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Ethnic differences in bone mineral density among midlife women in a multi-ethnic Southeast Asian cohort

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Abstract

Summary

Chinese Singaporean middle-aged women have significantly lower femoral neck bone mineral density and higher lumbar spine bone mineral density than Malays and Indians, after adjustment for age, body mass index, and height.

Purpose

Information regarding mediators of differences in bone mineral density (BMD) among Asian ethnicities are limited. Since the majority of hip fractures are predicted to be from Asia, differences in BMD in Asian ethnicities require further exploration. We compared BMD among the Chinese, Malay, or Indian ethnicities in Singapore, aiming to identify potential mediators for the observed differences.

Methods

BMD of 1201 women aged 45–69 years was measured by dual-energy X-ray absorptiometry. We examined the associations between ethnicity and BMD at both sites, before and after adjusting for potential mediators measured using standardized questionnaires and validated performance tests.

Results

Chinese women had significantly lower femoral neck BMD than Malay and Indian women. Of the more than 20 variables examined, age, body mass index, and height accounted for almost all the observed ethnic differences in femoral neck BMD between Chinese and Malays. However, Indian women still retained 0.047 g/cm2 (95% CI, 0.024, 0.071) higher femoral neck BMD after adjustment, suggesting that additional factors may contribute to the increased BMD in Indians. Although no crude ethnic differences in lumbar spine BMD were observed, adjusted regression model unmasked ethnic differences, wherein Chinese women had 0.061(95% CI, − 0.095, 0.026) and 0.065 (95% CI, − 0.091, 0.038) g/cm2 higher lumbar spine BMD compared to Malay and Indian women, respectively.

Conclusion

BMD in middle-aged Asian women differ by ethnicity and site. Particular attention should be paid to underweight women of Chinese ethnic origin, who may be at highest risk of osteoporosis at the femoral neck and hence hip fractures.

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Acknowledgments

The authors would like to acknowledge contributions of our study team (Dr Li Jun, Eng Sok Kheng, Chua Seok Eng, Poon Peng Cheng, Ng Poh Lian, Zhang Xuan, Teo Yean Ling, Saw Myat Sabai, Mok Poh Peng, and Ho Kum Chue) who assisted in recruitment and the data compilation. We are thankful to Low Siew Leng and Tan Sze Yee, the staff of Orthopedic Diagnostic Centre, who conducted all the DEXA scans for our participants.

Funding

This study was partially funded by a Singapore National Medical Research Council Grant (Number: CSASI16May007) to ELY.

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, National University Hospital, National University of Singapore, 1E Kent Ridge Road, Level 12, Singapore, 119228, Republic of Singapore

    Win Pa Pa Thu, Susan J. S. Logan, Michael S. Kramer & Eu Leong Yong

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

    Jane A. Cauley

  3. Departments of Epidemiology, Biostatistics & Occupational Health and of Pediatrics, McGill University Faculty of Medicine, Montreal, Quebec, H3G 1Y6, Canada

    Michael S. Kramer

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  1. Win Pa Pa Thu
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Correspondence to Eu Leong Yong.

Ethics declarations

The study was approved by the Domain Specific Review Board of the National Healthcare Group, Singapore (Reference Number 2014/00356). All participants provided written informed consent prior to the participation in the study.

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Thu, W.P.P., Logan, S.J.S., Cauley, J.A. et al. Ethnic differences in bone mineral density among midlife women in a multi-ethnic Southeast Asian cohort. Arch Osteoporos 14, 80 (2019). https://doi.org/10.1007/s11657-019-0631-0

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