Osteoporosis International

, Volume 23, Issue 7, pp 2009–2016 | Cite as

Fat mass is negatively associated with bone mineral content in Koreans

  • J. H. Kim
  • H. J. Choi
  • M. J. Kim
  • C. S. ShinEmail author
  • N. H. ChoEmail author
Original Article



Although obesity and osteoporosis are important public health problems, the effect of fat mass on bone mass remains controversial. This study demonstrated that fat mass was inversely related to bone mineral content, and abdominal obesity was significantly associated with bone mineral content independent of total fat mass.


Obesity and osteoporosis, two disorders of body composition, have become increasingly important public health problems throughout the world. However, the effect of fat mass on bone mass remains controversial. This study investigates the effect of fat mass and regional fat distribution on bone mass within a community-dwelling cohort.


A total of 3,042 subjects (1,284 men, 362 premenopausal women, and 1,396 postmenopausal women) were studied. Fat mass, percent fat mass, lean mass, percent lean mass, and bone mineral content (BMC) were measured by dual energy X-ray absorptiometry.


Fat mass and percent fat mass decreased significantly across increasing tertiles of BMC in all three subgroups (men, premenopausal and postmenopausal women). In contrast, lean mass and percent lean mass increased significantly across tertiles of BMC in men, and a similar trend was also identified in postmenopausal women. Interestingly, although correlation analysis showed a positive association between fat mass and BMC (p < 0.05), this association became negative after controlling for age and weight (p < 0.05). Finally, in premenopausal and postmenopausal women, subjects with the lowest waist circumference (WC) had the highest BMC in the higher three quartiles of percent fat mass after adjusting for age and weight (p < 0.05), indicating that abdominal obesity is associated with BMC independent of total fat mass.


This study demonstrated that fat mass was inversely related to BMC after removing the mechanical loading effect in Korean men and women. Moreover, abdominal obesity as measured by WC was significantly associated with BMC independent of total fat mass.


Abdominal obesity Bone mass Obesity Osteoporosis 


Conflicts of interest



  1. 1.
    Korea National Statistical Office (2010) Statistics KoreaGoogle Scholar
  2. 2.
    Weaver CM (2010) Role of dairy beverages in the diet. Physiol Behav 100:63–66PubMedCrossRefGoogle Scholar
  3. 3.
    Shin CS, Choi HJ, Kim MJ et al (2010) Prevalence and risk factors of osteoporosis in Korea: a community-based cohort study with lumbar spine and hip bone mineral density. Bone 47:378–387PubMedCrossRefGoogle Scholar
  4. 4.
    Cheng H, Gary L, Curtis J, Saag K, Kilgore M, Morrisey M, Matthews R, Smith W, Yun H, Delzell E (2009) Estimated prevalence and patterns of presumed osteoporosis among older Americans based on Medicare data. Osteoporos Int 20:1507–1515PubMedCrossRefGoogle Scholar
  5. 5.
    Looker A, Melton L III, Harris T, Borrud L, Shepherd J (2010) Prevalence and trends in low femur bone density among older US adults: NHANES 2005–2006 compared with NHANES III. J Bone Miner Res 25:64–71PubMedCrossRefGoogle Scholar
  6. 6.
    Wardlaw GM (1996) Putting body weight and osteoporosis into perspective. Am J Clin Nutr 63:433S–436SPubMedGoogle Scholar
  7. 7.
    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
  8. 8.
    Ravn P, Cizza G, Bjarnason NH, Thompson D, Daley M, Wasnich RD, McClung M, Hosking D, Yates AJ, Christiansen C (1999) Low body mass index is an important risk factor for low bone mass and increased bone loss in early postmenopausal women. Early postmenopausal intervention cohort (EPIC) study group. J Bone Miner Res 14:1622–1627PubMedCrossRefGoogle Scholar
  9. 9.
    Reid IR (2002) Relationships among body mass, its components, and bone. Bone 31:547–555PubMedCrossRefGoogle Scholar
  10. 10.
    Reid IR, Ames R, Evans MC, Sharpe S, Gamble G, France JT, Lim TM, Cundy TF (1992) Determinants of total body and regional bone mineral density in normal postmenopausal women—a key role for fat mass. J Clin Endocrinol Metab 75:45–51PubMedCrossRefGoogle Scholar
  11. 11.
    Guney E, Kisakol G, Ozgen G, Yilmaz C, Yilmaz R, Kabalak T (2003) Effect of weight loss on bone metabolism: comparison of vertical banded gastroplasty and medical intervention. Obes Surg 13:383–388PubMedCrossRefGoogle Scholar
  12. 12.
    Zhao L, Jiang H, Papasian C, Maulik D, Drees B, Hamilton J, Deng H (2008) Correlation of obesity and osteoporosis: effect of fat mass on the determination of osteoporosis. J Bone Miner Res 23:17–29PubMedCrossRefGoogle Scholar
  13. 13.
    Ducy P, Amling M, Takeda S, Priemel M, Schilling AF, Beil FT, Shen J, Vinson C, Rueger JM, Karsenty G (2000) Leptin inhibits bone formation through a hypothalamic relay: a central control of bone mass. Cell 100:197–207PubMedCrossRefGoogle Scholar
  14. 14.
    Williams G, Wang Y, Callon K, Watson M, Lin J, Lam J, Costa J, Orpe A, Broom N, Naot D (2009) In vitro and in vivo effects of adiponectin on bone. Endocrinology 150:3603PubMedCrossRefGoogle Scholar
  15. 15.
    Reid I, Plank L, Evans M (1992) Fat mass is an important determinant of whole body bone density in premenopausal women but not in men. J Clin Endocrinol Metab 75:779–782PubMedCrossRefGoogle Scholar
  16. 16.
    Khosla S, Atkinson EJ, Riggs BL, Melton LJ III (1996) Relationship between body composition and bone mass in women. J Bone Miner Res 11:857–863PubMedCrossRefGoogle Scholar
  17. 17.
    Hsu Y, Venners S, Terwedow H, Feng Y, Niu T, Li Z, Laird N, Brain J, Cummings S, Bouxsein M (2006) Relation of body composition, fat mass, and serum lipids to osteoporotic fractures and bone mineral density in Chinese men and women. Am J Clin Nutr 83:146PubMedGoogle Scholar
  18. 18.
    Zhao LJ, Liu YJ, Liu PY, Hamilton J, Recker RR, Deng HW (2007) Relationship of obesity with osteoporosis. J Clin Endocrinol Metab 92:1640–1646PubMedCrossRefGoogle Scholar
  19. 19.
    Gilsanz V, Chalfant J, Mo AO, Lee DC, Dorey FJ, Mittelman SD (2009) Reciprocal relations of subcutaneous and visceral fat to bone structure and strength. J Clin Endocrinol Metab 94:3387–3393PubMedCrossRefGoogle Scholar
  20. 20.
    Expert Panel on Detection E, Treatment of High Blood Cholesterol in Adults (2001) Executive summary of the third report of the national cholesterol education program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III). JAMA 285:2486–2497CrossRefGoogle Scholar
  21. 21.
    Wu F, Ames R, Clearwater J, Evans MC, Gamble G, Reid IR (2002) Prospective 10-year study of the determinants of bone density and bone loss in normal postmenopausal women, including the effect of hormone replacement therapy. Clin Endocrinol (Oxf) 56:703–711CrossRefGoogle Scholar
  22. 22.
    Wang MC, Bachrach LK, Van Loan M, Hudes M, Flegal KM, Crawford PB (2005) The relative contributions of lean tissue mass and fat mass to bone density in young women. Bone 37:474–481PubMedCrossRefGoogle Scholar
  23. 23.
    Cornish J, Reid IR (2001) Effects of amylin and adrenomedullin on the skeleton. J Musculoskelet Neuronal Interact 2:15–24PubMedGoogle Scholar
  24. 24.
    Goulding A, Taylor RW (1998) Plasma leptin values in relation to bone mass and density and to dynamic biochemical markers of bone resorption and formation in postmenopausal women. Calcif Tissue Int 63:456–458PubMedCrossRefGoogle Scholar
  25. 25.
    Reid IR, Evans MC, Cooper GJ, Ames RW, Stapleton J (1993) Circulating insulin levels are related to bone density in normal postmenopausal women. Am J Physiol 265:E655–E659PubMedGoogle Scholar
  26. 26.
    Geer EB, Shen W (2009) Gender differences in insulin resistance, body composition, and energy balance. Gend Med 6(Suppl 1):60–75PubMedCrossRefGoogle Scholar
  27. 27.
    Alberti K, Zimmet P, Shaw J (2005) The metabolic syndrome—a new worldwide definition. Lancet 366:1059–1062PubMedCrossRefGoogle Scholar
  28. 28.
    Choi HS, Kim KJ, Kim KM, Hur NW, Rhee Y, Han DS, Lee EJ, Lim SK (2010) Relationship between visceral adiposity and bone mineral density in Korean adults. Calcif Tissue Int 87:218–225PubMedCrossRefGoogle Scholar
  29. 29.
    Wajchenberg B (2000) Subcutaneous and visceral adipose tissue: their relation to the metabolic syndrome. Endocr Rev 21:697PubMedCrossRefGoogle Scholar
  30. 30.
    Heiss CJ, Sanborn CF, Nichols DL, Bonnick SL, Alford BB (1995) Associations of body fat distribution, circulating sex hormones, and bone density in postmenopausal women. J Clin Endocrinol Metab 80:1591–1596PubMedCrossRefGoogle Scholar
  31. 31.
    Prentice A, Parsons T, Cole T (1994) Uncritical use of bone mineral density in absorptiometry may lead to size-related artifacts in the identification of bone mineral determinants. Am J Clin Nutr 60:837–842PubMedGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2011

Authors and Affiliations

  1. 1.Department of Internal MedicineSeoul National University College of MedicineSeoulSouth Korea
  2. 2.Department of Preventive MedicineAjou University School of MedicineSuwonSouth Korea

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