Osteoporosis International

, Volume 18, Issue 4, pp 471–478

Determinants of bone mineral density in Chinese-American women

  • M. D. Walker
  • R. Babbar
  • A. Opotowsky
  • D. J. McMahon
  • G. Liu
  • J. P. Bilezikian
Original Article



Few data are available regarding bone mineral density (BMD) and its determinants among Chinese Americans. We identified determinants of BMD among 359 Chinese-American women in order to identify risk factors for low BMD in this burgeoning population. BMD in Chinese-American women is influenced by a number of factors, including immigration.


Osteoporosis and low BMD are common among Chinese women, including Chinese Americans, who are a growing population at risk for osteoporosis in the US. Few data are available regarding BMD and its determinants among Chinese-American women.


In this study, we examined predictors of BMD in 359 ambulatory Chinese-American women, ages 20–90, using stepwise multiple regression analysis. Variables in the model included age, weight, height, menarche age, years since menopause, immigration age, years in US, percentage of life in US, number of pregnancies, oral contraceptive use, family history of osteoporosis, family history of hip fracture, daily calcium intake, exercise, time outdoors, alcohol consumption and tobacco use.


Among premenopausal women, weight was the strongest predictor of BMD, accounting for 10.5% of the variance at the lumbar spine (LS), 15.2% at the total hip (TH) and 16.6% at the femoral neck (FN). Time outdoors was also a positive predictor of BMD (1.4% at LS, 2.8% at TH and 1.6% at FN), while family history of osteoporosis (1.4% at TH) and age (3.7% at FN) were negative predictors. Among postmenopausal women, greater BMD at the LS and TH was associated with greater weight and earlier immigration age. Weight accounted for 16.4% of the variance at the LS and 19.8% at the TH; immigration age accounted for 3.1% of the variance at the LS and 4.1% at the TH. At the FN, years since menopause and weight were predictors of BMD, accounting for 14.4% and 8.7% of the variance, respectively. While older age at immigration had a negative effect on BMD, years in and proportion of life in the United States were not significant predictors of BMD.


Bone mineral density in Chinese-American women is influenced by a number of biological and lifestyle factors, including immigration. The results of this study provide new insights into risk factors for low bone density as they relate to environmental determinants in the growing population of Chinese-American women.


Bone mineral density Chinese-American women Immigration Osteoporosis 


  1. 1.
    Liu Z, Piao J, Pang L, Qing X, Nan S, Pan Z, Guo Y, Wang X, Li F, Liu J, Cheng X (2002) The diagnostic criteria for primary osteoporosis and the incidence of osteoporosis in China. J Bone Miner Metab 20:181–189PubMedCrossRefGoogle Scholar
  2. 2.
    Riggs BL, Melton LJ 3rd (1995) The worldwide problem of osteoporosis: insights afforded by epidemiology. Bone 17:505S–511SPubMedCrossRefGoogle Scholar
  3. 3.
    Barnes J, Bennett CE (2002) The Asian Population:2000. United States Census 2000 BriefGoogle Scholar
  4. 4.
    Day JC (2001) National Population Projections. In: US Census Bureau. http://www.census.gov/population//www/pop-profile/natproj.html
  5. 5.
    Cummings SR, Nevitt MC, Browner WS, Stone K, Fox KM, Ensrud KE, Cauley J, Black D, Vogt TM (1995) Risk factors for hip fracture in white women. Study of Osteoporotic Fractures Research Group. N Engl J Med 332:767–773PubMedCrossRefGoogle Scholar
  6. 6.
    Dequeker J, Nijs J, Verstraeten A, Geusens P, Gevers G (1987) Genetic determinants of bone mineral content at the spine and radius: a twin study. Bone 8:207–209PubMedCrossRefGoogle Scholar
  7. 7.
    Evans RA, Marel GM, Lancaster EK, Kos S, Evans M, Wong SY (1988) Bone mass is low in relatives of osteoporotic patients. Ann Intern Med 109:870–873PubMedGoogle Scholar
  8. 8.
    Jouanny P, Guillemin F, Kuntz C, Jeandel C, Pourel J (1995) Environmental and genetic factors affecting bone mass. Similarity of bone density among members of healthy families. Arthritis Rheum 38:61–67PubMedCrossRefGoogle Scholar
  9. 9.
    Krall EA, Dawson-Hughes B (1993) Heritable and life-style determinants of bone mineral density. J Bone Miner Res 8:1–9PubMedGoogle Scholar
  10. 10.
    Pocock NA, Eisman JA, Hopper JL, Yeates MG, Sambrook PN, Eberl S (1987) Genetic determinants of bone mass in adults. A twin study. J Clin Invest 80:706–710PubMedCrossRefGoogle Scholar
  11. 11.
    Slemenda CW, Christian JC, Williams CJ, Norton JA, Johnston CC Jr (1991) Genetic determinants of bone mass in adult women: a reevaluation of the twin model and the potential importance of gene interaction on heritability estimates. J Bone Miner Res 6:561–567PubMedCrossRefGoogle Scholar
  12. 12.
    Nan L, Cason K (2004) Dietary pattern change and acculturation of Chinese Americans in Pennsylvania. J Am Diet Assoc 104:771–778CrossRefGoogle Scholar
  13. 13.
    Kin K, Lee JH, Kushida K, Sartoris DJ, Ohmura A, Clopton PL, Inoue T (1993) Bone density and body composition on the Pacific rim: a comparison between Japan-born and US-born Japanese-American women. J Bone Miner Res 8:861–869PubMedGoogle Scholar
  14. 14.
    Nomura A, Wasnich RD, Heilbrun LK, Ross PD, Davis JW (1989) Comparison of bone mineral content between Japan-born and US-born Japanese subjects in Hawaii. Bone Miner 6:213–223PubMedCrossRefGoogle Scholar
  15. 15.
    Xu L, Lu A, Zhao X, Chen X, Cummings SR (1996) Very low rates of hip fracture in Beijing, People’s Republic of China the Beijing Osteoporosis Project. Am J Epidemiol 144:901–907PubMedGoogle Scholar
  16. 16.
    Lau EM, Cooper C, Fung H, Lam D, Tsang KK (1999) Hip fracture in Hong Kong over the last decade–a comparison with the UK. J Public Health Med 21:249–250PubMedCrossRefGoogle Scholar
  17. 17.
    Lau EM, Cooper C, Wickham C, Donnan S, Barker DJ (1990) Hip fracture in Hong Kong and Britain. Int J Epidemiol 19:1119–1121PubMedCrossRefGoogle Scholar
  18. 18.
    Lau EM, Lee JK, Suriwongpaisal P, Saw SM, Das De S, Khir A, Sambrook P (2001) The incidence of hip fracture in four Asian countries: the Asian Osteoporosis Study (AOS). Osteoporos Int 12:239–243PubMedCrossRefGoogle Scholar
  19. 19.
    Walker MD, Babbar R, Opotowsky AR, Rohira A, Nabizadeh F, Della Badia M, Chung W, Chiang F, Mediratta A, McMahon D, Liu G, Bilezikian J (2006) A Referent Bone Mineral Density Database for Chinese American Women. Osteoporos Int 17:878–887PubMedCrossRefGoogle Scholar
  20. 20.
    Berenson AB, Breitkopf CR, Grady JJ, Rickert VI, Thomas A (2004) Effects of hormonal contraception on bone mineral density after 24 months of use. Obstet Gynecol 103:899–906PubMedGoogle Scholar
  21. 21.
    Chi I, Pun KK (1991) Dietary calcium intake and other risk factors: study of the fractured patients in Hong Kong. J Nutr Elder 10:73–87PubMedCrossRefGoogle Scholar
  22. 22.
    Paffenbarger RS Jr, Hyde RT, Wing AL, Hsieh CC (1986) Physical activity, all-cause mortality, and longevity of college alumni. N Engl J Med 314:605–613PubMedCrossRefGoogle Scholar
  23. 23.
    Paffenbarger RS Jr, Wing AL, Hyde RT (1978) Physical activity as an index of heart attack risk in college alumni. Am J Epidemiol 108:161–175PubMedGoogle Scholar
  24. 24.
    Bonnick SL, Johnston CC Jr, Kleerekoper M, Lindsay R, Miller P, Sherwood L, Siris E (2001) Importance of precision in bone density measurements. J Clin Densitom 4:105–110PubMedCrossRefGoogle Scholar
  25. 25.
    Cohen J, Cohen P (1983) Applied multiple regression/correlation analysis for the behavioral sciences. Lawrence Erlbaum and Associates, Hillsdale, NJGoogle Scholar
  26. 26.
    McGuigan FE, Murray L, Gallagher A, Davey-Smith G, Neville CE, Van’t Hof R, Boreham C, Ralston SH (2002) Genetic and environmental determinants of peak bone mass in young men and women. J Bone Miner Res 17:1273–1279PubMedCrossRefGoogle Scholar
  27. 27.
    Rubin LA, Hawker GA, Peltekova VD, Fielding LJ, Ridout R, Cole DE (1999) Determinants of peak bone mass: clinical and genetic analyses in a young female Canadian cohort. J Bone Miner Res 14:633–643PubMedCrossRefGoogle Scholar
  28. 28.
    Lau HH, Ng MY, Ho AY, Luk KD, Kung AW (2005) Genetic and environmental determinants of bone mineral density in Chinese women. Bone 36:700–709PubMedCrossRefGoogle Scholar
  29. 29.
    Elgan C, Fridlund B (2005) Bone mineral density in relation to body mass index among young women: A prospective cohort study. Int J Nurs StudGoogle Scholar
  30. 30.
    Lauderdale DS, Kuohung V, Chang SL, Chin MH (2003) Identifying older Chinese immigrants at high risk for osteoporosis. J Gen Intern Med 18:508–515PubMedCrossRefGoogle Scholar
  31. 31.
    Wang Q, Ravn P, Wang S, Overgaard K, Hassager C, Christiansen C (1996) Bone mineral density in immigrants from southern China to Denmark. A cross-sectional study. Eur J Endocrinol 134:163–167PubMedCrossRefGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2006

Authors and Affiliations

  • M. D. Walker
    • 1
  • R. Babbar
    • 2
  • A. Opotowsky
    • 3
  • D. J. McMahon
    • 1
  • G. Liu
    • 2
  • J. P. Bilezikian
    • 1
  1. 1.Department of MedicineCollege of Physicians and Surgeons, Columbia UniversityNew YorkUSA
  2. 2.Department of MedicineNew York Downtown HospitalNew YorkUSA
  3. 3.Department of MedicineBrigham and Women’s HospitalBostonUSA

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