Osteoporosis International

, Volume 16, Issue 12, pp 1827–1835 | Cite as

Bone status of Indian women from a low-income group and its relationship to the nutritional status

  • Veena Shatrugna
  • Bharati Kulkarni
  • P. Ajay Kumar
  • K. Usha Rani
  • N. Balakrishna
Original Article


Indian women from low-income groups consume diets that have inadequate calcium coupled with too few calories, proteins and micronutrients. Hospital-based data suggest that these women have osteoporotic hip fractures at a much earlier age than Western women. Studies reporting bone parameters of the Indian population involving large sample sizes are not available. This study was therefore carried out with 289 women in the 30–60-year age group to estimate the prevalence of osteoporosis and measure the bone parameters by dual energy X-ray absorptiometry (DXA). Their mean (± SD) age was 41.0±8.60 years. Their mean (± SD) height, weight and body mass index (BMI) were 149.1±5.49 cm, 49.2±9.85 kg and 22.1±3.99, respectively. Dietary intake of calcium was estimated to be 270±57 mg/day. The prevalence of osteoporosis at the femoral neck was around 29%. Bone mineral density (BMD) and T scores at all the skeletal sites were much lower than the values reported from the developed countries and were indicative of a high prevalence of osteopenia and osteoporosis. BMD showed a decline after the age of 35 years in cases of the lumbar spine and femoral neck. This was largely due to a decrease of bone mineral content (BMC). The nutritional status of women appears to be an important determinant of bone parameters. BMD and BMC at all the skeletal sites and whole body increased significantly with increasing body weight and BMI of women (P<0.05). However, bone area (BA) did not change with an increase in BMI. In the multiple regression analysis, apart from body weight, age, menopause and calcium intake were the other important determinants of BMD (P<0.05). In addition to these, height was also an important determinant of WB-BMC. This study highlights the urgent need for measures to improve the nutritional status, dietary calcium intake and thus the bone health of this population.


Body weight Bone mineral density Calcium intake Indian women Nutrition 



The authors would like to acknowledge the support and encouragement of Dr. B. Sivakumar and Dr. Ghafoorunissa, Deputy Directors (senior grade) and officers in-charge at the National Institute of Nutrition, Hyderabad. We are also grateful to Mr. Chenna Krishna Reddy, Mr. Narsimha Rao, Mr. Sambasiva Rao, Ms. Suvarna and Ms. Padma Siromani for their help during the course of the study. This study would not have been possible without the unstinting cooperation of the women from Addagutta, and we are grateful to them.


  1. 1.
    Cooper C, Campion G, Melton LJ III (1992) Hip fractures in the elderly: a worldwide projection. Osteoporos Int 2:285–289PubMedGoogle Scholar
  2. 2.
    Gabriel SE, Tosteson ANA, Leibson CL, Crowson CS, Pond GR, Hammond CS, Melton LJ III (2002) Direct medical costs attributable to osteoporotic fractures. Osteoporos Int 13:323–330CrossRefPubMedGoogle Scholar
  3. 3.
    Gupta AK, Samuel KC, Kurian PM, Rallan RC (1967) Preliminary study of the incidence and aetiology of femoral neck fractures in Indians. Indian J Med Res 55:1341–1348PubMedGoogle Scholar
  4. 4.
    Vaishnava H, Rizvi SNA (1974) Frequency of osteomalacia and osteoporosis in fractures of proximal femur. Lancet 1:676–677CrossRefGoogle Scholar
  5. 5.
    Shatrugna V, Soundarrajan N, Sundariah P, Raman L (1990) Back pain: the feminine affliction. Econ Pol Wkly 25:WS2–WS6Google Scholar
  6. 6.
    Shatrugna V (1998) Osteoporosis in the Asian region: newer questions. In: Shetty P, Gopalan C (eds) Diet, nutrition and chronic diseases. Smith-Gordon, UK, pp 81–83Google Scholar
  7. 7.
    Sridhar CB, Ahuja MMS, Bhargava S (1970) Is osteoporosis a nutritional disease? J Assoc Phys India 18:671–676Google Scholar
  8. 8.
    Khanna P, Bhargava S (1971) Roentgen assessment of bone density in north Indian population. Indian J Med Res 59:1599–1609PubMedGoogle Scholar
  9. 9.
    National Nutrition Monitoring Bureau (2002) Diet and nutritional status of rural population. National Institute of Nutrition, Hyderabad, IndiaGoogle Scholar
  10. 10.
    Bharadwaj JA, Kendurkar SM, Vaidya PR (1983) Age and symptomatology of menopause in Indian women. J Postgrad Med 29:218–222PubMedGoogle Scholar
  11. 11.
    Wilson P, Horwath C (1996) Validation of a short food frequency questionnaire for assessment of dietary calcium intake in women. Eur J Clin Nutr 50:220–228PubMedGoogle Scholar
  12. 12.
    Montomoli M, Gonnelli S, Giacchi M, Mattei R, Cuda C, Rassi S, Gennari C (2002) Validation of a food frequency questionnaire for nutritional calcium intake assessment in Italian women. Eur J Clin Nutr 56:21–30CrossRefPubMedGoogle Scholar
  13. 13.
    Cadeau BJ, Malkin A (1973) A relative heat stability test for the identification of serum alkaline phosphatase isoenzymes. Clin Chim Acta 45:235–242CrossRefPubMedGoogle Scholar
  14. 14.
    Schele F, Artur Y, Floc’h AY, Slest G (1988) Total tartrate-resistant and tartrate-inhibited acid phosphatase in serum : biological variations and reference limits. Clin Chem 34:685–690PubMedGoogle Scholar
  15. 15.
    World Health Organization (1995) Physical status: the use and interpretation of anthropometry. Technical Report Series 354. WHO, GenevaGoogle Scholar
  16. 16.
    National Institute of Nutrition (1989) Nutritive value of Indian foods. Indian Council of Medical Research, Hyderabad, IndiaGoogle Scholar
  17. 17.
    National Nutrition Monitoring Bureau (1994) Report of urban survey slums. National Institute of Nutrition, Hyderabad, IndiaGoogle Scholar
  18. 18.
    Ilich JZ, Brownbill RA, Tanborini L (2003) Bone and nutrition in elderly women: protein, energy and calcium as main determinants of bone mineral density. Eur J Clin Nutr 57:554–565CrossRefPubMedGoogle Scholar
  19. 19.
    Warming L, Hassager C, Christiansen C (2002) Changes in bone mineral density with age in men and women: a longitudinal study. Osteoporos Int 13:105–112CrossRefPubMedGoogle Scholar
  20. 20.
    Pedrazzon M, Girasole G, Bertoldo F, Bianchi G, Cepollaro C, Del Puente A, Giannini S, Gonnelli S, Maggio D, Marcocci c, Minisoli S, Palummeri E, Rossini M, Sartori L (2003) Definition of a population specific DXA reference standard in Italian women: the Densitometric Italian Normative Study (DINS). Osteoporos Int 14:978–982CrossRefPubMedGoogle Scholar
  21. 21.
    Going S, Lohman T, Houtkooper L, Metcalfe L, Flint-Wagner H, Blew R, Stanford V, Cussler E, Martin J, Teixeira P, Harris M, Millikren L, Figueroa-Galvez A, Weber J (2003) Effects of exercise on bone mineral density in calcium replete post-menopausal women with and without hormone replacement therapy. Osteoporos Int 14:637–643CrossRefPubMedGoogle Scholar
  22. 22.
    Gallagher D, Heymsfield SB, Heo M, Jebb SA, Murgatroyd PR, Sakamoto Y (2000) Healthy percentage body fat ranges: an approach for developing guidelines based on body mass index. Am J Clin Nutr 72:694–701PubMedGoogle Scholar
  23. 23.
    Deurenberg P, Deurenberg-Yap M, Guricci S (2002) Asians are different from Caucasians and from each other in their body mass index/body fat percent relationship. Obes Rev 3:141–146CrossRefPubMedGoogle Scholar
  24. 24.
    World Health Organization (2000) The Asia Pacific perspective—redefining obesity and its treatment. International Diabetes Institute Health Communications Australia Pty LtdGoogle Scholar
  25. 25.
    Snowdon DA, Kane RL, Beesan WL, Burke GL, Sprafka JM, Potter J, Iso H, Jacobs DR, Phillips RL (1989) Is early natural menopause a biologic marker of health and aging? Am J Public Health 79:709–714PubMedGoogle Scholar
  26. 26.
    Yoshimura N, Kinoshita H, Danjoh S, Takijiri T, Morioka S, Kasamatsu T, Sakata K, Hashmoto T (2002) Bone loss at the lumbar spine and the proximal femur in a rural Japanese community, 1990–2000: the Miyama study. Osteoporos Int 13:803–808CrossRefPubMedGoogle Scholar
  27. 27.
    Lau EMC, Lynn H, Woo J, Melton LJIII (2003) Areal and volumetric bone-density in Hong Kong, Chinese: a comparison with Caucasions living in the United States. Osteoporos Int 14:583–588PubMedGoogle Scholar
  28. 28.
    Calvo MS, Kumar R, Health H III (1990) Persistently elevated parathyroid hormone secretion and action in young women after 4 weeks of ingesting high phosphorus, low calcium diets. J Clin Endocrinol Metab 70:1334–1340PubMedGoogle Scholar
  29. 29.
    National Institute of Nutrition (2002) Annual Report. National Institute of Nutrition, Hyderabad, IndiaGoogle Scholar
  30. 30.
    He M, Li ETS, Kung AWC (1999) Dual-energy X-ray absorptiometry for body composition estimation in Chinese women. Eur J Clin Nutr 53:933–937CrossRefPubMedGoogle Scholar
  31. 31.
    Felson DT, Zhang YQ, Hannan MT, Anderson JJ (1993) Effects of weight and body mass index on bone mineral density in men and women: the Framingham study. J Bone Miner Res 8:567–573Google Scholar
  32. 32.
    Stevenson JC, Lees B, Devenport M, Cust MP, Ganger KF (1989) Determinants of bone density in normal women: risk factors for osteoporosis? BMJ 298:924–928PubMedGoogle Scholar
  33. 33.
    Pocock NA, Eisman JA, Hopper JL, Yeates MG, Sambrook PN, Eberl S (1987) Genetic determinants of bone mass in adults. A twins study. J Clin Invest 80:706–710PubMedGoogle Scholar
  34. 34.
    Rubin LA, Hawker GA, Peltekova VD, Fielding LJ, Ridout R, Cole DE (1999) Determinants of peak bone mass: clinical and genetic analysis in a young female Canadian cohort. J Bone Miner Res 14:633–643PubMedGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2005

Authors and Affiliations

  • Veena Shatrugna
    • 1
  • Bharati Kulkarni
    • 1
  • P. Ajay Kumar
    • 1
  • K. Usha Rani
    • 1
  • N. Balakrishna
    • 1
  1. 1.National Institute of NutritionIndian Council of Medical ResearchHyderabadIndia

Personalised recommendations