Skip to main content
SpringerLink
Log in

Reference values of bone mineral density and prevalence of osteoporosis in Chinese adults

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

Abstract

Summary

We pooled bone mineral density (BMD) data published in 91 articles including 139,912 Chinese adults and then established a national-wide BMD reference database at the lumbar spine and femur neck for Chinese adults. The prevalence of osteoporosis in the middle-aged and elderly Chinese population was also estimated.

Introduction

Well-accepted reference value of BMD is lacking in Chinese. We established the reference database and assessed osteoporosis prevalence based on published literature conducted in the Mainland China, Taiwan, and Hong Kong Chinese.

Methods

We searched for all published articles indexed in MEDLINE, PubMed, CNKI, and SinoMed up to January 2013. We included cross-sectional studies that examined BMD using a dual-energy X-ray absorptiometry at the femur neck (FN) and/or lumbar spine (LS) in healthy adults. Overall age-specific mean (SD) BMD were pooled after standardization.

Results

Ninety-one studies including 51,906 males and 88,006 females (≥20 years) in 38 cities in China were included in this pooling study. Gender- and age-specific reference curves of standardized BMD (sBMD) at the LS and FN were constructed. The sBMD cutoffs for osteoporosis classification were 0.746 and 0.549 in women, and 0.680 and 0.568 g/cm2 in men; age-standardized prevalence of osteoporosis was 23.9 % and 12.5 % in women and 3.2 % and 5.3 % in men aged ≥50 years at the LS and FN, respectively. Meta-regression analysis showed that greater age and altitude, lower latitude, smaller city size, earlier detection time, and random sample were correlated to lower sBMD in at least one gender-specific bone sites; the Hologic DXA produced a higher value of FN sBMD than the other two devices (Lunar and Norland).

Conclusion

We have established a national-wide BMD reference database at the LS and FN for Chinese adults and estimated the prevalence of osteoporosis in the middle-aged and elderly Chinese population.

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
Fig. 4

Similar content being viewed by others

References

  1. Kanis JA, Melton LJ 3rd, Christiansen C, Johnston CC, Khaltaev N (1994) The diagnosis of osteoporosis. J Bone Miner Res 9:1137–1141. doi:10.1002/jbmr.5650090802

    Article  CAS  PubMed  Google Scholar 

  2. Kanis JA (1994) Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: synopsis of a WHO report. WHO Study Group. Osteoporos Int 4:368–381

    Article  CAS  PubMed  Google Scholar 

  3. Looker AC, Wahner HW, Dunn WL, Calvo MS, Harris TB, Heyse SP, Johnston CC Jr, Lindsay R (1998) Updated data on proximal femur bone mineral levels of US adults. Osteoporos Int 8:468–489

    Article  CAS  PubMed  Google Scholar 

  4. Kanis JA, McCloskey EV, Johansson H, Oden A, Melton LJ 3rd, Khaltaev N (2008) A reference standard for the description of osteoporosis. Bone 42:467–475. doi:10.1016/j.bone.2007.11.001

    Article  CAS  PubMed  Google Scholar 

  5. Cui LH, Choi JS, Shin MH, Kweon SS, Park KS, Lee YH, Nam HS, Jeong SK, Im JS (2008) Prevalence of osteoporosis and reference data for lumbar spine and hip bone mineral density in a Korean population. J Bone Miner Metab 26:609–617. doi:10.1007/s00774-007-0847-8

    Article  PubMed  Google Scholar 

  6. Cheng XG, Yang DZ, Zhou Q, Zhuo TJ, Zhang HC, Xiang J, Wang HF, Ou PZ, Liu JL, Xu L, Huang GY, Huang QR, Barden HS, Weynand LS, Faulkner KG, Meng XW (2007) Age-related bone mineral density, bone loss rate, prevalence of osteoporosis, and reference database of women at multiple centers in China. J Clin Densitom 10:276–284. doi:10.1016/j.jocd.2007.05.004

    Article  PubMed  Google Scholar 

  7. Wu XP, Liao EY, Huang G, Dai RC, Zhang H (2003) A comparison study of the reference curves of bone mineral density at different skeletal sites in native Chinese, Japanese, and American Caucasian women. Calcif Tissue Int 73:122–132. doi:10.1007/s00223-002-1069-7

    Article  CAS  PubMed  Google Scholar 

  8. Tenenhouse A, Joseph L, Kreiger N, Poliquin S, Murray TM, Blondeau L, Berger C, Hanley DA, Prior JC (2000) Estimation of the prevalence of low bone density in Canadian women and men using a population-specific DXA reference standard: the Canadian Multicentre Osteoporosis Study (CaMos). Osteoporos Int 11:897–904

    Article  CAS  PubMed  Google Scholar 

  9. Hoiberg M, Nielsen TL, Wraae K, Abrahamsen B, Hagen C, Andersen M, Brixen K (2007) Population-based reference values for bone mineral density in young men. Osteoporos Int 18:1507–1514. doi:10.1007/s00198-007-0399-8

    Article  CAS  PubMed  Google Scholar 

  10. Zhu H, Fang J, Luo X, Yu W, Zhao Y, Li X, Du J, Lu Y (2010) A survey of bone mineral density of healthy Han adults in China. Osteoporos Int 21:765–772. doi:10.1007/s00198-009-1010-2

    Article  CAS  PubMed  Google Scholar 

  11. Kanis JA, Oden A, McCloskey EV, Johansson H, Wahl DA, Cooper C (2012) A systematic review of hip fracture incidence and probability of fracture worldwide. Osteoporos Int 23:2239–2256. doi:10.1007/s00198-012-1964-3

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  12. Leslie WD, Lix LM, Johansson H, Oden A, McCloskey E, Kanis JA (2011) Spine-hip discordance and fracture risk assessment: a physician-friendly FRAX enhancement. Osteoporos Int 22:839–847. doi:10.1007/s00198-010-1461-5

    Article  CAS  PubMed  Google Scholar 

  13. Chen Z, Zeng S, Yu L (2011) The study of the status of bone mineral density in middle-aged and elderly adults in Xiamen City. Chin J Osteoporos 17:892–895

    Google Scholar 

  14. Zhang H, Hu YQ, Zhang ZL (2011) Age trends for hip geometry in Chinese men and women and the association with femoral neck fracture. Osteoporos Int 22:2513–2522. doi:10.1007/s00198-010-1479-8

    Article  CAS  PubMed  Google Scholar 

  15. Wu XP, Liao EY, Zhang H, Dai RC, Shan PF, Cao XZ, Liu SP, Jiang Y (2004) Determination of age-specific bone mineral density and comparison of diagnosis and prevalence of primary osteoporosis in Chinese women based on both Chinese and World Health Organization criteria. J Bone Miner Metab 22:382–391

    PubMed  Google Scholar 

  16. Hou LJ, Kong XL, Huang BL, Gai W (2004) Analysis of 2726 people s BMD in Beijing Fangshan area. J Clin Exp Med 03:71–73

    Google Scholar 

  17. Liu DJ, Feng YL, Chen RT, Yu FW, Liu Y, Mo M (2008) To analyse the bone mineral density of anteroposterior lumbar and left hip in 1899 cases of physical examination. Chin J Osteoporos 14:109–113

    Google Scholar 

  18. Jiang JS, Wang KZ, Wang CS (2009) Investigation of BMD in 1478 cases in Xi'an. Chin J Osteoporos 15:428–431

    Google Scholar 

  19. Wu Q, Tao G, Mou S, Liu X (2000) The survey of bone mineral density of health pepole in Haidian district of Beijing. J Health Care Med Chin PLA 02:16–18

    Google Scholar 

  20. Hou SM, Li X, Xue J, Jian Y, Li WX, Yu H, Zhang YJ (2002) Analysis of bone mineral density of healthy people in Shanxi of China. J Fourth Mil Med Univ 23:1115–1117

    Google Scholar 

  21. Yeh LR, Chen CK, Lai PH (2004) Normal bone mineral density in anteroposterior, lateral spine and hip of Chinese men in Taiwan: effect of age change, body weight and height. J Chin Med Assoc 67:287–295

    PubMed  Google Scholar 

  22. Lu Y, Fuerst T, Hui S, Genant HK (2001) Standardization of bone mineral density at femoral neck, trochanter and Ward's triangle. Osteoporos Int 12:438–444

    Article  CAS  PubMed  Google Scholar 

  23. Hui SL, Gao S, Zhou XH, Johnston CC Jr, Lu Y, Gluer CC, Grampp S, Genant H (1997) Universal standardization of bone density measurements: a method with optimal properties for calibration among several instruments. J Bone Miner Res 12:1463–1470

    Article  CAS  PubMed  Google Scholar 

  24. Wu XP, Liao EY, Dai RC, Shan PF, Fang TY, Luo XH, Pi YZ, Jiang Y (2005) Comparison of spine and femur reference data in native Chinese women from different regions of China. Osteoporos Int 16:1215–1224. doi:10.1007/s00198-004-1827-7

    Article  PubMed  Google Scholar 

  25. Chen YM, Ho SC, Lam SS (2010) Higher sea fish intake is associated with greater bone mass and lower osteoporosis risk in postmenopausal Chinese women. Osteoporos Int 21:939–946. doi:10.1007/s00198-009-1029-4

    Article  PubMed  Google Scholar 

  26. World Health Organization (1994) Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. WHO technical report series 843:1–129, Geneva, Switzerland

  27. Population Census Office under the State Council, Department of Population Social, Science and Technology Statistics, National Bureau of Statistics of the People's Republic of China (2009) Tabulation on 2009 population census of the People's Republic of China, vol 1. China Statistics Press, Beijing

    Google Scholar 

  28. Looker AC, Borrud LG, Hughes JP, et al. (2012) Lumbar spine and proximal femur bone mineral density, bone mineral content, and bone area: United States, 2005–2008. Vital Health Stat 11(251):1–132

    Google Scholar 

  29. Iki M, Kagamimori S, Kagawa Y, Matsuzaki T, Yoneshima H, Marumo F (2001) Bone mineral density of the spine, hip and distal forearm in representative samples of the Japanese female population: Japanese Population-Based Osteoporosis (JPOS) Study. Osteoporos Int 12:529–537

    Article  CAS  PubMed  Google Scholar 

  30. Ahmad OB, Boschi-Pinto C, Lopez AD, Murray CJL, Lozano R, Inoue M (2000) Age standardization of rates: a new WHO standard. World Health Organization, Geneva

    Google Scholar 

  31. Rickard DJ, Subramaniam M, Spelsberg TC (1999) Molecular and cellular mechanisms of estrogen action on the skeleton. J Cell Biochem Suppl 32–33:123–132. doi:10.1002/(SICI)1097-4644

    Article  Google Scholar 

  32. Looker AC, Melton LJ 3rd, Borrud LG, Shepherd JA (2012) Lumbar spine bone mineral density in US adults: demographic patterns and relationship with femur neck skeletal status. Osteoporos Int 23:1351–1360. doi:10.1007/s00198-011-1693-z

    Article  CAS  PubMed  Google Scholar 

  33. Lau EM, Lynn H, Woo J, Melton LJ 3rd (2003) Areal and volumetric bone density in Hong Kong Chinese: a comparison with Caucasians living in the United States. Osteoporos Int 14:583–588. doi:10.1007/s00198-003-1402-7

    Article  CAS  PubMed  Google Scholar 

  34. Bhudhikanok GS, Wang MC, Eckert K, Matkin C, Marcus R, Bachrach LK (1996) Differences in bone mineral in young Asian and Caucasian Americans may reflect differences in bone size. J Bone Miner Res 11:1545–1556. doi:10.1002/jbmr.5650111023

    Article  CAS  PubMed  Google Scholar 

  35. Megyesi MS, Hunt LM, Brody H (2011) A critical review of racial/ethnic variables in osteoporosis and bone density research. Osteoporos Int 22:1669–1679. doi:10.1007/s00198-010-1503-z

    Article  CAS  PubMed  Google Scholar 

  36. Leslie WD (2012) Clinical review: ethnic differences in bone mass–clinical implications. J Clin Endocrinol Metab 97:4329–4340. doi:10.1210/jc.2012-2863

    Article  CAS  PubMed  Google Scholar 

  37. Shin CS, Choi HJ, Kim MJ, Kim JT, Yu SH, Koo BK, Cho HY, Cho SW, Kim SW, Park YJ, Jang HC, Kim SY, Cho NH (2010) Prevalence and risk factors of osteoporosis in Korea: a community-based cohort study with lumbar spine and hip bone mineral density. Bone 47:378–387. doi:10.1016/j.bone.2010.03.017

    Article  PubMed  Google Scholar 

  38. Dawson-Hughes B, Looker AC, Tosteson AN, Johansson H, Kanis JA, Melton LJ 3rd (2012) The potential impact of the National Osteoporosis Foundation guidance on treatment eligibility in the USA: an update in NHANES 2005-2008. Osteoporos Int 23:811–820. doi:10.1007/s00198-011-1694-y

    Article  CAS  PubMed  Google Scholar 

  39. Faulkner KG, Cummings SR, Nevitt MC, Pressman A, Jergas M, Genant HK (1995) Hip axis length and osteoporotic fractures. Study of Osteoporotic Fractures Research Group. J Bone Miner Res 10:506–508. doi:10.1002/jbmr.5650100323

    Article  CAS  PubMed  Google Scholar 

  40. Cummings SR, Cauley JA, Palermo L, Ross PD, Wasnich RD, Black D, Faulkner KG (1994) Racial differences in hip axis lengths might explain racial differences in rates of hip fracture. Study of Osteoporotic Fractures Research Group. Osteoporos Int 4:226–229

    Article  CAS  PubMed  Google Scholar 

  41. Gurlek A, Bayraktar M, Ariyurek M (2000) Inappropriate reference range for peak bone mineral density in dual-energy X-ray absorptiometry: implications for the interpretation of T-scores. Osteoporos Int 11:809–813

    Article  CAS  PubMed  Google Scholar 

  42. Namwongprom S, Rojnastein S, Mangklabruks A, Soontrapa S, Wongboontan C, Ongphiphadhanakul B (2012) Importance of ethnic base standard references for the diagnosis of osteoporosis in Thai women. J Clin Densitom 15:295–301. doi:10.1016/j.jocd.2011.10.005

    Article  PubMed  Google Scholar 

  43. Fan B, Lu Y, Genant H, Fuerst T, Shepherd J (2010) Does standardized BMD still remove differences between Hologic and GE-Lunar state-of-the-art DXA systems? Osteoporos Int 21:1227–1236. doi:10.1007/s00198-009-1062-3

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  44. Webb AR, Kline L, Holick MF (1988) Influence of season and latitude on the cutaneous synthesis of vitamin D3: exposure to winter sunlight in Boston and Edmonton will not promote vitamin D3 synthesis in human skin. J Clin Endocrinol Metab 67:373–378

    Article  CAS  PubMed  Google Scholar 

  45. Zhuo Q, Wang Z, Piao J, Ma G, Zhai F, He Y, Yang X (2009) Geographic variation in the prevalence of overweight and economic status in Chinese adults. Br J Nutr 102:413–418. doi:10.1017/S0007114508184732

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

The study was jointly supported by the 5010 Program for Clinical Researches of Sun Yat-sen University (No. 2007032) and the National Natural Science Foundation of China (No. 30872100, 81072299).

Conflicts of interest

None

Author information

Authors and Affiliations

  1. Guangdong Provincial Key Laboratory of Food, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, People’s Republic of China

    Z-Q. Zhang, Z-Q. Chen, C-X. Zhang & Y-M. Chen

  2. School of Public Health and Primary Care, The Chinese University of Hong Kong, Room 407, 4th Floor, Lei Yuen Health Centre, Shatin, N.T., Hong Kong SAR

    S. C. Ho

  3. Guangzhou Center for Disease Control and Prevention, Guangzhou, 510080, People’s Republic of China

    Z-Q. Chen

  4. Department of Medical Statistics & Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, People’s Republic of China

    Y-M. Chen

Authors
  1. Z-Q. Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S. C. Ho
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Z-Q. Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. C-X. Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Y-M. Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to S. C. Ho or Y-M. Chen.

Electronic supplementary material

Below is the link to the electronic supplementary material.

ESM 1

(DOC 361 kb)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Zhang, ZQ., Ho, S.C., Chen, ZQ. et al. Reference values of bone mineral density and prevalence of osteoporosis in Chinese adults. Osteoporos Int 25, 497–507 (2014). https://doi.org/10.1007/s00198-013-2418-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00198-013-2418-2

Keywords

Search

Navigation