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Osteoporosis International

, Volume 15, Issue 6, pp 439–446 | Cite as

Risk factors for low bone mineral density and the 6-year rate of bone loss among premenopausal and perimenopausal women

  • Kathleen E. Bainbridge
  • MaryFran Sowers
  • Xihong Lin
  • Sioban D. Harlow
Original Article

Abstract

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.

Keywords

Bone density Bone loss Longitudinal studies Premenopause Risk factors 

Notes

Acknowledgement

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.

References

  1. 1.
    Sowers MF (2000) Lower peak bone mass and its decline. Baillieres Clin Endocrinol Metab 14:317–329CrossRefGoogle Scholar
  2. 2.
    Bainbridge KE, Sowers MF, Crutchfield M, et al (2002) Natural history of bone loss over 6 years among premenopausal and early postmenopausal women. Am J Epidemiol 156:410–417CrossRefPubMedGoogle Scholar
  3. 3.
    Melton LJ, Atkinson EJ, O’Connor MK, et al (2000) Determinants of bone loss from the femoral neck in women of different ages. J Bone Miner Res 15:24–31PubMedGoogle Scholar
  4. 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
  5. 5.
    Revilla M, Villa LF, Hernandez ER, et al (1997) Influence of weight and gonadal status on total and regional bone mineral content and on weight-bearing and non-weight bearing bones, measured by dual-energy X-ray absorptiometry. Maturitas 28:69–74CrossRefPubMedGoogle Scholar
  6. 6.
    Sowers MF, Kshirsagar A, Crutchfield MM, et al (1992) Joint influence of fat and lean body composition compartments on femoral bone mineral density in premenopausal women. Am J Epidemiol 136:257–265PubMedGoogle Scholar
  7. 7.
    Snow-Harter CM (1994) Bone health and prevention of osteoporosis in active and athletic women. Clin Sports Med 13:389–404PubMedGoogle Scholar
  8. 8.
    Sowers MFR, Galuska DA (1993) Epidemiology of bone mass in premenopausal women. Epidemiol Rev 15:374–398PubMedGoogle Scholar
  9. 9.
    Sowers MF (1996) Pregnancy and lactation as risk factors for subsequent bone loss and osteoporosis. J Bone Miner Res 11:1052–1060PubMedGoogle Scholar
  10. 10.
    Lloyd T, Taylor DS (2001) Calcium intake and peak bone mass. J Am Med Womens Assoc 56:49–52PubMedGoogle Scholar
  11. 11.
    Tudor-Locke C, McColl RS (2000) Factors related to variation in premenopausal bone mineral status: a health promotion approach. Osteoporos Int 11:1–24CrossRefPubMedGoogle Scholar
  12. 12.
    Hall SL, Greendale GA (1998) The relation of dietary vitamin C intake to bone mineral density: results from the PEPI study. Calcif Tissue Int 63:183–189CrossRefPubMedGoogle Scholar
  13. 13.
    Leveille SG, LaCroix AZ, Koepsell TD, et al (1997) Dietary vitamin C and bone mineral density in postmenopausal women in Washington State, USA. J Epidemiol Community Health 51:479–485PubMedGoogle Scholar
  14. 14.
    Sowers MFR, Wallace RB (1990) Retinol, supplemental vitamin A and bone status. J Clin Epidemiol 43:693–699PubMedGoogle Scholar
  15. 15.
    Laitinen K, Valimaki M (1991) Alcohol and bone. Calcif Tissue Int 49[Suppl]:S70–S73Google Scholar
  16. 16.
    Law MR, Hackshaw AK (1997) A meta-analysis of cigarette smoking, bone mineral density and risk of hip fracture: recognition of a major effect. BMJ 315:841–846PubMedGoogle Scholar
  17. 17.
    Snow CM (1996) Exercise and bone mass in young and premenopausal women. Bone 18:51S–55SCrossRefPubMedGoogle Scholar
  18. 18.
    Laatikainen AK, Kroger HP, Tukiainen HO, et al (1999) Bone mineral density in perimenopausal women with asthma: a population-based cross-sectional study. Am J Respir Crit Care Med 159:1179–1185PubMedGoogle Scholar
  19. 19.
    Pfeilschifter J, Diel IJ (2000) Osteoporosis due to cancer treatment: pathogenesis and management. J Clin Oncol 18:1570–1593PubMedGoogle Scholar
  20. 20.
    Pollitzer WS, Anderson JJB (1989) Ethnic and genetic differences in bone mass: a review with a hereditary vs environmental perspective. Am J Clin Nutr 50:1244–1259PubMedGoogle Scholar
  21. 21.
    Hunter DJ, de Lange M, Andrew T, et al (2001) Genetic variation in bone mineral density and calcaneal ultrasound: a study of the influence of menopause using female twins. Osteoporos Int 12:406–411CrossRefPubMedGoogle Scholar
  22. 22.
    Lips P (1997) Epidemiology and predictors of fractures associated with osteoporosis. Am J Med 103:20S–26SPubMedGoogle Scholar
  23. 23.
    Gilfillan C, Silberberg S, Scrivenor P, et al (1994) Determinants of forearm mineral density and its correlation with fracture history in women. Maturitas 20:199–208PubMedGoogle Scholar
  24. 24.
    Honkanen R, Kroger H, Tuppurainen M, et al (1995) Fractures and low axial bone density in perimenopausal women. J Clin Epidemiol 48:881–888CrossRefPubMedGoogle Scholar
  25. 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. 26.
    Bray GA (1987) Overweight is risking fate: definition, classification, prevalence and risks. Ann N Y Acad Sci 499:14–28Google Scholar
  27. 27.
    Block G, Hartman AM, Dresser CM, et al (1986) A data-based approach to diet questionnaire design and testing. Am J Epidemiol 124:453–469PubMedGoogle Scholar
  28. 28.
    National Cancer Institute (1993) HHHQ-DIETSYS Analysis software, version 3.0Google Scholar
  29. 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
  30. 30.
    Sallis JF, Haskell WL, Wood PD, et al (1985) Physical activity assessment methodology in the five-city project. Am J Epidemiol 121:91–106PubMedGoogle Scholar
  31. 31.
    SAS proprietary software, release 6.12; SAS Institute, Cary, NC, USAGoogle Scholar
  32. 32.
    Diggle PJ, Liang K-Y, Zeger S (1994) Analysis of longitudinal data. Clarendon Press, OxfordGoogle Scholar
  33. 33.
    Sowers MF, Kshirsagar A, Crutchfield M, et al (1991) Body composition, age and femoral bone mass of young adult women. Ann Epidemiol 1:245–254PubMedGoogle Scholar
  34. 34.
    Torgerson DJ, Campbell MK, Reid DM (1995) Life-style, environmental and medical factors influencing peak bone mass in women. Br J Rheumatol 34:620–624PubMedGoogle Scholar
  35. 35.
    New SA, Bolton-Smith C, Grubb DA, et al (1997) Nutritional influences on bone mineral density: a cross-sectional study in premenopausal women. Am J Clin Nutr 65:1831–1839PubMedGoogle Scholar
  36. 36.
    Harris S, Dallal GE, Dawson-Hughes B (1992) Influence of body weight on rates of change in bone density of the spine, hip, and radius in postmenopausal women. Calcif Tissue Int 50:19–23PubMedGoogle Scholar
  37. 37.
    Tremollieres FA, Pouilles J-M, Ribot C (1993) Vertebral postmenopausal bone loss is reduced in overweight women: a longitudinal study in 155 early postmenopausal women. J Clin Endocrinol Metab 77:683–696PubMedGoogle Scholar
  38. 38.
    Ravn P, Cizza G, Bjarnason NH, et al (1999) Low body mass index is an important risk factor for low bone mass and increased bone loss in early postmenopausal women. J Bone Miner Res 14:1622–1627PubMedGoogle Scholar
  39. 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
  40. 40.
    Rubin CT, Lanyon LE (1985) Regulation of bone mass by mechanical strain magnitude. Calcif Tissue Int 37:411–417PubMedGoogle Scholar
  41. 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
  42. 42.
    Reid IR (2002) Relationships among body mass, its components, and bone. Bone 31:547–555CrossRefPubMedGoogle Scholar
  43. 43.
    Zmuda JM, Cauley JA, Ljung B-M, Bauer DC, Cummings SR, Kuller LH (2001) Bone mass and breast cancer risk in older women: differences by stage at diagnosis. J Natl Cancer Inst 93:930–936CrossRefPubMedGoogle Scholar
  44. 44.
    Zhang Y, Kiel DP, Kreger BE, Cupples LA, Ellison C, Dorgan JF, Schatzkin, A, Levy D, Felson DT (1997) Bone mass and the risk of breast cancer among postmenopausal women. N Engl J Med 336:611–617CrossRefPubMedGoogle Scholar
  45. 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
  46. 46.
    Cox ML, Khan SA, Gau DW, et al (1991) Determinants of forearm bone density in premenopausal women: a study in one general practice. Br J Gen Pract 41:194–196PubMedGoogle Scholar
  47. 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
  48. 48.
    Honkanen R, Kroger H, Tuppurainen M, et al (1995) Fractures and low axial bone density in perimenopausal women. J Clin Epidemiol 48:881–888CrossRefPubMedGoogle Scholar
  49. 49.
    Sabatier JP, Guaydier-Souquieres G, Benmalek A, et al (1999) Evolution of lumbar bone mineral content during adolescence and adulthood: a longitudinal study in 395 healthy females 10–24 years of age and 206 premenopausal women. Osteoporos Int 9:476–482CrossRefPubMedGoogle Scholar
  50. 50.
    Lloyd T, Chinchilli VM, Johnson-Rollings N, et al (2000) Adult female hip bone density reflects teenage sports–exercise patterns but not teenage calcium intake. Pediatrics 106:40–44PubMedGoogle Scholar
  51. 51.
    Feskanich D, Korrick SA, Greenspan SL, et al (1999) Moderate alcohol consumption and bone density among postmenopausal women. J Womens Health 8:65–73PubMedGoogle Scholar
  52. 52.
    Holbrook TL, Barrett-Connor E (1993) A prospective study of alcohol consumption and bone mineral density. BMJ 306:1506–1509PubMedGoogle Scholar
  53. 53.
    Clark K, Sowers MF (1996) Alcohol dependence, smoking status, reproductive characteristics, and bone mineral density in premenopausal women. Res Nurs Health 19:399–408CrossRefPubMedGoogle Scholar
  54. 54.
    Reichman ME, Judd JT, Longcope C, et al (1993) Effects of alcohol consumption on plasma and urinary hormone concentrations in premenopausal women. J Natl Cancer Inst 85:722–727PubMedGoogle Scholar
  55. 55.
    Rico H (1990) Alcohol and bone disease. Alcohol Alcohol 25:345–352PubMedGoogle Scholar
  56. 56.
    Laitinen K, Lamberg-Allardt C, Tunninen R, et al (1991) Transient hypoparathyroidism during acute alcohol intoxication. N Engl J Med 324:721–727PubMedGoogle Scholar
  57. 57.
    Daniell HW (1976) Osteoporosis of the slender smoker. Vertebral compression fractures and loss of metacarpal cortex in relation to postmenopausal cigarette smoking and lack of obesity. Arch Intern Med 136:298–304PubMedGoogle Scholar
  58. 58.
    Ortego-Centeno N, Munoz-Torres M, Hernandez-Quero J, et al (1994) Bone mineral density, sex steroids, and mineral metabolism in premenopausal smokers. Calcif Tissue Int 55:403–407PubMedGoogle Scholar
  59. 59.
    Michnovicz JJ, Hershcopf RJ, Naganuma H, et al (1986) Increased 2-hydroxylation of estradiol as a possible mechanism for the anti-estrogenic effect of cigarette smoking. N Engl J Med 315:1305–1309PubMedGoogle Scholar
  60. 60.
    Jensen GF (1986) Osteoporosis of the slender smoker revisited by epidemiologic approach. Eur J Clin Invest 16:239–242PubMedGoogle Scholar
  61. 61.
    LaPorte RE, Montoye HJ, Casperson CJ (1985) Assessment of physical activity in epidemiologic research: problems and prospects. Public Health Rep 100:131–146PubMedGoogle Scholar
  62. 62.
    Todd KS, Hudes M, Calloway DH (1983) Food intake measurement: problems and approaches. Am J Clin Nutr 37:139–146PubMedGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2004

Authors and Affiliations

  • Kathleen E. Bainbridge
    • 1
  • MaryFran Sowers
    • 1
    • 2
  • Xihong Lin
    • 3
  • Sioban D. Harlow
    • 1
  1. 1.Department of Epidemiology, School of Public HealthUniversity of MichiganAnn ArborUSA
  2. 2.Suite 310, 339 East LibertyAnn ArborUSA
  3. 3.Department of Biostatistics, School of Public HealthUniversity of MichiganAnn ArborUSA

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