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Changes in bone mineral density over time by body mass index in the health ABC study

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Abstract

Summary

Obesity appears protective against osteoporosis in cross-sectional studies. However, results from this longitudinal study found that obesity was associated with bone loss over time. Findings underscore the importance of looking at the longitudinal relationship, particularly given the increasing prevalence and duration of obesity among older adults.

Introduction

Cross-sectional studies have found a positive association between body mass index (BMI) and bone mineral density (BMD), but little is known about the longitudinal relationship in US older adults.

Methods

We examined average annual rate of change in BMD by baseline BMI in the Health, Aging, and Body Composition Study. Repeated measurement of BMD was performed with dual-energy X-ray absorptiometry (DXA) at baseline and years 3, 5, 6, 8, and 10. Multivariate generalized estimating equations were used to predict mean BMD (femoral neck, total hip, and whole body) by baseline BMI (excluding underweight), adjusting for covariates.

Results

In the sample (n = 2570), 43 % were overweight and 24 % were obese with a mean baseline femoral neck BMD of 0.743 g/cm2, hip BMD of 0.888 g/cm2, and whole-body BMD of 1.09 g/cm2. Change in total hip or whole-body BMD over time did not vary by BMI groups. However, obese older adults lost 0.003 g/cm2 of femoral neck BMD per year more compared with normal weight older adults (p < 0.001). Femoral neck BMD change over time did not differ between the overweight and normal weight BMI groups (p = 0.74). In year 10, adjusted femoral neck BMD ranged from 0.696 g/cm2 among obese, 0.709 g/cm2 among normal weight, and 0.719 g/cm2 among overweight older adults.

Conclusions

Findings underscore the importance of looking at the longitudinal relationship between body composition and bone mineral density among older adults, indicating that high body mass may not be protective for bone loss over time.

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Acknowledgments

Analysis was supported by the National Institutes of Health (NIH) grants T32 4G000262 and R01AG028556. This research was supported in part by the Intramural Research Program of the NIH, National Institute on Aging, and the Pepper Center (P30AG028747, Shari Waldstein). This research was supported by National Institute on Aging (NIA) Contracts N01-AG-6-2101, N01-AG-6-2103, N01-AG-6-2106; NIA grant R01-AG028050; and NINR grant R01-NR012459. We would like to thank William G. Hawkes, Ph.D., for his contribution to the methods of this manuscript through his work on Jennifer Lloyd’s dissertation committee.

Author information

Authors and Affiliations

  1. Centers for Medicare and Medicaid Services, 7500 Security Blvd, WB-06-05, Baltimore, MD, 21244, USA

    J. T. Lloyd & D. E. Alley

  2. Department of Epidemiology and Public Health, University of Maryland, Baltimore, MD, USA

    D. E. Alley, M. C. Hochberg & D. L. Orwig

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

    S. R. Waldstein & D. L. Orwig

  4. Department of Psychology, University of Maryland, Baltimore County, Baltimore, MD, USA

    S. R. Waldstein

  5. Laboratory of Epidemiology and Population Sciences, Intramural Research Program, National Institute on Aging, Bethesda, MD, USA

    T. B. Harris

  6. Sticht Center on Aging, Wake Forest School of Medicine, Winston-Salem, NC, USA

    S. B. Kritchevsky

  7. Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA

    A. V. Schwartz

  8. Department of Epidemiology, Graduate School of Public Health University of Pittsburgh, Pittsburgh, PA, USA

    E. S. Strotmeyer

  9. University of Tennessee Health Science Center, Memphis, TN, USA

    C. Womack

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  1. J. T. Lloyd
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For the Health ABC Study

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Correspondence to J. T. Lloyd.

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The statements contained herein are those of the authors and do not necessarily reflect the views or policies of the Centers for Medicare and Medicaid Services.

Conflicts of interest

Jennifer Tower Lloyd, Dawn E Alley, Marc C Hochberg, Shari R Waldstein, Tamara B Harris, Stephen B Kritchevsky, Ann V Schwartz, Elsa S Strotmeyer, Catherine R Womack, and Denise L Orwig declare that they have no conflict of interest.

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Lloyd, J.T., Alley, D.E., Hochberg, M.C. et al. Changes in bone mineral density over time by body mass index in the health ABC study. Osteoporos Int 27, 2109–2116 (2016). https://doi.org/10.1007/s00198-016-3506-x

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  • DOI: https://doi.org/10.1007/s00198-016-3506-x

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