Osteoporosis International

, Volume 19, Issue 12, pp 1785–1796 | Cite as

Change in bone mineral density and its determinants in pre- and perimenopausal Chinese women: the Hong Kong perimenopausal women osteoporosis study

  • S. C. Ho
  • S. G. Chan
  • Y. B. Yip
  • C. S. Y. Chan
  • J. L. F. Woo
  • A. Sham
Original Article



This 30-month study investigating bone change and its determinants in 438 perimenopausal Chinese women revealed that the fastest bone loss occurred in women undergoing menopausal transition but maintenance of body weight and physical fitness were beneficial for bone health. Soy protein intake also seemed to exert a protective effect.


This 30-month follow-up study aims to investigate change in bone mineral density and its determinants in Hong Kong Chinese perimenopausal women.


Four hundred and thirty-eight women aged 45 to 55 years were recruited through random telephone dialing and primary care clinic. Bone mass, body composition, lifestyle measurements were obtained at baseline and at 9-, 18- and 30-month follow-ups. Univariate and stepwise multiple regression analyses were performed with the regression coefficients of BMD/C (derived from baseline and follow-up measurements) as the outcome variables. Menopausal status was classified as pre- or postmenopausal or transitional.


Menopausal status was the strongest determinant of bone changes. An annual bone loss of about 0.5% was observed among premenopausal, 2% to 2.5% among transitional, and about 1.5% in postmenopausal women. Multiple regression analyses, revealed that a positive regression slope of body weight was protective for follow-up bone loss at all sites. Number of pregnancy, soy protein intake and walking were protective for total body BMC. Higher baseline LM was also protective for neck of femur BMD.


Maintenance of body weight and physical fitness were observed to have a protective effect on for bone loss in Chinese perimenopausal women.


Bone loss Bone mineral density Determinants Perimenopausal women 



The authors would like to thank Ms Daisy Fung and Ms Aggie Ip for preparation of the manuscript.


This study was funded by the Hong Kong Government Health Services Research Fund #511023.

Conflicts of interest



  1. 1.
    Cummings SR, Black D (1995) Bone mass measurements and risk of fracture in Caucasian women: a review of findings from prospective studies. Am J Med 98(Suppl 2A):24S–28SPubMedCrossRefGoogle Scholar
  2. 2.
    Hansen MA, Overgaard K, Riis BJ, Christiansen C (1991) Role of peak bone mass and bone loss in postmenopausal osteoporosis: 12 year study. Brit Med J 303:961–964PubMedCrossRefGoogle Scholar
  3. 3.
    WHO Study Group on Assessment of Fracture Risk and Its Application to Screening for Postmenopausal Osteoporosis: Report of a World Health Organization Study Group. World Health Organ Tech Rep Ser 1994; 843Google Scholar
  4. 4.
    Gambacciani M, Spinetti A, De Simone L, Cappagli B, Maffei S, Taponeco F, Fioretti P (1993) The relative contributions of menopause and aging to postmenopausal vertebral osteopenia. J Clin Endocrinol Metab 77(5):1148–1151PubMedCrossRefGoogle Scholar
  5. 5.
    Van Beresteijn ECH, Van’t Hof MA, Schaafsma G, De Waard H, Duursma SA (1990) Habitual dietary calcium intake and cortical bone loss in perimenopausal women: a longitudinal study. Calcif Tissue Int 47:338–344PubMedCrossRefGoogle Scholar
  6. 6.
    Recker RR, Lappe JM, Davies KM, Kimmel DB (1992) Change in bone mass immediately before menopause. J Bone Miner Res 7:857–862PubMedGoogle Scholar
  7. 7.
    Gambacciani M, Spinetti A, Taponeco F, Cappagli B, Maffei S, Manetti P, Piaggesi L, Fioretti P (1994) Bone loss in perimenopausal women: a longitudinal study. Maturitas 18:191–197PubMedCrossRefGoogle Scholar
  8. 8.
    Rodin A, Murby B, Smith MA, Caleffi M, Fentiman I, Chapman MG, Fogelman I (1990) Premenopausal bone loss in the lumbar spine and neck of femur: a study of 225 Caucasian women. Bone 11:1–5PubMedCrossRefGoogle Scholar
  9. 9.
    Ho SC, Hsu S, Leung PC, Chan C, Fan YK, Chan SG (1993) A longitudinal study of the determinants of bone mass in Chinese women aged 21–40. I. Baseline association of anthropometric measurements with bone mineral density. Ann Epidemiol 3:256–263PubMedCrossRefGoogle Scholar
  10. 10.
    Dawson-Hughes D, Krall EA, Harris S (1993) Risk factors for bone loss in healthy postmenopausal women. Osteoporos Int Suppl 1:S27–S31CrossRefGoogle Scholar
  11. 11.
    Krall EA, Dawson-Hughes B (1993) Heritable and life-style determinants of bone mineral density. J Bone Miner Res 8:1–9PubMedGoogle Scholar
  12. 12.
    Hu JF, Zhao XH, Jia JB, Parpia B, Campbell TC (1993) Dietary calcium and bone density among middle-aged and elderly women in China. Am J Clin Nutr 58:219–227PubMedGoogle Scholar
  13. 13.
    Franceschi S, Schinella D, Bidoli E, Dal Maso L, La Vecchia C, Parazzini F, Zecchin R (1996) The influence of body size, smoking, and diet on bone density in pre- and postmenopausal women. Epidemiol 7:411–414CrossRefGoogle Scholar
  14. 14.
    Ho SC, Leung PC, Swaminathan R, Chan C, Chan SG, Lindsay R (1994) Determinants of bone mass in Chinese women aged 21-40. II Pattern of dietary calcium intake and association with bone mineral density. Osteoporos Int 4:167–175PubMedCrossRefGoogle Scholar
  15. 15.
    Dawson-Hughes B, Dallal GE, Krall EA, Sadowski L, Sahyoun N, Tannenbaum S (1990) A controlled trial of the effect of calcium supplementation on bone density in postmenopausal women. N Engl J Med 323(13):878–883PubMedGoogle Scholar
  16. 16.
    Ho SC, Chen YM, Woo JLF, Lam SSH (2004) High habitual calcium intake attenuates bone loss in early postmenopausal Chinese women: an 18 month follow-up study. J Clin Endoc Metab 89(5):2166–2170CrossRefGoogle Scholar
  17. 17.
    Ho SC, Chan SG, Yi Q, Wong E, Leung PC (2001) Soy intake and the maintenance of peak bone mass in Hong Kong Chinese Women. J Bone Miner Res 16(7):1363–1369PubMedCrossRefGoogle Scholar
  18. 18.
    Ho SC, Woo J, Lam S, Chen YM, Sham A, Lau J (2003) Soy protein consumption and bone mass in early postmenopausal Chinese women. Osteoporos Int 14:835–842PubMedCrossRefGoogle Scholar
  19. 19.
    Kelley GA (1998) Exercise and regional bone mineral density in postmenopausal women: a meta-analytic review of randomized trials. Am J Phys Med Rehab 77(1):76–87CrossRefGoogle Scholar
  20. 20.
    Armamento-Villareal R, Villareal DT, Avioli LV, Civitelli R (1992) Estrogen status and heredity are major determinants of premenopausal bone mass. J Clin Invest 90:2464–2471PubMedCrossRefGoogle Scholar
  21. 21.
    Hoffman S, Grisso JA, Kelsey JL, Gammon MD, O’Brien LA (1993) Parity, lactation and hip fracture. Osteoporos Int 3:171–176PubMedCrossRefGoogle Scholar
  22. 22.
    Hu JF, Zhao XH, Chen JS, Fitzpatrick J, Parpia B, Campbell TC (1994) Bone density and lifestyle characteristics in premenopausal and postmenopausal Chinese women. Osteoporos Int 4(6):288–297PubMedCrossRefGoogle Scholar
  23. 23.
    Pouilles JM, Tremollieres F, Bonneu M, Ribot C (1994) Influence of early age at menopause on vertebral bone mass. J Bone Miner Res 9(3):311–315PubMedGoogle Scholar
  24. 24.
    Gambacciani M, Spinetti A, De Simone L, Cappagli B, Taponeco F, Ciaponi M, Piaggesi L, Gallo R, Facchini V (1995) Postmenopausal bone loss of the proximal femur: estimated contributions of menopause and aging. Menopause 2(3):169–174CrossRefGoogle Scholar
  25. 25.
    Ho SC, Chan SG, Yip YB, Cheng A, Yi Q, Chan SY (1999) Menopausal symptoms and symptom clustering in Chinese women. Maturitas 33:219–227PubMedCrossRefGoogle Scholar
  26. 26.
    Report of a WHO Scientific Group (1981) Research on the menopause. WHO technical report series 670. World Health Oragnization, GenevaGoogle Scholar
  27. 27.
    Sallis JF, Haskell WL, Wood PD, Fortmann SP, Rogers T, Blair SN, Paffenbarger RS Jr (1985) Physical activity assessment methodology in the five-city project. Am J Epidemiol 121:91–106PubMedGoogle Scholar
  28. 28.
    Whittemore AS, Wu-Williams AH, Lee M, Zheng S, Gallagher RP, Jiao DA, Zhou L, Wang XH, Chen K, Jung D et al (1990) Diet, physical activity and colorectal cancer among Chinese in North America and China. J Natl Cancer Inst 82:915–926PubMedCrossRefGoogle Scholar
  29. 29.
    U.S. Department of Health, Education and Welfare & Food & Agriculture Organization of the United Nations: Food Composition Table for Use in East Asia, 1972Google Scholar
  30. 30.
    Paul AA, Southgate DAT (1978) McCance and Widdowson’s the composition of foods. Elsevier/North-Holland Biomedical Press, New YorkGoogle Scholar
  31. 31.
    Recker R, Lappe J, Davies K, Heaney R (2000) Characterization of perimenopausal bone loss: a prospective study. J Bone Miner Res 15(10):1965–1973PubMedCrossRefGoogle Scholar
  32. 32.
    Hansen MA, Overgaard K, Christiansen C (1995) Spontaneous postmenopausal bone loss in different skeletal areas - followed up for 15 years. J Bone Miner Res 10(2):205–210PubMedGoogle Scholar
  33. 33.
    Mizuno K, Suzuki A, Ino Y, Asada Y, Kikkawa F, Tomoda Y (1995) Postmenopausal bone loss in Japanese women. Int J Gynecol Obstet 50:33–39CrossRefGoogle Scholar
  34. 34.
    Frost HM (1997) On our age-related bone loss: insights from a new paradigm. J Bone Miner Res 12(10):1539–1546PubMedCrossRefGoogle Scholar
  35. 35.
    Ravn P, Hetland ML, Overgaard K, Christiansen C (1994) Premenopausal and postmenopausal changes in bone mineral density of the proximal femur measured by dual-energy X-ray absorptiometry. J Bone Miner Res 9(12):1975–1980PubMedGoogle Scholar
  36. 36.
    Lindsay R, Cosman F, Herrington BS, Himmelstein S (1992) Bone mass and body composition in normal women. J Bone Miner Res 7:55–63PubMedGoogle Scholar
  37. 37.
    Edelstein SL, Barrett-Connor E (1993) Relation between body size and bone mineral density in elderly men and women. Am J Epidemiol 138:160–169PubMedGoogle Scholar
  38. 38.
    Sowers MFR, Kshirsagar A, Crutchfield MM, Updike S (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
  39. 39.
    Ulrich CM, Georgiou CC, Snow-Harter CM, Gillis DE (1996) Bone mineral density in mother-daughter pairs: relations to lifetime exercise, lifetime milk consumption, and calcium supplements. Am J Clin Nutr 63:72–79PubMedGoogle Scholar
  40. 40.
    Chen YM, Ho SC, Woo J (2006) Greater fruit intake is associated with better bone mass among postmenopausal Chinese women. Br J Nutr 96(4):745–751PubMedGoogle Scholar
  41. 41.
    Feskanich D, Willett WC, Stamfer MJ, Colditz GA (1996) Protein consumption and bone fractures in women. Am J Epidemiol 143:472–479PubMedGoogle Scholar
  42. 42.
    Bell J, Whiting SF (2002) Elderly women need dietary protein to maintain bone mass. Nutr Rev 60:337–341PubMedCrossRefGoogle Scholar
  43. 43.
    Tucker KL, Hannan MT, Kiel DP (2001) The acid-base hypothesis: diet and bone in the framingham osteoporosis study. Eur J Nutr 40:231–237PubMedCrossRefGoogle Scholar
  44. 44.
    Chen YM, Ho SC, Lam SSH, Ho SSS, Woo JLF (2003) Soy isoflavones have a favorable effect on bone loss in Chinese postmenopausal women with lower bone mass: a double-blind randomized-controlled trial. J Clin Endoc Metab 88(10):4740–4747CrossRefGoogle Scholar
  45. 45.
    Alekel DL, Germain AS, Peterson CT, Hanson KB, Stewart JW, Toda T (2000) Isoflavone-rich soy protein isolate attenuates bone loss in the lumbar spine of perimenopausal women. Am J Clin Nutr 72(3):844–852PubMedGoogle Scholar
  46. 46.
    Fanti P, Monier-Faugere MC, Geng Z, Schmidt J, Morris PE, Cohen D, Malluche HH (1998) The phytoestrogen genistein reduces bone loss in short-term ovariectomized rats. Osteoporos Int 8:274–281PubMedCrossRefGoogle Scholar
  47. 47.
    Arjmandi BH, Khalil DA, Smith BJ, Lucas EA, Juma S, Payton ME, Wild RA (2003) Soy protein has a greater effect on bone in postmenopausal women not on hormone replacement therapy, as evidenced by reducing bone resorption and urinary calcium excretion. J Clin Endocrinol Metab 88:1048–1054PubMedCrossRefGoogle Scholar
  48. 48.
    Krall EA, Dawson-Hughes B (1994) Walking is related to bone density and rates of bone loss. Am J Med 96:20–26PubMedCrossRefGoogle Scholar
  49. 49.
    Villa ML, Marcus R, Delay RR, Kelsey JL (1995) Factors contributing to skeletal health of postmenopausal Mexican-American women. J Bone Miner Res 10(8):1233–1242PubMedGoogle Scholar
  50. 50.
    Kritz-Silverstein D, Barrett-Conner E (1994) Grip strength and bone mineral density in older women. J Bone Miner Res 9(1):45–51PubMedCrossRefGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2008

Authors and Affiliations

  • S. C. Ho
    • 1
  • S. G. Chan
    • 1
  • Y. B. Yip
    • 1
  • C. S. Y. Chan
    • 1
  • J. L. F. Woo
    • 2
  • A. Sham
    • 1
  1. 1.Department of Community and Family MedicineThe Chinese University of Hong KongShatin, N.T.Hong Kong
  2. 2.Department of Medicine and TherapeuticsThe Chinese University of Hong KongShatin, N.T.Hong Kong

Personalised recommendations