Skip to main content

Advertisement

SpringerLink
Log in

Effects of physical activity and dietary calcium intake on bone mineral density and osteoporosis risk in a rural Thai population

  • Original Article
  • Published:
Osteoporosis International Aims and scope Submit manuscript

Abstract

The objective of the study was to determine the effects of modifiable risk factors on bone mineral density in postmenopausal Thai women. Dietary calcium intake (g/day), energy expenditure (kcal/day), and sunlight exposure (h/day) were assessed in 129 rural Thai women aged 63 years (range 50 to 84 years). Bone mineral density (BMD) at the femoral neck, lumbar spine, and distal radius were measured by dual-energy X-ray absorptiometry (DXA). The average dietary calcium intake was 236 ± 188 g/day (mean ± SD), while the energy expenditure was 2,118 ± 656 kcal/day with 1.1 ± 1.7 h of sunlight exposure. In multiple linear regression analysis, dietary calcium intake, energy expenditure, and years since menopause were significant and independent predictors of BMD at various sites. The three factors together accounted for between 35% and 45% of the variance of BMD. The prevalence of osteoporosis (defined as BMD T-scores ≤−2.5) was 33% at the femoral neck, 42% at the lumbar spine, and 35% at the distal radius. The risk of osteoporosis was higher in women with lower dietary calcium intake (≤138 mg/day; prevalence rate ratio [PRR], 1.4; 95% confidence interval [CI], 1.0 to 1.9), lower energy expenditure (≤1,682 kcal; PRR, 1.7; 95% CI, 1.2 to 2.3), and greater years since menopause (≥6 years; PRR, 2.6; 95% CI, 1.2 to 5.8). The population attributable risk fraction of osteoporosis risk due to the three factors was 70%. These results suggest that in the Thai population, low dietary calcium intake and low physical activity together with advancing years since menopause were independent risk factors for low 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

Similar content being viewed by others

References

  1. Kanis JA (2002) Diagnosis of osteoporosis and assessment of fracture risk. Lancet 359:1929–1936

    Article  PubMed  Google Scholar 

  2. Cooper C, Campion G, Melton LJ (1992) Hip fractures in the elderly: a world-wide projection. Osteoporos Int 2:25–29

    Google Scholar 

  3. Ooms ME, Lips P, Van Lingen A, Valkenburg HA (1993) Determinants of bone mineral density and risk factors for osteoporosis in healthy elderly women. J Bone Miner Res 8:669–675

    CAS  PubMed  Google Scholar 

  4. Hannan MT, Felson DT, Dawson-Hughes B et al (2000) Risk factors for longitudinal bone loss in elderly men and women: the Framingham Osteoporosis Study. J Bone Miner Res 15:710–720

    CAS  PubMed  Google Scholar 

  5. Johnell O, Gullberg B, Kanis JA et al (1995) Risk factors for hip fracture in European women: the MEDOS Study. Mediterranean Osteoporosis Study. J Bone Miner Res 10:1802–1815

    CAS  PubMed  Google Scholar 

  6. Nguyen TV, Center JR, Sambrook PN, Eisman JA (2001) Risk factors for proximal humerus, forearm, and wrist fractures in elderly men and women: the Dubbo Osteoporosis Epidemiology Study. Am J Epidemiol 153:587–595

    Article  CAS  PubMed  Google Scholar 

  7. 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 Res 15: 322–331

    CAS  PubMed  Google Scholar 

  8. Lau EM, Suriwongpaisal P, Lee JK et al (2001) Risk factors for hip fracture in Asian men and women: the Asian osteoporosis study. J Bone Miner Res 16:572–580

    CAS  PubMed  Google Scholar 

  9. Suzuki T (2001) Risk factors for osteoporosis in Asia. J Bone Miner Metab 19:133–141

    Google Scholar 

  10. Yamamoto K, Nakamura T, Kishimoto H, Hagino H, Nose T (1993) Risk factors for hip fracture in elderly Japanese women in Tottori Prefecture, Japan. Osteoporos Int 3[Suppl 1]:S48–S50

  11. Cumming RG (1990) Calcium intake and bone mass: a quantitative review of the evidence. Calcif Tissue Int 47:194-201

    CAS  PubMed  Google Scholar 

  12. Cumming RG, Nevitt MC (1997) Calcium for prevention of osteoporotic fractures in postmenopausal women. J Bone Miner Res 12:1321–1329

    Google Scholar 

  13. Welten DC, Kemper HC, Post GB, van Saveren WA (1995) A meta-analysis of the effect of calcium intake on bone mass in young and middle aged females and males. J Nutr 125:2802–2813

    CAS  PubMed  Google Scholar 

  14. Shea B, Wells G, Cranney A et al (2002) Meta-analysis of therapies for postmenopausal osteoporosis, VII: meta-analysis of calcium supplementation for the prevention of postmenopausal osteoporosis. Endocr Rev 23:552–559

    Article  CAS  PubMed  Google Scholar 

  15. Alagol F, Shihadeh Y, Boztepe H et al (2000) Sunlight exposure and vitamin D deficiency in Turkish women. J Endocrinol Invest 23:173–177

    PubMed  Google Scholar 

  16. Fonseca V, Tongia R, el-Hazmi M, Abu-Aisha H (1984) Exposure to sunlight and vitamin D deficiency in Saudi Arabian women. Postgrad Med J 60:589–591

    CAS  PubMed  Google Scholar 

  17. Glerup H, Mikkelsen K, Poulsen L et al (2000) Commonly recommended daily intake of vitamin D is not sufficient if sunlight exposure is limited. J Intern Med 247:260–268

    Article  CAS  PubMed  Google Scholar 

  18. Aloia JF, Cohn SH, Ostuni JA, Cane R, Ellis K (1978) Prevention of involutional bone loss by exercise. Ann Intern Med 89:356–358

    CAS  PubMed  Google Scholar 

  19. Bassey EJ (1995) Exercise in primary prevention of osteoporosis in women. Ann Rheum Dis 54:861–862

    CAS  PubMed  Google Scholar 

  20. Berard A, Bravo G, Gauthier P (1997) Meta-analysis of the effectiveness of physical activity for the prevention of bone loss in postmenopausal women. Osteoporos Int 7:331–337

    CAS  PubMed  Google Scholar 

  21. Kelly GA (1998) Aerobic exercise and bone density at the hip in postmenopausal women: a meta-analysis. Prev Med 27:798–807

    Article  CAS  PubMed  Google Scholar 

  22. Pongchaiyakul C, Kosulwat V, Rojroongwasinkul N, Charoenkiatkul S, Chotmongkol R, Rajatanavin R (2002) Bone mineral density in rural Thai adults living in Khon Kaen province. J Med Asso Thai 85:235–244

    Google Scholar 

  23. Institute of Nutrition, Mahidol University (1997) Food composition database for INMUCAL program. Institute of Nutrition, Mahidol University, Salaya, Nakhonpathom, Thailand

  24. Ainsworth BE, Haskell WL, Leon AS et al (1993) Compendium of physical activites: classification of energy costs of human physical activities. Med Sc Sports Exerc 25:71–80

    CAS  Google Scholar 

  25. Skov T, Deddens J, Petersen MR, Endahl L (1998) Prevalence proportion ratios: estimation and hypothesis testing. Int J Epidemiol 27:91–95

    Article  CAS  PubMed  Google Scholar 

  26. Deddens J, Petersen MR, Lei X (2003) Estimation of prevalence ratios when PROC GENMOD does not converge. In: Proceedings of SAS Users Group International 28 (SUGI28), Paper 270. Seattle, Washington. http://www3.sas.com/proceedings/sugi28/270-28.pdf. Cited 21 July 2003

  27. Eide GE, Gefeller O (1995) Sequential and average attributable fractions as aids in the selection of preventive strategies. J Clin Epidemiol 48:645–655

    Article  CAS  PubMed  Google Scholar 

  28. SAS Institute (1990) SAS/STAT: user’s guide, release 6.03. SAS Institute, Cary, NC, pp 549–640

  29. Chan HH, Lau EM, Woo J, Lin F, Sham A, Leung PC (1996) Dietary calcium intake, physical activity and the risk of vertebral fracture in Chinese. Osteoporos Int 6:228–232

    CAS  PubMed  Google Scholar 

  30. Prince RL, Smith M, Dick IM et al (1991) Prevention of postmenopausal osteoporosis: a comparative study of exercise, calcium supplementation, and hormone-replacement therapy. N Engl J Med 325:1189–1195

    Google Scholar 

  31. Boonyaratavej N, Suriyawongpaisal P, Takkinsatien A, Wanvarie S, Rajatanavin R, Apiyasawat P (2001) Physical activity and risk factors for hip fractures in Thai women. Osteoporos Int 12:244–248

    Article  PubMed  Google Scholar 

  32. Snow-Harter C, Whalen R, Myburgh K, Arnaud S, Marcus R (1992) Bone mineral density, muscle strength, and recreational exercise in men. J Bone Miner Res 7:1291–1296

    CAS  PubMed  Google Scholar 

  33. Nelson ME, Fisher EC, Dilmanian FA, Dallal GE, Evans WJ (1991) A 1-y walking program and increased dietary calcium in postmenopausal women: effects on bone. Am J Clin Nutr 53:1304–1311

    Google Scholar 

  34. Whitt MC, Levin S, Ainsworth BE, Dubose KD (2003) Evaluation of a two-part survey item to assess moderate physical activity: the Cross-Cultural Activity Participation Study. J Womens Health 12:203–212

    Google Scholar 

  35. Phadungkiat S, Chariyalertsak S, Rajatanavin R, Chiengthong K, Suriyawongpaisal P, Woratanarat P (2002) Incidence of hip fracture in Chiang Mai. J Med Assoc Thai 85:565–571

    PubMed  Google Scholar 

  36. Lau EM, Lee JK, Suriwongpaisal P et al (2001) The incidence of hip fracture in four Asian countries: the Asian Osteoporosis Study (AOS). Osteoporos Int 12:239–243

    Article  CAS  PubMed  Google Scholar 

  37. Hakeem R, Thomas J, Badruddin SH (2002) Urbanisation and activity pattern of south Asian children. J Pak Med Assoc 52:402–407

    CAS  PubMed  Google Scholar 

  38. Jonsson B, Gardsell P, Johnell O, Sernbo I, Gullberg B (1993) Life-style and different fracture prevalence: a cross-sectional comparative population-based study. Calcif Tissue Int 52:425–433

    PubMed  Google Scholar 

  39. Ringsberg KA, Gardsell P, Johnell O, Josefsson PO, Obrant KJ (2001) The impact of long-term moderate physical activity on functional performance, bone mineral density and fracture incidence in elderly women. Gerontology 47:15–20

    Article  CAS  PubMed  Google Scholar 

  40. Bouillon RA, Auwerx JH, Lissens WD, Pelemans WK (1987) Vitamin D status in the elderly: seasonal substrate deficiency causes 1,25-dihydroxycholecalciferol deficiency. Am J Clin Nutr 45:755–763

    CAS  PubMed  Google Scholar 

  41. Dattani JT, Exton-Smith AN, Stephen JM (1984) Vitamin D status of the elderly in relation to age and exposure to sunlight. Hum Nutr Clin Nutr 38:131–137

    CAS  PubMed  Google Scholar 

  42. Kessenich CR, Rosen CJ (1996) Vitamin D and bone status in elderly women. Orthop Nurs 15:67–71

    CAS  PubMed  Google Scholar 

  43. McKenna MJ (1992) Differences in vitamin D status between countries in young adults and the elderly. Am J Med 93:69–77

    CAS  PubMed  Google Scholar 

  44. Kanis J, Johnell O, Gullberg B et al (1999) Risk factors for hip fracture in men from southern Europe: the MEDOS study. Mediterranean Osteoporosis Study. Osteoporos Int 9:45–54

    Article  CAS  PubMed  Google Scholar 

  45. Chailurkit LO, Pongchaiyakul C, Kosulwat V, Rojroongwasinkul N, Charoenkiatkul S, Rajatanavin, R (2001) Different mechanism of bone loss in ageing women and men in Khon Kaen Province. J Med Assoc Thai 84:1175–1182

    CAS  PubMed  Google Scholar 

  46. Creedon A, Cashman KD (2000) The effect of high salt and high protein intake on calcium metabolism, bone composition and bone resorption in the rat. Br J Nutr 84:49–56

    CAS  PubMed  Google Scholar 

  47. Dawson-Hughes B, Harris SS (2002) Calcium intake influences the association of protein intake with rates of bone loss in elderly men and women. Am J Clin Nutr 75:773–779

    CAS  PubMed  Google Scholar 

  48. Heaney RP (2001) Protein intake and bone health: the influence of belief systems on the conduct of nutritional science. Am J Clin Nutr 73:5–6

    CAS  PubMed  Google Scholar 

  49. Kerstetter JE, O’Brien KO, Insogna KL (2003) Low protein intake: the impact on calcium and bone homeostasis in humans. J Nutr 133:S855–S861

    Google Scholar 

Download references

Acknowledgements

This study was supported by the Thailand Research Fund.

Author information

Authors and Affiliations

  1. Division of Endocrinology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand

    C. Pongchaiyakul

  2. Bone and Mineral Research Program, Garvan Institute of Medical Research, 384 Victoria Street, Darlinghurst, NSW 2010, Sydney, Australia

    C. Pongchaiyakul, T. V. Nguyen & J. A. Eisman

  3. Institute of Nutrition, Mahidol University, Salaya Campus, Phutthamonthon, Thailand

    V. Kosulwat, N. Rojroongwasinkul & S. Charoenkiatkul

  4. Department of Medicine, Faculty of Medicine, Mahidol University, Bangkok, Thailand

    R. Rajatanavin

Authors
  1. C. Pongchaiyakul
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. T. V. Nguyen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. V. Kosulwat
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. N. Rojroongwasinkul
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. S. Charoenkiatkul
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. J. A. Eisman
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. R. Rajatanavin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to C. Pongchaiyakul.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Pongchaiyakul, C., Nguyen, T.V., Kosulwat, V. et al. Effects of physical activity and dietary calcium intake on bone mineral density and osteoporosis risk in a rural Thai population. Osteoporos Int 15, 807–813 (2004). https://doi.org/10.1007/s00198-004-1613-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00198-004-1613-6

Keywords

Search

Navigation