Skip to main content

Advertisement

SpringerLink
Log in

Large Bone not Necessarily High Bone Mineral Density: Evidence from a National Survey

  • Original Research
  • Published:
Calcified Tissue International Aims and scope Submit manuscript

Abstract

There is scarcity of population-level data on the bone areal size (BA) that produces the highest bone mineral density (BMD), and how BA relates to BMD among racial groups. We use population-level data to estimate the BA that coincide with the highest BMD among racial groups in the United States. A total of 7425 participants, age 18–75 years, whose BA and BMD were measured in the United States National Health and Nutrition Examination Survey (NHANES) 2009–2014, were assessed in this study. Multiple regression models were used to estimate race-specific relationships between BA and BMD. The critical BA that associates with the highest (peak) BMD among racial groups adjusted for confounders was estimated. Results showed a curvilinear relationship between BA and BMD at the population level such that BMD increases with BA at lower values and then decreases after a peak value. Races combined, BA of about 45 cm2 seems to correspond to a peak femur BMD in this sample. The peak BMD was different among racial groups. The BA at which BMD peaks was lower among blacks and Mexicans compared to whites. We conclude that femur BMD increases up to a critical femur BA and then decreases thereafter. Persons with femur BA at or close to the critical value may tend to have higher than average BMD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Deng HW, Xu FH, Davies KM, Heaney R, Recker RR (2002) Differences in bone mineral density, bone mineral content, and bone area in fracturing and nonfracturing women, and their interrelationships at the spine and hip. J Bone Miner Metab 20(6):358–366

    Article  CAS  PubMed  Google Scholar 

  2. Brazerol WF, McPhee AJ, Mimouni F, Specker BL, Tsang RC (1988) Serial ultraviolet B exposure and serum 25 hydroxyvitamin D response in young adult American blacks and whites: no racial differences. J Am Coll Nutr 7:111–118

    Article  CAS  PubMed  Google Scholar 

  3. Looker AC, Melton LJ, Harris T, Borrud L, Shepherd J, McGowan J (2009) Age, gender, and race/ethnicity differences in total body and subregional bone density. Osteoporos Int 20:1141–1149

    Article  CAS  PubMed  Google Scholar 

  4. Gutiérrez OM, Farwell WR, Kermah D, Taylor EN (2011) Racial differences in the relationship between vitamin D, bone mineral density, and parathyroid hormone in the National Health and Nutrition Examination Survey. Osteoporos Int 22(6):1745–1753

    Article  CAS  PubMed  Google Scholar 

  5. Liel Y, Edwards J, Shary J, Spicer KM, Gordon L, Bell NH (2013) The effects of race and body habitus on bone mineral density of the radius, hip, and spine in premenopausal women. J Clin Endocrinol Metab 66(6):1245–1247

    Google Scholar 

  6. David T. Felson DT, Zhang Y, Hannan MT, Anderson JJ (1993) Effects of weight and body mass index on bone mineral density in men and women: The Framingham study. J Bone Miner Res 8:567–573

    Google Scholar 

  7. McCloskey E (2009) Identifying people at high risk of fracture. WHO Fracture Risk Assessment Tool, a new clinical tool for informed treatment decisions. International Osteoporosis Foundation Web. https://www.iofbonehealth.org/sites/default/files/ PDFs/WOD%20Reports/FRAX_report_09.pdf. Accessed 15 November 2017

  8. Sowers MR, Kshirsagar A, Crutchfield MM, Updike S (1992) Joint influence of fat and lean body composition compartments on femoral bone mineral density in premenopausal women. Am J Epidemiol 136(3):257–265

    Article  CAS  PubMed  Google Scholar 

  9. Looker AC, Frenk SM (2015) Percentage of adults aged 65 and over with osteoporosis or low bone mass at the femur neck or lumbar spine: United States, 2005–2010. Division of Health and Nutrition Examination Surveys. Centers for Disease Control. National Center for Health Statistics. August 2015 Web https://www.cdc.gov/nchs/data/hestat/osteoporsis/ osteoporosis2005_2010.htm. Accessed 26 December 2016

  10. Tangpricha V, Pearce EN, Chen TC, Holick MF (2002) Vitamin D insufficiency among free-living healthy young adults. Am J Med 112:659–662

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Brenner M, Hearing VJ (2008) The Protective role of melanin against UV damage in human skin. Photochem Photobiol 84(3):539–549

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Centers for Disease Control and Prevention (2015) National Health and Nutrition Examination Survey 2013–2014 data documentation, codebook, and frequencies. National Center for Health Statistics. Hyattsville, MD: US Department of Health and Human Services Web http://wwwn.cdc.gov/Nchs/Nhanes/2013-2014/DXXFEM_H.htm# Protocol_and_Procedure. Accessed 1 July 2016

  13. Centers for Disease Control and Prevention (2013) National Center for Health Statistics (NCHS). National Health and Nutrition Examination Survey Data 2009–2010. Hyattsville, MD: US Department of Health and Human Services Web http://wwwn.cdc.gov/ nchs/nhanes/search/nhanes09_10.aspx. Accessed 2 August 2014

  14. Patel R, Collins D, Bullock S, Swaminathan R, Blake GM, Fogelman I (2001) The effect of season and vitamin D supplementation on bone mineral density in healthy women: a double-masked crossover study. Osteoporos Int 12:319–325

    Article  CAS  PubMed  Google Scholar 

  15. Centers for Disease Control and Prevention (2014) National Health and Nutrition Examination Survey Brochures and Consent Documents. National Center for Health Statistics. Hyattsville, MD: US Department of Health and Human Services 2009 Web https://www.cdc.gov/nchs/nhanes/nhanes2009-2010/brochures09 _10.htm. Accessed 28 December 2015

  16. Centers for Disease Control and Prevention (2012) Dual Energy X-ray Absorptiometry - Femur Bone Measurements 2009. National Center for Health Statistics. Hyattsville, MD: US Department of Health and Human Services Web http://wwwn.cdc.gov/Nchs/Nhanes/ 2009-2010/DXXFEM_F.htm. Accessed 28 December 2015

  17. Njeh CF, Fuerst T, Hans D, Blake GM, Genant HK (1999) Radiation exposure in bone mineral density assessment. Appl Radiat Isot 50:215–236

    Article  CAS  PubMed  Google Scholar 

  18. Genant HK, Engelke K, Fuerst T, Güer C-C, Grampp S, Harris ST, Jergas M, Lang T, Lu Y, Majumdar S, Mathur A, Takada M (1996) Noninvasive assessment of bone mineral and structure: state of the art. J Bone Miner Res 11:707–730

    Article  CAS  PubMed  Google Scholar 

  19. Cleveland W, Devlin S (1988) Locally-weighted regression: an approach to regression analysis by local fitting. J Am Stat Assoc 83:596–610

    Article  Google Scholar 

  20. Centers for Disease Control and Prevention (2013) National Health and Nutrition Examination Survey analytical guide 2007–2010. National Center for Health Statistics. Hyattsville, MD: US Department of Health and Human Services 2010 Web http://www.cdc.gov/nchs/data/nhanes/analyticnote_2007-2010.pdf. Accessed 28 December 2015

  21. Vega E, Ghirlinghelli G, Mautalen C, Valzacchi RG, Scaglia H, Zylberstein C (1998) Bone mineral density and bone size in men with primary osteoporosis and vertebral fractures. Calcif Tissue Int 62:465–469

    Article  CAS  PubMed  Google Scholar 

  22. Leslie WD, Tsang JF, Lix LM (2008) Effect of total hip bone area on osteoporosis diagnosis and fractures. J Bone Miner Res 2008 Sep 23(9):1468–1476

    Article  Google Scholar 

  23. Curtis E, Harvey N, D’Angelo S, Cooper C, Taylor P, Pearson G, Cooper C (2016) Assessment of bone mineral content and fracture risk: a UK prospective cohort study. Lancet 387(S32):32–32

    Article  Google Scholar 

  24. Holick MF (2004) Sunlight and vitamin D for bone health and prevention of autoimmune diseases, cancers, and cardiovascular disease. Am J Clin Nutr 80(suppl 6):S1678–S1688

    Article  Google Scholar 

  25. Harris SS (2006) Vitamin D and non-Hispanic blacks. Symposium: optimizing vitamin D intake for populations with special needs: barriers to effective food fortification and supplementation. J. Nutr 136:1126–1129

    Article  CAS  PubMed  Google Scholar 

  26. Toloza SM, Cole DE, Gladman DD, Ibañez D, Urowitz MB (2010) Vitamin D insufficiency in a large female SLE cohort. Lupus 19(1):13–19

    Article  CAS  PubMed  Google Scholar 

  27. Katzman DK, Bachrach LK, Carter DR, Marcus R (1997) Clinical and anthropometric correlates of bone mineral acquisition in healthy adolescent girls. J Clin Endocrinol Metab 1997 73(6):1332–1333

    Article  Google Scholar 

Download references

Acknowledgements

Our sincere gratitude goes to the United States Centers for Disease Control and Prevention of the Department of Health and Human Services for making the NHANES datasets publicly available for use by professionals.

Author information

Authors and Affiliations

  1. Southeast Missouri State University, Cape Girardeau, USA

    Francis Tayie & Chen Wu

Authors
  1. Francis Tayie
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chen Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Francis Tayie.

Ethics declarations

Conflict of interest

Francis Tayie and Chen Wu have no conflict of interest regarding this article publication.

Human and Animal Rights and Informed Consent

The Research Ethics Review Board of the National Center for Health Statistics approved the survey procedures and obtained informed consent from all participants.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tayie, F., Wu, C. Large Bone not Necessarily High Bone Mineral Density: Evidence from a National Survey. Calcif Tissue Int 104, 145–151 (2019). https://doi.org/10.1007/s00223-018-0479-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00223-018-0479-0

Keywords

Search

Navigation