Risk factors for low bone mineral density and the 6-year rate of bone loss among premenopausal and perimenopausal women
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.
KeywordsBone density Bone loss Longitudinal studies Premenopause Risk factors
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.
- 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 13:1124–1140Google Scholar
- 15.Laitinen K, Valimaki M (1991) Alcohol and bone. Calcif Tissue Int 49[Suppl]:S70–S73Google 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 53:132–142Google Scholar
- 26.Bray GA (1987) Overweight is risking fate: definition, classification, prevalence and risks. Ann N Y Acad Sci 499:14–28Google Scholar
- 28.National Cancer Institute (1993) HHHQ-DIETSYS Analysis software, version 3.0Google Scholar
- 29.Bowes and Church’s food values of portions commonly used (1980) In: Pennington JAT, Church HN (eds). Harper and Row, New York, NY, USAGoogle Scholar
- 31.SAS proprietary software, release 6.12; SAS Institute, Cary, NC, USAGoogle Scholar
- 32.Diggle PJ, Liang K-Y, Zeger S (1994) Analysis of longitudinal data. Clarendon Press, OxfordGoogle Scholar
- 39.Brot C, Jensen LB, Sorensen OH (1997) Bone mass and risk factors for bone loss in perimenopausal Danish women. J Int Med 242:505–511Google 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 75:779–782Google 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 14:102–110Google 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 110:232–233Google Scholar