Osteoporosis International

, Volume 30, Issue 5, pp 1071–1078 | Cite as

Association of blood n-3 fatty acid with bone mass and bone marrow TRAP-5b in the elderly with and without hip fracture

  • B.-J. KimEmail author
  • H. J. Yoo
  • S. J. Park
  • M. K. Kwak
  • S. H. Lee
  • S. J. Kim
  • M. W. Hamrick
  • C. M. Isales
  • S. H. Ahn
  • J.-M. Koh
Original Article



The plasma n-3 fatty acid level was 26.2% lower in patients with osteoporotic hip fracture than in those with osteoarthritis. In all patients, n-3 fatty acid was positively associated with bone mineral density and inversely associated with tartrate-resistant acid phosphatase-5b level in bone marrow aspirates, reflecting the bone microenvironment.


Despite the potential beneficial role of n-3 fatty acid (FA) on bone metabolism, the specific mechanisms underlying these effects in humans remain unclear. Here, we assessed whether the plasma n-3 level, as an objective indicator of its status, is associated with osteoporosis-related phenotypes and bone-related markers in human bone marrow (BM) samples.


This was a case-control and cross-sectional study conducted in a clinical unit. n-3 FA in the blood and bone biochemical markers in the BM aspirates were measured by gas chromatography/mass spectrometry and immunoassay, respectively. BM fluids were collected from 72 patients who underwent hip surgery because of either osteoporotic hip fracture (HF; n = 28) or osteoarthritis (n = 44).


After adjusting for confounders, patients with HF had 26.2% lower plasma n-3 levels than those with osteoarthritis (P = 0.006), and each standard deviation increment in plasma n-3 was associated with a multivariate-adjusted odds ratio of 0.40 for osteoporotic HF (P = 0.010). In multivariate analyses including all patients, a higher plasma n-3 level was associated with higher bone mass at the lumbar spine (β = 0.615, P = 0.002) and total femur (β = 0.244, P = 0.045). Interestingly, the plasma n-3 level was inversely associated with the tartrate-resistant acid phosphatase-5b level (β = − 0.633, P = 0.023), but not with the bone-specific alkaline phosphatase level, in BM aspirates.


These findings provide clinical evidence that n-3 FA is a potential inhibitor of osteoclastogenesis that favors human bone health.


Bone mass Bone resorption n-3 fatty acid Osteoporotic fracture 


Funding information

This study was supported by a grant from the Bio & Medical Technology Development Program of the National Research Foundation, funded by the Korean government, MSIP (2016M3A9E8941329).

Compliance with ethical standards

This study was approved by the Institutional Review Board of Asan Medical Center and was conducted according to the Ethical Principles for Medical Research Involving Human Subjects as defined by the Helsinki Declaration.

Informed consent

All participants in this study provided informed consent.

Conflicts of interest


Supplementary material

198_2019_4881_MOESM1_ESM.docx (37 kb)
ESM 1 (DOCX 37 kb)


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2019

Authors and Affiliations

  • B.-J. Kim
    • 1
    Email author
  • H. J. Yoo
    • 2
  • S. J. Park
    • 3
  • M. K. Kwak
    • 1
  • S. H. Lee
    • 1
  • S. J. Kim
    • 2
  • M. W. Hamrick
    • 4
  • C. M. Isales
    • 5
  • S. H. Ahn
    • 6
  • J.-M. Koh
    • 1
  1. 1.Division of Endocrinology and Metabolism, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulSouth Korea
  2. 2.Department of Convergence Medicine, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulSouth Korea
  3. 3.Asan Institute for Life SciencesSeoulSouth Korea
  4. 4.Department of Cellular Biology and Anatomy, Medical College of GeorgiaAugusta UniversityAugustaUSA
  5. 5.Department of Orthopedic Surgery, Medical College of GeorgiaAugusta UniversityAugustaUSA
  6. 6.Department of EndocrinologyInha University School of MedicineIncheonSouth Korea

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