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Factors associated with bone mineral density in healthy African women

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Abstract

Summary

There is a paucity of normative bone mineral density (BMD) data in healthy African women. Baseline total hip and lumbar spine BMD was measured in premenopausal women. BMD distribution was comparable to that of a reference population and was impacted by several factors including contraception and duration of lactation.

Introduction

Normative data on bone mineral density (BMD) and the cumulative impact of lactation, contraceptive use, and other factors on BMD in healthy African women have not been well studied.

Objectives

The objective of this study was to determine the factors associated with BMD in healthy premenopausal women in Uganda and Zimbabwe.

Methods

Baseline total hip (TH) and lumbar spine (LS) BMD was measured by dual x-ray absorptiometry in 518 healthy, premenopausal black women enrolling in VOICE, an HIV-1 chemoprevention trial, at sites in Uganda and Zimbabwe. Contraceptive and lactation histories, physical activity assessment, calcium intake, and serum vitamin D levels were assessed. Independent factors associated with BMD were identified using an analysis of covariance model.

Results

The study enrolled 331 women from Zimbabwe and 187 women from Uganda. Median age was 29 years (IQR 25, 32) and median body mass index (BMI) was 24.8 kg/m2 (IQR 22.2, 28.6). In univariate analyses, lower TH BMD values were associated with residence in Uganda (p < 0.001), lower BMI (p < 0.001), and any use of and duration of depot-medroxyprogresterone acetate. Use of oral contraceptives, progestin-only implants, and higher physical activity levels were protective against reduced BMD. Similarly, lower LS BMD values were associated with these same factors but also higher parity and history of breastfeeding. In a multivariable analysis, lower TH and LS BMD values were associated with enrollment in Uganda, lower BMI, and lower physical activity level; contraceptive use was associated with lower spine BMD, and breastfeeding contributed to lower total hip BMD.

Conclusions

Among healthy premenopausal women, TH and LS BMD was higher in Zimbabwe than Uganda. Additional factors independently associated with BMD included BMI, physical activity level, contraceptive use, and lactation.

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Acknowledgments

We are grateful to the research participants for their participation in our study. We would also like to thank the Microbicide Trials Network (MTN)-003B Protocol Team, the MTN-003 (VOICE) protocol team, and the UZ-UCSF and MU-JHU research site teams for sample and data collection as well as SCHARP, our data management center. We acknowledge Karen B. Patterson for her dedication in quality control of the scans and other study data. This work would not have been possible without the support of staff of the Osteoporosis Research Center at the University of Pittsburgh.

Funding

The Microbicide Trials Network is funded by the National Institute of Allergy and Infectious Diseases (UM1AI068633, UM1AI068615, UM1AI106707), with co-funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the National Institute of Mental Health, all components of the US National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Visit www.mtnstopshiv.org.

UZ-UCSF Clinical Trials Unit Grant Number - UM1 AI 0694361 I

MU-JHU Clinical Trials Unit Grant Number - UM1 AI069530

Conflicts of interest

None.

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Authors and Affiliations

  1. University of Zimbabwe-University of California San Francisco Collaborative Research Programme, 15 Phillips Avenue, Belgravia, Harare, Zimbabwe

    Nyaradzo M. Mgodi, Tsitsi Magure & Z. Mike Chirenje

  2. Statistical Center for HIV/AIDS Research & Prevention (SCHARP), Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    Cliff Kelly & James Y. Dai

  3. Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda

    Brenda Gati & Clemensia Nakabiito

  4. University of Pittsburgh, Pittsburgh, PA, USA

    Susan Greenspan & Sharon A. Riddler

  5. FHI360, Durham, NC, USA

    Vivian Bragg

  6. University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Edward Livant

  7. Division of AIDS, National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA

    Jeanna M. Piper

  8. University of Washington, Seattle, WA, USA

    Jeanne M. Marrazzo

Authors
  1. Nyaradzo M. Mgodi
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  2. Cliff Kelly
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  9. Clemensia Nakabiito
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  10. Tsitsi Magure
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  12. Z. Mike Chirenje
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  13. Sharon A. Riddler
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for the MTN-003B Protocol Team

Corresponding author

Correspondence to Nyaradzo M. Mgodi.

Additional information

Sources of Funding: NIAID (5UM1AI068633), NICHD, and NIMH, all of the US National Institutes of Health.

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Mgodi, N.M., Kelly, C., Gati, B. et al. Factors associated with bone mineral density in healthy African women. Arch Osteoporos 10, 3 (2015). https://doi.org/10.1007/s11657-015-0206-7

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