Journal of Bone and Mineral Metabolism

, Volume 33, Issue 5, pp 507–515 | Cite as

Contributions of fat mass and fat distribution to hip bone strength in healthy postmenopausal Chinese women

  • Hong Da Shao
  • Guan Wu Li
  • Yong Liu
  • Yu You Qiu
  • Jian Hua Yao
  • Guang Yu TangEmail author
Original Article


The fat and bone connection is complicated, and the effect of adipose tissue on hip bone strength remains unclear. The aim of this study was to clarify the relative contribution of body fat accumulation and fat distribution to the determination of proximal femur strength in healthy postmenopausal Chinese women. This cross-sectional study enrolled 528 healthy postmenopausal women without medication history or known diseases. Total lean mass (LM), appendicular LM (ALM), percentage of lean mass (PLM), total fat mass (FM), appendicular FM (AFM), percentage of body fat (PBF), android and gynoid fat amount, android-to-gynoid fat ratio (AOI), bone mineral density (BMD), and proximal femur geometry were measured by dual energy X-ray absorptiometry. Hip structure analysis was used to compute some variables as geometric strength-related parameters by analyzing the images of the hip generated from DXA scans. Correlation analyses among anthropometrics, variables of body composition and bone mass, and geometric indices of hip bone strength were performed with stepwise linear regression analyses as well as Pearson’s correlation analysis. In univariate analysis, there were significantly inverse correlations between age, years since menopause (YSM), hip BMD, and hip geometric parameters. Bone data were positively related to height, body weight, LM, ALM, FM, AFM, and PBF but negatively related to AOI and amount of android fat (all P < 0.05). AFM and AOI were significantly related to most anthropometric parameters. AFM was positively associated with height, body weight, and BMI. AFM was negatively associated with age and YSM. AOI was negatively associated with height, body weight, and BMI. AOI positively associated with age and YSM. LM, ALM, and FM had a positive relationship with anthropometric parameters (P < 0.05 for all). PLM had a negative relationship with those parameters. The correlation between LM, ALM, FM, PLM, ALM, age, and YSM was not significant. In multivariate linear regression analysis, the hip bone strength was observed to have a consistent and unchanged positive association with AFM and a negative association with AOI, whereas its association with other variables of body composition was not significant after adjusting for age, years since menopause, height, body weight, and BMI. AFM may be a positively protective effect for hip bone strength while AOI, rather than android fat, shows a strong negative association with hip bone strength after making an adjustment for confounders (age, YSM, height, body weight, and BMI) in healthy postmenopausal Chinese women. Rational weight control and AOI reduction during menopause may have vital clinical significance in decreasing postmenopausal osteoporosis.


Bone mineral density Hip structure analysis Lean mass Fat mass Fat distribution 



This study was supported by grants from the National Natural Science Foundation of China (81071134, 81371517) and from the 5810 Foundation of Shanghai Tenth People’s Hospital (11RD104).

Conflict of Interest

Hong-Da Shao, MD, Guan-Wu Li, MD, Yong Liu, MD, Yu-You Qiu, MD, Guang-Yu Tang declared that they have no conflicts of interest.


  1. 1.
    Nguyen TV, Center JR, Eisman JA (2000) Osteoporosis in elderly men and women: effects of dietary calcium, physical activity, and body mass index. J Bone Miner Metab 15:322–331CrossRefGoogle Scholar
  2. 2.
    Marks R (2010) Hip fracture epidemiological trends, outcomes, and risk factors, 1970-2009. Int J Gen Med 3:1–17PubMedCentralPubMedGoogle Scholar
  3. 3.
    Beck TJ, Petit MA, Wu G et al (2009) Does obesity really make the femur stronger? BMD, geometry, and fracture incidence in the women’s health initiative-observational study. J Bone Miner Metab 24:1369–1379CrossRefGoogle Scholar
  4. 4.
    Zhao LJ, Jiang H, Papasian CJ et al (2008) Correlation of obesity and osteoporosis: effect of fat mass on the determination of osteoporosis. J Bone Miner Metab 23:17–29CrossRefGoogle Scholar
  5. 5.
    Cui LH, Shin MH, Kweon SS et al (2007) Relative contribution of body composition to bone mineral density at different sites in men and women of South Korea. J Bone Miner Metab 25:165–171CrossRefPubMedGoogle Scholar
  6. 6.
    El Hage R, Jacob C, Moussa E et al (2011) Relative importance of lean mass and fat mass on bone mineral density in a group of Lebanese postmenopausal women. J Clin Densitom 14:326–331CrossRefPubMedGoogle Scholar
  7. 7.
    Nur H, Toraman NF, Arica Z et al (2012) The relationship between body composition and bone mineral density in postmenopausal Turkish women. Rheumatol Int. doi: 10.1007/s00296-012-2391-7 PubMedGoogle Scholar
  8. 8.
    Kim JH, Choi HJ, Kim MJ et al (2012) Fat mass is negatively associated with bone mineral content in Koreans. Osteoporos Int 23:2009–2016CrossRefPubMedGoogle Scholar
  9. 9.
    Hsu YH, Venners SA, Terwedow HA et al (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 83:146–154PubMedGoogle Scholar
  10. 10.
    Ho-Pham LT, Nguyen ND, Lai TQ et al (2010) Contributions of lean mass and fat mass to bone mineral density: a study in postmenopausal women. BMC Musculoskelet Disord 11:59PubMedCentralCrossRefPubMedGoogle Scholar
  11. 11.
    Cheng Q, Zhu YX, Zhang MX et al (2012) Age and sex effects on the association between body composition and bone mineral density in healthy Chinese men and women. Menopause 19:448–455CrossRefPubMedGoogle Scholar
  12. 12.
    Fu X, Ma X, Lu H et al (2011) Associations of fat mass and fat distribution with bone mineral density in pre- and postmenopausal Chinese women. Osteoporos Int 22:113–119CrossRefPubMedGoogle Scholar
  13. 13.
    Dytfeld J, Ignaszak-Szczepaniak M, Gowin E et al (2011) Influence of lean and fat mass on bone mineral density (BMD) in postmenopausal women with osteoporosis. Arch Gerontol Geriatr 53:e237–e242CrossRefPubMedGoogle Scholar
  14. 14.
    Zillikens MC, Uitterlinden AG, van Leeuwen JP et al (2010) The role of body mass index, insulin, and adiponectin in the relation between fat distribution and bone mineral density. Calcif Tissue Int 86:116–125PubMedCentralCrossRefPubMedGoogle Scholar
  15. 15.
    Li GW, Chang SX, Xu Z et al (2013) Prediction of hip osteoporotic fractures from composite indices of femoral neck strength. Skeletal Radiol 42:195–201CrossRefPubMedGoogle Scholar
  16. 16.
    Li GW, Tang GY, Liu Y et al (2012) MR spectroscopy and micro-CT in evaluation of osteoporosis model in rabbits: comparison with histopathology. Eur Radiol 22:923–929CrossRefPubMedGoogle Scholar
  17. 17.
    Dongmei N, Iki M, Tamaki J et al (2012) Association between weight changes and changes in hip geometric indices in the Japanese female population during 10-year follow-up: Japanese Population-based Osteoporosis (JPOS) Cohort Study. Osteoporos Int 23:1581–1591CrossRefPubMedGoogle Scholar
  18. 18.
    Deere K, Sayers A, Rittweger J et al (2012) Habitual levels of high, but not moderate or low, impact activity are positively related to hip BMD and geometry: results from a population-based study of adolescents. J Bone Miner Metab 27:1887–1895CrossRefGoogle Scholar
  19. 19.
    Khalil N, Sutton-Tyrrell K, Strotmeyer ES et al (2011) Menopausal bone changes and incident fractures in diabetic women: a cohort study. Osteoporos Int 22:1367–1376PubMedCentralCrossRefPubMedGoogle Scholar
  20. 20.
    Kang SM, Yoon JW, Ahn HY et al (2011) Android fat depot is more closely associated with metabolic syndrome than abdominal visceral fat in elderly people. PLoS ONE 6:e27694PubMedCentralCrossRefPubMedGoogle Scholar
  21. 21.
    Marques EA, Moreira P, Wanderley F et al (2012) Appendicular fat mass is positively associated with femoral neck bone mineral density in older women. Menopause 19:311–318CrossRefPubMedGoogle Scholar
  22. 22.
    Faulkner KG, Wacker WK, Barden HS et al (2006) Femur strength index predicts hip fracture independent of bone density and hip axis length. Osteoporos Int 17:593–599CrossRefPubMedGoogle Scholar
  23. 23.
    Choi HS, Kim KJ, Kim KM et al (2010) Relationship between visceral adiposity and bone mineral density in Korean adults. Calcif Tissue Int 87:218–225CrossRefPubMedGoogle Scholar
  24. 24.
    Reid IR (2010) Fat and bone. Arch Biochem Biophys 503:20–27CrossRefPubMedGoogle Scholar
  25. 25.
    Sahin G, Polat G, Baethiş S et al (2003) Body composition, bone mineral density, and circulating leptin levels in postmenopausal Turkish women. Rheumatol Int 23:87–91PubMedGoogle Scholar
  26. 26.
    Genaro PS, Pereira GA, Pinheiro MM et al (2010) Influence of body composition on bone mass in postmenopausal osteoporotic women. Arch Gerontol Geriatr 51:295–298CrossRefPubMedGoogle Scholar
  27. 27.
    Park JH, Song YM, Sung J et al (2012) The association between fat and lean mass and bone mineral density: the healthy twin study. Bone 50:1006–1011CrossRefPubMedGoogle Scholar
  28. 28.
    Abernathy RP, Black DR (1996) Healthy body weights: an alternative perspective. Am J Clin Nutr 63:448S–451SPubMedGoogle Scholar
  29. 29.
    McTernan PG, Anderson LA, Anwar AJ et al (2002) Glucocorticoid regulation of p450 aromatase activity in human adipose tissue: gender and site differences. J Clin Endocrinol Metab 87:1327–1336CrossRefPubMedGoogle Scholar
  30. 30.
    Faloni AP, Sasso-Cerri E, Rocha FR et al (2012) Structural and functional changes in the alveolar bone osteoclasts of estrogen-treated rats. J Anat 220:77–85PubMedCentralCrossRefPubMedGoogle Scholar
  31. 31.
    Williams GA, Wang Y, Callon KE et al (2009) In vitro and in vivo effects of adiponectin on bone. Endocrinology 150:3603–3610CrossRefPubMedGoogle Scholar
  32. 32.
    Tu Q, Zhang J, Dong LQ et al (2011) Adiponectin inhibits osteoclastogenesis and bone resorption via APPL1-mediated suppression of Akt1. J Biol Chem 286:12542–12553PubMedCentralCrossRefPubMedGoogle Scholar
  33. 33.
    Gaspard UJ, Gottal JM, van den Brûle FA (1995) Postmenopausal changes of lipid and glucose metabolism: a review of their main aspects. Maturitas 21:171–178CrossRefPubMedGoogle Scholar
  34. 34.
    Sumino H, Ichikawa S, Yoshida A et al (2003) Effects of hormone replacement therapy on weight, abdominal fat distribution, and lipid levels in Japanese postmenopausal women. Int J Obes 27:1044–1051CrossRefGoogle Scholar
  35. 35.
    Lee K, Lee S, Kim YJ et al (2008) Waist circumference, dual-energy X-ray absortiometrically measured abdominal adiposity, and computed tomographically derived intra-abdominal fat area on detecting metabolic risk factors in obese women. Nutrition 24:625–631CrossRefPubMedGoogle Scholar
  36. 36.
    Yoo HJ, Park MS, Yang SJ et al (2012) The differential relationship between fat mass and bone mineral density by gender and menopausal status. J Bone Miner Metab 30:47–53CrossRefPubMedGoogle Scholar
  37. 37.
    Thomas T, Burguera B, Melton LJ 3rd et al (2001) Role of serum leptin, insulin, and estrogen levels as potential mediators of the relationship between fat mass and bone mineral density in men versus women. Bone 29:114–120CrossRefPubMedGoogle Scholar
  38. 38.
    Van Pelt RE, Gozansky WS, Wolfe P et al (2014) Estrogen or raloxifene during postmenopausal weight loss: adiposity and cardiometabolic outcomes. Obesity 22:1024–1031PubMedCentralCrossRefPubMedGoogle Scholar

Copyright information

© The Japanese Society for Bone and Mineral Research and Springer Japan 2014

Authors and Affiliations

  • Hong Da Shao
    • 1
  • Guan Wu Li
    • 2
  • Yong Liu
    • 1
  • Yu You Qiu
    • 1
  • Jian Hua Yao
    • 1
  • Guang Yu Tang
    • 1
    Email author
  1. 1.Department of Radiology, Shanghai Tenth People’s HospitalTongji University School of MedicineShanghaiChina
  2. 2.Department of Radiology, Yueyang HospitalShanghai University of Traditional Chinese MedicineShanghaiChina

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