-5

Keywords

Search

Navigation