Osteoporosis International

, Volume 22, Issue 11, pp 2829–2836 | Cite as

Bone health in healthy Indian population aged 50 years and above

  • R. K. MarwahaEmail author
  • N. Tandon
  • M. K. Garg
  • R. Kanwar
  • A. Narang
  • A. Sastry
  • A. Saberwal
  • K. Bhadra
  • A. Mithal
Original Article



One thousand six hundred healthy subjects aged more than 50 years, residing in Delhi, were evaluated for bone mineral metabolic parameters. High prevalence of osteoporosis (35.1% subjects) was observed in this population. Bone mineral density (BMD) correlated positively with body mass index (BMI) and negatively with PTH levels. No correlation was observed with serum 25(OH)D levels.


To assess the bone health status in elderly Indians and compare peripheral DXA (pDXA) with central DXA in evaluation of osteoporosis.


The study involved 1,600 healthy subjects more than 50 years of age residing in Delhi, India, who underwent anthropometric, biochemical, and hormonal evaluation. BMD was measured by DXA at lumbar spine, hip, and distal radius; and by pDXA at forearm and calcaneum.


Seven hundred ninety-two males and 808 postmenopausal females, with a mean age of 57.67 ± 9.46 years were evaluated. Osteoporosis was present in 35.1% subjects (M—24.6%, F—42.5%) and osteopenia in 49.5% (M—54.3%, F—44.9%). Prevalence of osteoporosis increased with age in females, but not in males. BMD at all sites, except distal radius, was positively correlated with BMI (r = 0.037, p = 0.14). Total body BMD was negatively correlated with alkaline phosphatase (r = −0.184, p < 0.00001) and PTH levels (r = −0.099, p < 0.00001), respectively. No significant correlation was observed between serum 25(OH)D levels and BMD at any site. BMD at forearm and calcaneum, measured using pDXA, showed strong positive correlation with BMD measured by central DXA. pDXA had sensitivity of 88%, specificity of 55%, and negative and positive predictive values of 89% and 52%, respectively, at T-score −2.5 at peripheral sites compared to central DXA.


A high prevalence of osteoporosis was observed in elderly Indian subjects. pDXA has high negative predictive value, making it a useful tool in population screening for osteoporosis.


Bone mineral density DXA Osteopenia Osteoporosis Serum 25(OH)D levels 



We acknowledge the help provided by M. Kalaivani for the statistical analysis.

Conflicts of interest


Supplementary material

198_2010_1507_MOESM1_ESM.doc (33 kb)
Supplementary Table 1 Correlation of BMD with anthropometric and biochemical data* (DOC 33 kb)
198_2010_1507_MOESM2_ESM.doc (34 kb)
Supplementary Table 2 Peripheral BMD (gm/cm2) data (DOC 33 kb)
198_2010_1507_MOESM3_ESM.doc (28 kb)
Supplementary Table 3 Correlation of peripheral BMD with BMD by central DXA at various sites (DOC 28 kb)
198_2010_1507_MOESM4_ESM.doc (28 kb)
Supplementary Table 4 Predictive value of peripheral DXA at different cutoff value of T-score at forearm or calcaneum (DOC 27 kb)


  1. 1.
    International Osteoporosis Foundation (2009) The Asian Audit: Epidemiology, costs and burden of osteoporosis in Asia 2009.
  2. 2.
    Johnell O, Kanis JA (2006) An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int 17:1726PubMedCrossRefGoogle Scholar
  3. 3.
    Kanis JA, Oden A, Johnell O, De Laet C, Jonsson B, Oglesby AK (2003) The components of excess mortality after hip fracture. Bone 32:468PubMedCrossRefGoogle Scholar
  4. 4.
    Trombetti A, Herrmann F, Hoffmeyer P et al (2002) Survival and potential years of life lost after hip fracture in men and age-matched women. Osteoporos Int 13:731PubMedCrossRefGoogle Scholar
  5. 5.
    Osteoporosis Society of India (2003) Action plan osteoporosis: consensus statement of an expert group. New DelhiGoogle Scholar
  6. 6.
    Mithal A, Wahl DA, Bonjour J-P, Burckhardt P, Dawson-Hughes B, Eisman JA et al (2009) Global vitamin D status and determinants of hypovitaninosis D. Osteoporos Int 20(11):1807–1829PubMedCrossRefGoogle Scholar
  7. 7.
    Harinarayan CV, Joshi SR (2009) Vitamin D status in India—its implications and remedial measures. J Assoc Phys India 57:40–48Google Scholar
  8. 8.
    Roy D, Swarbrick C, King Y et al (2005) Differences in peak bone mass in women of European and South Asian origin can be explained by differences in body size. Osteoporos Int 16:1254–1262PubMedCrossRefGoogle Scholar
  9. 9.
    Marwaha RK, Tandon N, Reddy DR, Aggarwal R, Singh R, Sawhney RC, Saluja B, Ganie MA, Singh S (2005) Vitamin D and bone mineral density status of healthy schoolchildren in northern India. Am J Clin Nutr 82(2):477–482PubMedGoogle Scholar
  10. 10.
    Marwaha RK, Tandon N, Reddy DHK, Mani K, Puri S, Aggarwal N et al (2007) Peripheral bone mineral density and its predictors in healthy schoolgirls from two socioeconomic groups in Delhi. Osteoporos Int 18:375–383PubMedCrossRefGoogle Scholar
  11. 11.
    Tandon N, Marwaha RK, Kalra S, Gupta N, Dudha A, Kochupillai N (2003) Bone mineral parameters in healthy young Indian adults with optimal vitamin D availability. Natl Med J India 16:298–302PubMedGoogle Scholar
  12. 12.
    Paul TV, Thomas N, Seshadri MS, Oommen R, Jose A, Mahendri NV (2008) Prevalence of osteoporosis in ambulatory postmenopausal women from a semiurban region in Southern India: relationship to calcium nutrition and vitamin D status. Endocr Pract 14:665–671PubMedGoogle Scholar
  13. 13.
    Arya V, Bhambri R, Godbole MM, Mithal A (2004) Vitamin D status and its correlation with bone mineral density in healthy Asian Indians. Osteoporos Int 15:56–61PubMedCrossRefGoogle Scholar
  14. 14.
    Elizabeth J, Dayananda G, Satyavati K, Kumar P (2009) Bone mineral density in healthy south Indian men. JPBS 22:41–43Google Scholar
  15. 15.
    Chibber G, Roy R, Eunice M, Srivastava M, Ammini AC (2007) Prevalence of osteoporosis among elderly women living in Delhi and rural Haryana. IJEM 1(1&2):11–14Google Scholar
  16. 16.
    Usha G, Krishnaswamy B (2002) Bone mineral density and fracture threshold in South Indian elderly. J Assoc Physicians India 50:247–249PubMedGoogle Scholar
  17. 17.
    Shatrugna V, Kulkarni B, Kumar PA, Rani KU, Balakrishna N (2005) Bone status of Indian women from a low-income group and its relationship to the nutritional status. Osteoporos Int 16:1827PubMedCrossRefGoogle Scholar
  18. 18.
    Gupta A (1998) Osteoporosis in India—the nutritional hypothesis. In: Mithal A, Rao DS, Zaidi M (eds) Metabolic bone disorders. Hindustan Book Depot, Lucknow, pp 115–132Google Scholar
  19. 19.
    Hollick MF (2007) Vitamin D deficiency. N Engl J Med 357:266–281CrossRefGoogle Scholar
  20. 20.
    Lips P (2001) Vitamin D deficiency and secondary hyperparathyroidism in the elderly: consequences for bone loss and fractures and therapeutic implications. Endocr Rev 22:477–501PubMedCrossRefGoogle Scholar
  21. 21.
    Genant HK, Cooper C, Poor G, Reid I, Ehrlich G, Kanis J et al (1999) Interim report and recommendations of the World Health Organization Task-Force for Osteoporosis. Osteoporos Int 10:259–264PubMedCrossRefGoogle Scholar
  22. 22.
    Hui SL et al (1997) Universal standardization of bone density measurements: a method with optimal properties for calibration among several instruments. J Bone Miner Res 12:1463–1470PubMedCrossRefGoogle Scholar
  23. 23.
    Lu Y, Fuerst T, Hui S, Genant HK (2001) Standardization of bone mineral density at femoral neck, trochanter and ward's triangle. Osteoporos Int 12:438–444PubMedCrossRefGoogle Scholar
  24. 24.
    Bonnick SL (2010) Bone density data among technologies and manufacturers (chapter 6) In: Bone densitometry in clinical practice: Application and interpretation, 3 rd edn. Published by Humana Press, a part of springer + Business media, LLC¸ pp 141–161Google Scholar
  25. 25.
    Kanis JA (2007) WHO Scientific Group Technical Report: Assessment of osteoporosis at the primary health care level. WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield, UKGoogle Scholar
  26. 26.
    Siris ES, Miller PD, Barrett-Connor E, Faulkner KG, Wehren LE, Abbott TA et al (2001) Identification and fracture outcomes of undiagnosed low bone mineral density in post menopausal women. Results from the National Osteoporosis Risk Assessment JAMA 286:2815–2822Google Scholar
  27. 27.
    Messinger-Rapport BJ, Thacker HL (2002) Prevention for older women, part-3: a practical guide to prevention and treatment of osteoporosis. Geriatrics 57:16–27PubMedGoogle Scholar
  28. 28.
    Melton LJ, Crowson CS, O'Fallon WM (1999) Fracture incidence in Olmsted County, Minnesota: comparison of urban with rural rates and changes in urban rates over time. Osteoporos Int 9:29PubMedCrossRefGoogle Scholar
  29. 29.
    Shatrugna V, Ammini AC, Tandon N, Goswami R, Gupta N, Bhatia E et al. (2010) Population based reference standards of peak bone mineral density of Indian males and females—an ICMR multi task force study. ICMR PublicationGoogle Scholar
  30. 30.
    Makker A, Mishra G, Singh BP, Tripathi A, Singh MM (2008) Normative bone mineral density data at multiple skeletal sites in Indian subjects. Arch Osteoporos 3:25–37CrossRefGoogle Scholar
  31. 31.
    Marwaha RK, Kanwar R, Kalaivani V, Aggarwal R et al (2009) Peak bone mineal sensity of physically active healthy Indian men with adequate nutrition and no known current constraints to bone mineralization. J Clin Densitom 12:341–321CrossRefGoogle Scholar
  32. 32.
    Alkel DL, Peterson CT, Werner RK, Mortillaro E, Ahmed N, Kukreja SC (2002) Frame size, ethnicity, and biologic contributors to areal and volumetric lumbar spine bone mineral density in Indian/Pakistani and American Caucasian premenopausal women. J Clin Densitom 5:175–186CrossRefGoogle Scholar
  33. 33.
    Ebeling PR (1998) Osteoporosis in men. New insights into aetiology, pathogenesis, prevention and management. Drugs Aging 13(6):421–434PubMedCrossRefGoogle Scholar
  34. 34.
    Kocjan T, Tan TM, Conway GS, Prelevic G (2006) Vitamin D status in patients with osteopenia or osteoporosis—an audit of an endocrine clinic. Int J Vitam Nutr Res 76(5):307–313PubMedCrossRefGoogle Scholar
  35. 35.
    Jorde R, Sneve M, Torjesen PA, Figenschau Y, Hansen JB, Grimnes G (2010) No significant effect on bone mineral density by high doses of vitamin D3 given to overweight subjects for one year. Nutr J 9:1PubMedCrossRefGoogle Scholar
  36. 36.
    McCabe LD, Martin BR, McCabe GP, Johnston CC, Weaver CM, Peacock M (2004) Dairy intakes affect bone density in the elderly. Am J Clin Nutr 80:1066–1074PubMedGoogle Scholar
  37. 37.
    Storm D, Eslin R, Porter ES, Musgrave K, Vereault D, Patton C, Kessenich C, Mohan S, Chen T, Holick MF, Rosen CJ (1998) Calcium supplementation prevents seasonal bone loss and changes in biochemical markers of bone turnover in elderly New England women: a randomized placebo-controlled trial. J Clin Endocrinol Metab 83:3817–3825PubMedCrossRefGoogle Scholar
  38. 38.
    Scholtissen S, Guillemin F, Bruyère O, Collette J, Dousset B, Kemmer C et al (2009) Assessment of determinants for osteoporosis in elderly men. Osteoporos Int 20:1157–1166PubMedCrossRefGoogle Scholar
  39. 39.
    Hamson C, Goh L, Sheldon P, Samanta A (2003) Comparative study of bone mineral density, calcium, and vitamin D status in the Gujrati and white populations of Leicaster. Postgrad Med J 79:279–283PubMedCrossRefGoogle Scholar
  40. 40.
    Cranney A, Horsley T, O’Donnell S et al (2007) Effectiveness and safety of vitamin D in relation to bone health. Evid Rep Technol Assess 158:1–23Google Scholar
  41. 41.
    Roy DK, Berry JL, Pye SR, Adams JE, Swarbrick CM et al (2007) Vitamin D status and bone mass in UK South Asian Women. Bone 40:200–204PubMedCrossRefGoogle Scholar
  42. 42.
    Miller PD, Siris ES, Barrett-Connor E, Faulkner KG, Wehren LE, Abbott TA et al (2002) Prediction of fracture risk in postmenopausal white women with peripheral bone densitometry: Evidence from the National Osteoporosis Risk Assessment. J Bone Miner Res 17:2222–2230PubMedCrossRefGoogle Scholar
  43. 43.
    Patel R, Blake GM, Jefferies A, Sautereau-Chandley PM, Fogelman I (1998) A comparison of a peripheral DXA system with conventional densitometry of spine and femur. J Clin Densitom 1:235–244PubMedCrossRefGoogle Scholar
  44. 44.
    Sharma S, Tandon R, Mahajan A, Kour A, Kumar D (2006) Preliminary screening of osteoporosis and osteopenia in urban women from Jammu using calcaneal QUS. Indian J Med Sci 60:183–189PubMedCrossRefGoogle Scholar
  45. 45.
    Chen JX, Gong J, Zhang TM, Wu QL, Xu H (2006) Correlations between bone mineral density of the hand and other skeletal sites as measured by DXA in Chinese women and men. J Clin Densitom 4:461–468CrossRefGoogle Scholar
  46. 46.
    Pouilles JM, Tremollieres FA, Martinez S, Delsol M, Ribot C (2001) Ability of peripheral DXA measurements of the forearm to predict low axial bone mineral density at menopause. Osteoporos Int 12:71–76PubMedCrossRefGoogle Scholar
  47. 47.
    Picard D, Brown JP, Rosenthall L, Couturier M, Lévesque J, Dumont M, Ste-Marie LG, Tenenhouse A, Dodin S (2004) Ability of peripheral DXA measurement to diagnose osteoporosis as assessed by central DXA measurement. J Clin Densitom 7(1):111–118PubMedCrossRefGoogle Scholar
  48. 48.
    Clowes JA, Peel NF, Eastell R (2007) Device specific thresholds to diagnose osteoporosis at the proximal femur: an approach to interpreting peripheral bone measurements in clinical practice. Osteoporos Int 18:1557–1559CrossRefGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2011

Authors and Affiliations

  • R. K. Marwaha
    • 1
    Email author
  • N. Tandon
    • 2
  • M. K. Garg
    • 3
  • R. Kanwar
    • 1
  • A. Narang
    • 1
  • A. Sastry
    • 1
  • A. Saberwal
    • 1
  • K. Bhadra
    • 1
  • A. Mithal
    • 4
  1. 1.Department of Endocrinology and Thyroid Research CentreInstitute of Nuclear Medicine and Allied SciencesDelhiIndia
  2. 2.Department of Endocrinology and MetabolismAll India Institute of Medical SciencesNew DelhiIndia
  3. 3.Department of Endocrinology and MetabolismArmy Hospital (Research and Referral)Delhi CanttIndia
  4. 4.Division of Endocrinology and DiabetesMedanta MedicityGurgaonIndia

Personalised recommendations