Calcified Tissue International

, Volume 92, Issue 6, pp 501–508 | Cite as

High Serum Total Bilirubin as a Protective Factor Against Hip Bone Loss in Healthy Middle-Aged Men

  • Beom-Jun Kim
  • Jung-Min KohEmail author
  • Seong Hee Ahn
  • Seung Hun Lee
  • Eun Hee Kim
  • Sung Jin Bae
  • Hong-Kyu Kim
  • Jae Won Choe
  • Ghi Su Kim
Original Research


Bilirubin is known to have a physiologic role as an antioxidant that efficiently scavenges peroxyl radicals and suppresses oxidation, and oxidative stress has detrimental effects on bone metabolism. In the present study, we performed a 3-year longitudinal study of healthy middle-aged men, investigating the association between serum total bilirubin concentrations and annualized changes in bone mineral density (BMD). The study enrolled a total of 917 Korean men aged 40 years or older who had undergone comprehensive routine health examinations with an average follow-up interval of 3 years. BMD at proximal femur sites was measured with dual-energy X-ray absorptiometry using the same equipment at baseline and follow-up. The overall mean annualized rates of bone loss at the total femur, femoral neck, and trochanter were −0.25 %/year, −0.34 %/year, and −0.44 %/year, respectively. After adjustment for potential confounders, the rates of bone loss at all proximal femur sites were significantly attenuated in a dose–response fashion across increasing bilirubin concentrations (P = 0.006–0.046). Moreover, compared to subjects in the lowest bilirubin quartile category, those in the highest bilirubin quartile category showed significantly less bone loss at all proximal femur sites after adjustment for confounding factors (P = 0.010–0.048). This study provides the first clinical evidence that serum total bilirubin could be a protective marker against future bone loss, especially in subjects without liver diseases.


Bilirubin Bone loss Antioxidant Bone density 



This study was supported by grants from the Korea Health Technology R&D Project and the National Project for Personalized Genomic Medicine, Ministry of Health & Welfare, Republic of Korea (projects A110536 and A111218-GM03, respectively).


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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Beom-Jun Kim
    • 1
  • Jung-Min Koh
    • 1
    Email author
  • Seong Hee Ahn
    • 1
  • Seung Hun Lee
    • 1
  • Eun Hee Kim
    • 2
  • Sung Jin Bae
    • 2
  • Hong-Kyu Kim
    • 2
  • Jae Won Choe
    • 2
  • Ghi Su Kim
    • 1
  1. 1.Division of Endocrinology and MetabolismAsan Medical Center, University of Ulsan College of MedicineSeoulKorea
  2. 2.Health Promotion CenterAsan Medical Center, University of Ulsan College of MedicineSeoulKorea

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