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Bone density in black and white South African women: contribution of ethnicity, body weight and lifestyle

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Abstract

Summary

Ethnic differences in bone mineral density (BMD) between healthy adult black and white South African women were studied. Higher BMD was only noted at the femoral sites in black women. Body weight significantly impacted these findings. A lower fracture risk at all skeletal sites cannot be assumed in black South African (SA) women.

Purpose

Bone mineral density (BMD) varies amongst women of different ethnicities. African-Americans have higher BMD at all skeletal sites compared with whites. On the African continent, bone density studies suggest site-specific ethnic differences in BMD. To examine the contribution of body weight and lifestyle characteristics to ethnic differences in BMD between adult black and white South African women, we assessed lumbar spine (SBMD), femoral neck (FNBMD) and total femoral BMD (FTBMD) by dual-energy X-ray absorptiometry (DXA) in 184 black and 143 white women aged between 23 and 82 years.

Methods

BMDs were compared amongst pre- and postmenopausal blacks and whites before and after adjustment for covariates with significant univariate association with BMD. Volumetric bone mineral apparent density (BMAD) of the spine and femoral neck was also calculated to account for ethnic differences in bone size.

Results

Before adjustment, SBMD was lower (p < 0.05), FTBMD similar and FNBMD (p < 0.01) higher in premenopausal black women. Similar SBMD, but significantly higher BMD at the femoral sites (p < 0.01), was noted in postmenopausal blacks compared with whites. Amongst anthropometric measures and lifestyle factors, only adjustment for weight significantly altered these observed ethnic differences in bone density. After adjustment for weight, SBMD remained lower in premenopausal blacks and became lower in young postmenopausal blacks. Weight adjustment eliminated all ethnic differences in proximal femoral BMD measurements, with the exception of FNBMD that remained higher in younger postmenopausal blacks. Before adjustment, calculated SBMAD was similar and FNBMAD consistently higher in blacks in all the menstrual groups. Adjustment for weight did not alter these findings.

Conclusion

Most of the observed ethnic difference in BMD was explained by differences in body weight between black and white SA women. The higher femoral BMD in older blacks may explain, the lower hip fracture prevalence in black South African women. The lower SBMD in pre- and postmenopausal black women in this study suggests that factors other than BMD should be considered to explain a lower vertebral fracture prevalence in blacks, if a lower fracture prevalence does indeed exist.

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References

  1. Solomon L (1968) Osteoporosis and fracture of the femoral neck in the South African Bantu. J Bone Joint Surg 50(B):2–12

    CAS  Google Scholar 

  2. Aspray TJ, Prentice A, Cole TJ, Sawo Y, Reeve J, Francis RM (1996) Low bone mineral content is common, but osteoporotic fractures are rare in elderly rural Gambian women. J Bone Miner Res 11(7):1019–1025

    Article  CAS  PubMed  Google Scholar 

  3. Dent CE, Engelbrecht HE, Godfrey RC (1968) Osteoporosis at lumbar vertebrae and calcification of abdominal aorta in women living in Durban. BMJ 4:76–79

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  4. Cauley JA, Lui LY, Ensrud KE, Zmuda JM, Stone KL, Hochbeg MD, Cummings SR (2005) Bone mineral density and the risk of incident Non-spinal fractures in black and white women. JAMA 293(17):2102–2108

    Article  CAS  PubMed  Google Scholar 

  5. Barrett-Connor E, Siris ES, Wehren LE, Miller PD, Abbott TA, Berger ML, Santora AC, Sherwood LM (2005) Osteoporosis and fracture risk in women of different ethnic groups. J Bone Miner Res 20(2):185–194

    Article  PubMed  Google Scholar 

  6. Cauley JA, Palermo L, Vogt M, Ensrud KE, Ewing S, Hochberg M, Nevitt MC, Black DM (2008) Prevalent vertebral fractures in black women and white women. J Bone Miner Res 23(9):1458–1467

    Article  PubMed Central  PubMed  Google Scholar 

  7. Lansdown D, Bennet B, Thiel S, Ahmed O, Dixon L, Vokes TJ (2011) Prevalence of vertebral fractures on chest radiographs of elderly African American and Caucasian women. Osteoporos Int 22(8):2365–2371

    Article  PubMed Central  Google Scholar 

  8. Henry YM, Eastell R (2000) Ethnic and gender differences in bone density and bone in young adults: effect of bone size. Osteoporos Int 11:512–517

    Article  CAS  PubMed  Google Scholar 

  9. Ettinger B, Sidney S, Cummings SR, Libanati C, Bikle DD, Tekawa IS, Tolan K, Steiger P (1997) Racial differences in bone density between young adult black and white subjects persist after adjustment for anthropometric, lifestyle and biochemical differences. J Clin Endocrinol Metab 82(2):429–434

    CAS  PubMed  Google Scholar 

  10. Looker AC, Johnston CC Jr, Wahner HW, Dunn WL, Calvo MS, Harris TB, Heyse SP, Lindsay RL (1995) Prevalence of low femoral bone density in older U.S. women from NHANES III. J Bone Miner Res 10(5):796–802

    Article  CAS  PubMed  Google Scholar 

  11. Liel Y, Edwards J, Shary J, Spicer KM, Gordon L, Bell NH (1988) The effects of race and body habitus on bone mineral density of the radius, hip and spine in premenopausal women. J Clin Endocrinol Metab 66(6):1247–1250

    Article  CAS  PubMed  Google Scholar 

  12. Finkelstein JS, Lee M-L T, Sowers M, Ettinger B, Neer RM, Kelsey JL, Cauley JA, Huang M, Greendale GA (2002) Ethnic variation in bone density in premenopausal and early perimenopausal women: effects of anthropometric and lifestyle factors. J Clin Endocrinol Metab 87(7):3057–3067

    Article  CAS  PubMed  Google Scholar 

  13. Carter DR, Bouxsein ML, Marcus R (1992) New approaches for interpreting projected bone densitometry data. J Bone Miner Res 7(2):137–145

    Article  CAS  PubMed  Google Scholar 

  14. Katzman DK, Bachrach LK, Carter DR, Marcus R (1991) Clinical and anthropometric correlates of bone mineral acquisition in healthy adolescent girls. J Clin Endocrinol Metab 73:1332–1339

    Article  CAS  PubMed  Google Scholar 

  15. Dibba B, Prentice A, Laskey MA, Stirling DM, Cole TJ (1999) An investigation of ethnic differences in bone mineral, hip axis length, calcium metabolism and bone turnover between West African and Caucasian adults living in the United Kingdom. Ann Human Biol 26(3):229–242

    Article  CAS  Google Scholar 

  16. Melton LJ III, Marquez MA, Achenbach SJ, Riggs BL (2002) Variations in bone density among persons of African heritage. Osteoporos Int 13:551–559

    Article  Google Scholar 

  17. Prentice A, Shaw J, Laskey AN, Cole TJ, Fraser DR (1991) Bone mineral content of British and rural Gambian women aged 18–80+ years. J Bone Miner Res 12:201–214

    Article  CAS  Google Scholar 

  18. Daniels ED, Pettifor JM, Schnitzler CM, Russell SW, Patel DN (1995) Ethnic differences in bone density in female South African nurses. J Bone Miner Res 10(3):359–367

    Article  CAS  PubMed  Google Scholar 

  19. Chantler S, Dickie K, Goedecke JH, Levitt NS, Lambert EV, Evans J, Joffe Y, Micklesfield LK (2012) Site-specific differences in bone mineral density in black and white premenopausal South African women. Osteoporos Int 23:533–542

    Article  CAS  PubMed  Google Scholar 

  20. Excoffier L, Pelligrini B, Sanchez-Mazas A, Simon C, Langaney A (1987) Genetics and history of sub-Saharan Africa. Yearb Phys Anthropol 30:151–194

    Article  Google Scholar 

  21. Kahn HS (1991) A major error in nomograms for estimating body mass index. Am J Clin Nutr 54:435–437

    CAS  PubMed  Google Scholar 

  22. Binkley NC, Schmeer P, Wasnich RD, Lechnik L (2002) Position Statement. International Society for Clinical Densitometry Position Development Panel and Scientific Advisory Committee. What are the criteria by which a densitometric diagnosis of osteoporosis can be made in males and non-Caucasians? J Clin Densitom 5(3):19–27

    Article  Google Scholar 

  23. Kanis JA (1997) Assessment of fracture risk and its application to screening for post-menopausal osteoporosis: Synopsis of a WHO-report. Osteoporos Int 1994; 4:368–381

  24. Bererhi H, Constable A, Lindell AE, Coutino J, Kharousi W (1994) A study of bone mineral density versus age in Omani women—a comparison with normal British women. Nucl Med Commun 15:99–103

    Article  CAS  PubMed  Google Scholar 

  25. Luckey MM, Meier DE, Mandeli JP, DaCosta MC, Hubbard ML, Goldsmith SJ (1989) Radial and vertebral bone density in white and black women: evidence for racial differences in pre-menopausal bone homeostasis. J Clin Endocrinol Metab 69:762–770

    Article  CAS  PubMed  Google Scholar 

  26. DeSimone DP, Stevens J, Edwards J, Shary J, Gordon L, Bell NH (1989) Influence of body habitus and race on bone mineral density of the midradius, hip and spine in aging women. J Bone Miner Res 6(4):827–830

    Google Scholar 

  27. Gilsanz V, Roe TF, Mora S, Costin G, Goodman WG (1991) Changes in vertebral bone density in black girls and white girls during childhood and puberty. N Engl J Med 325(23):1597–1600

    Article  CAS  PubMed  Google Scholar 

  28. McVeigh JA, Norris SA, Cameron N, Pettifor JM (2004) Association between physical activity and bone mass in black and white South African children at age 9 yr. J Applied Physiol 97(3):1–11

    Article  Google Scholar 

  29. Vidulich L, Norris SA, Cameron N, Pettifor JM (2006) Differences in bone size and bone mass between black and white 10-year-old South African children. Osteoporos Int 17:433–440

    Article  CAS  PubMed  Google Scholar 

  30. Solomon L (1979) Bone density in ageing Caucasian and African populations. Lancet 57(B):1326–1329

    Article  Google Scholar 

  31. Cauley JA, Lui LY, Stone KL, Hillier TA, Zmuda JM, Hochberg M, Beck TJ, Ensrud KE (2005) Longitudinal study of changes in hip bone mineral density among Caucasian and African-American women. J Am Geriatr Soc 53:183–189

    Article  PubMed  Google Scholar 

  32. Luckey MM, Wallenstein S, Lapinski R, Meier DE (1996) A prospective study of bone loss in African-American and white women—a clinical research center study. J Clin Endocrinol Metab 81(3):2948–2956

    CAS  PubMed  Google Scholar 

  33. Albala C, Yanez M, Devoto E, Sostin C, Zeballos C, Santos JL (1996) Obesity as a protective factor for postmenopausal osteoporosis. Int J Obes Relat Metab Disord 20(11):1027–1032

    CAS  PubMed  Google Scholar 

  34. Glauber HS, Vollmer WM, Nevitt MC, Ensrud KE, Orwoll ES (1995) Body weight versus body fat distribution, adiposity, and frame size as predictors of bone density. J Clin Endocrinol Metab 80:1118–1123

    CAS  PubMed  Google Scholar 

  35. Salamone LM, Glynn N, Black D, Epstein RS, Palermo L, Meilahn E, Kuller LH, Cauley JA (1995) Body composition and bone mineral density in premenopausal and early perimenopausal women. J Bone Miner Res 10(11):1762–1768

    Article  CAS  PubMed  Google Scholar 

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

    CAS  PubMed  Google Scholar 

  37. Meldrum DR, Davidson BJ, Taturyn IV, Judd HL (1981) Changes in circulating steroids with aging in postmenopausal women. Obstet Gynecol 57:624–629

    CAS  PubMed  Google Scholar 

  38. Stewart A, Kumar V, Reid DM (2006) Long-term fracture prediction by DXA and QUS: a 10-year prospective study. J Bone Miner Res 21(3):413–418

    Article  PubMed  Google Scholar 

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Acknowledgements

This work was supported by grants from the Medical Research Council of South Africa and the Women’s Health Initiative Indianapolis. We thank Madele du Plessis for performing the dietary analyses.

Conflicts of interest

None.

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Authors and Affiliations

  1. Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Health Sciences, University of Stellenbosch, P.O. Box 19063, Tygerberg, Cape Town, 7505, South Africa

    Magda Conradie, Maria M. Conradie & Stephen Hough

  2. Centre for Statistical Analysis, University of Stellenbosch, P.O. Box 19063, Tygerberg, Cape Town, 7505, South Africa

    Martin Kidd

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  1. Magda Conradie
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  2. Maria M. Conradie
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  3. Martin Kidd
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  4. Stephen Hough
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Correspondence to Magda Conradie.

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Conradie, M., Conradie, M.M., Kidd, M. et al. Bone density in black and white South African women: contribution of ethnicity, body weight and lifestyle. Arch Osteoporos 9, 193 (2014). https://doi.org/10.1007/s11657-014-0193-0

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