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Z-score discordance and contributing factors in healthy premenopausal women with low bone mineral density: the Korean National Health and Nutrition Examination Survey 2008–9

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Abstract

The premenopausal period is important for bone health and prevention of future fractures, but measuring bone mineral density (BMD) at only one site may not be sufficient to determine therapeutic strategies for low BMD in premenopausal women due to the presence of Z-score discordance. In this study, we investigated Z-score discordance in addition to contributing factors of idiopathic low BMD in healthy premenopausal Korean women. We studied 3003 premenopausal women aged 18–50 years, without secondary causes for low BMD and history of fragility fracture, who had participated in the Fourth Korean National Health and Nutrition Examination Surveys (2008–2009). Low body mass index (BMI), low vitamin D level, and low body muscle mass were associated with low BMD even in premenopausal women. Risk factors differed depending on the anatomic site. Low BMI and low vitamin D level were risk factors for low femoral neck BMD (FN-BMD), but not for low lumbar spine BMD (LS-BMD). Only total muscle mass had a slight effect on low LS-BMD. Z-score discordance was much higher than expected, in 75 and 73.8 % of the low LS-BMD and low FN-BMD groups, respectively. Our findings suggest the need to consider BMD discordance in premenopausal women and also to provide information on correctable factors affecting low BMD in younger populations. Long-term follow-up is needed to evaluate the possible effect of Z-score discordance on the prognosis of osteoporosis and subsequent fracture risk.

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Acknowledgments

This work was supported by a National Research Foundation of Korea (NRF) grant funded by the Korean government (MEST) (No. 20110001024).

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    Authors and Affiliations

    1. Division of Endocrinology and Metabolism, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Gyeonggi, South Korea

      Kyeong Hye Park

    2. Yonsei University Graduate School of Medicine, Seoul, South Korea

      Kyeong Hye Park & Jung Soo Lim

    3. Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Gangwon, South Korea

      Jung Soo Lim

    4. Department of Internal Medicine, Seoul National University Bundang Hospital, Sungnam, Gyeonggi, South Korea

      Kyoung Min Kim

    5. Division of Endocrinology, Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea

      Yumie Rhee & Sung-Kil Lim

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    Correspondence to Sung-Kil Lim.

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    K.H. Park and J.S. Lim contributed equally to this work.

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    Park, K.H., Lim, J.S., Kim, K.M. et al. Z-score discordance and contributing factors in healthy premenopausal women with low bone mineral density: the Korean National Health and Nutrition Examination Survey 2008–9. J Bone Miner Metab 34, 668–677 (2016). https://doi.org/10.1007/s00774-015-0715-x

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