Abstract
The aim of this study was to investigate the relationship between body surface area (BS) and bone mineral density (BMD) and the associated osteoporosis risk at various skeletal regions in women from mainland China. BMD was measured at the posteroanterior (PA) spine (L1–L4), supine lateral spine (L2–L4) including volumetric BMD (vBMD), hip including femoral neck, trochanter and total hip, and forearm, including radius+ulna ultradistal (R+UUD), 1/3 site (R+U1/3) and total region (R+UT) using a dual-energy X-ray absorptiometry (DXA) fan-beam bone densitometer (Hologic QDR 4500A) in 3418 females aged from 18 to 75 years. Data analysis revealed a positive correlation between BS and BMD at the various skeletal regions (r=0.114–0.373, all P=0.000), but no correlation with vBMD (r=0.000, P=0.934). Using the stepwise regression model, BMDs at various skeletal regions were dependent variables while height, weight, body mass index (BMI), BS and projective bone area (BA) were independent variables; BS was determined to be the most important variable that affected the PA spine, hip and forearm BMDs. Subjects were divided into three groups according to size: large BS group (LBSG), intermediate BS group (IBSG) and small BS group (SBSG). The BMD at different skeletal regions of subjects between groups exhibited a significant gradient difference, with LBSG>IBSG>SBSG, but this was not seen for vBMD. On the fitting curves where BMD varied with age at the PA spine, femoral neck, total hip and R+UUD, BMDs of LBSG were 6.93–9.29% higher than those of IBSG and 12.1–16.9 % higher than those of SBSG, whereas those of SBSG were 6.12–9.59% lower than those of IBSG at various skeletal regions, respectively. The prevalence rates and risks of osteoporosis of LBSG were significantly lower than those of SBSG and IBSG, whereas those of IBSG were obviously lower than those of SBSG at various skeletal regions, respectively, presenting a gradient difference among the three study groups, LBSG<IBSG<SBSG. Our study shows that the relationship between BS and BMD exceeds that between BMD and height or weight in women in mainland China. When areal BMD is employed, those with a larger BS have higher areal BMD and lower risks of osteoporosis while, conversely, those with a smaller BS have lower areal BMD, and therefore higher risk for osteoporosis. However, when vBMD is used, these differences diminish or even disappear.
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References
Ross PD, Norimatsu H, Davis JW et al. (1991) A comparison of hip fracture incidence among native Japanese, Japanese Americans, and American Caucasians. Am J Epidemiol 133:801–809
Sugimoto T, Tsutsumi M, Fujii Y et al. (1992) Comparison of bone mineral content among Japanese, Koreans, and Taiwanese assessed by dual-photon absorptiometry. J Bone Miner Res 7:153–159
Dempster DW, Lindsay R (1993) Pathogenesis of osteoporosis. Lancet 341:797–801
Villa ML (1994) Cultural determinants of skeletal health: the need to consider both race and ethnicity in bone research. J Bone Miner Res 9:1329–1332
Faulkner RA, McCulloch RG, Fyke SL et al. (1995) Comparison of areal and estimated volumetric bone mineral density values between older men and women. Osteoporos Int 5:271–275
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
Bachrach LK, Hastie T, Wang MC, Narasimhan B, Marcus R (1999) Bone mineral acquisition in healthy Asian, Hispanic, Black, and Caucasian youth: a longitudinal study. J Clin Endocrinol Metab 84:4702–4712
Melton LJ 3rd, Khosla S, Achenbach BJ, O’Connor MK, O’Fallon WM, Riggs BL (2000) Effects of body size and skeletal site on the estimated prevalence of osteoporosis in women and men. Osteoporos Int 11:977–983
Melton LJ III (2001) The prevalence of osteoporosis: gender and racial comparison. Calcif Tissue Int 69:179–181
Marquez MA, Melton LJ 3rd, Muhs JM et al. (2001) Bone density in an immigrant population from Southeast Asia. Osteoporos Int 12:595–604
Looker AC, Wahner HW, Dunn WL et al. (1995) Proximal femur bone mineral levels of US adults. Osteoporos Int 5:389–409
Tobias JH, Cook DG, Chambers TJ, Dalzell N (1994) A comparison of bone mineral density between Caucasian, Asian and Afro-Caribbean women. Clin Sci 87:587–591
Memon A, Pospula WM, Tantawy AY, Abdul-Ghafars S, Suresh A, Al-Rowaih A (1998) Incidence of hip fracture in Kuwait. Int J Epidemiol 27:860–865
Maalouf G, Salem S, Sandid M et al. (2000) Bone mineral density of the Lebanese reference population. Osteoporos Int 11:756–764
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
Schwartz AV, Kelsey JL, Maggi S et al. (1999) International variation in the incidence of hip fractures: cross-national project on osteoporosis for the World Health Organization Program for Research on Aging. Osteoporos Int 9:242–253
Kin K, Kushida K, Yamazaki K, Okamoto S, Inoue T (1991) Bone mineral density of the spine in normal Japanese subjects using dual-energy X-ray absorptiometry: effect of obesity and menopausal status. Calcif Tissue Int 49:101–106
Harris S, Dallal GE, Dawson-Hughers B (1992) Influence of body weight on rates of change in bone density of the spine, hip, and radius in postmenopausal women. Calcif Tissue Int 50:19–23
Tremollieres FA, Pouilles JM, Ribot C (1993) Vertebral postmenopausal bone loss is reduced in overweight women: a longitudinal study in 155 early postmenopausal women. J Clin Endocrinol Metab 77:683–686
Kaneko M, Miyake T, Yokoyama E et al. (2000) Standard radial bone mineral density and physical factors in ordinary Japanese women. J Bone Miner Metab 18:31–35
Pors Nielsen S, Kolthoff N, Bärenholdt O et al. (1998) Diagnosis of osteoporosis by planar bone densitometry: can body size be disregarded? Br J Radiol 71:934–943
Hyldstrup L, Pors Nielsen S (2001) Metacarpal index by digital X-ray radiogrammetry. J Clin Densitom 4:299–306
Reinus WR, McAlister WH, Schranck F, Chines A, Whyte MP (1998) Differing lumbar vertebral mineralization rates in ambulatory pediatric patients with osteogenesis imperfecta. Calcif Tissue Int 62:17–20
Korpelainen R, Korpelainen J, Heikkinen J, Vaananen K, Keinanen-Kiukaanniemi S (2003) Lifestyle factors are associated with osteoporosis in lean women but not in normal and overweight women: a population-based cohort study of 1222 women. Osteoporos Int 14:34–43
Reid IR, Legge M, Stapleton JP, Evans MC, Grey AB (1995) Regular exercise dissociates fat mass and bone density in premenopausal women. J Clin Endocrinol Metab 80:1764–1768
Valdimarsson O, Kristinsson JO, Stefansson SO, Valdimarsson S, Sigurdsson G (1999) Lean mass and physical activity as predictors of bone mineral density in 16–20-year old women. J Int Med 245:489–496
Gillette-Guyonnet S, Nourhashemi F, Lauque S, Grandjean H, Vellas B (2000) Body composition and osteoporosis in elderly women. Gerontology 46:189–193
Pluijm SM, Visser M, Smit JH, Popp-Snijders C, Roos JC, Lips P (2001) Determinants of bone mineral density in older men and women: body composition as mediator. J Bone Miner Res 16:2142–2151
Taaffe DR, Cauley JA, Danielson M et al. (2001) Race and sex effects on the association between muscle strength, soft tissue, and bone mineral density in healthy elders: the Health, Aging, and Body Composition Study. J Bone Miner Res 16:1343–1352
Bemben DA, Langdon DB (2002) Relationship between estrogen use and musculoskeletal function in postmenopausal women. Maturitas 42:119–127
Wu XP, Liao EY, Dai RC, Luo XH, Zhang H (2003) Effects of projective bone area size of the spine on bone density and the diagnosis of osteoporosis in healthy premenopausal women in China. Br J Radiol 76:452–458
Marcus R, Greendale G, Blunt BA et al. (1994) Correlates of bone mineral density in the postmenopausal estrogen/progestin interventions trial. J Bone Miner Res 9:1467–1476
Cundy T, Cornish J, Evans MC, Gamble G, Stapleton J, Reid IR (1995) Sources of interracial variation in bone mineral density. J Bone Miner Res 10:368–373
Peel NF, Eastell R (1994) Diagnostic value of estimated volumetric bone mineral density of the lumbar spine in osteoporosis. J Bone Miner Res 9:317–320
Bonnick SL, Johnston CC Jr, Kleerekoper M et al. (2001) Importance of precision in bone density measurements. J Clin Densitom 4:105–110
Hu YM, Wu XL, Hu ZH et al. (1999) Study of formula for calculating body surface area of the Chinese adults. Acta Physiol Sin 51:45–48 (in Chinese)
Kanis JA, Melton LJ 3rd, Christiansen C, Johnston CC, Khaltaev N (1994) The diagnosis of osteoporosis. J Bone Miner Res 9:1137–1141
Liao EY, Wu XP, Lou XH et al. (2003) Establishment and evaluation of bone mineral density reference databases appropriate for diagnosis and evaluation of osteoporosis in Chinese women. J Bone Miner Metab 21:185–193
Wu XP, Liao EY, Zhang H, Shan PF, Cao XZ, Liu SP (2004) Establishment of BMD reference plots and determination of peak BMD at multiple skeletal regions in mainland Chinese women and the diagnosis of osteoporosis. Osteoporos Int 15:71–79
Mazess RB, Barden H (1999) Bone density of the spine and femur in adult white females. Calcif Tissue Int 65:91–99
Dougherty G, Al-Marzouk N (2001) Bone density measured by dual-energy X-ray absorptiometry in healthy Kuwaiti women. Calcif Tissue Int 68:225–229
Liao EY, Wu XP, Deng XG et al. (2002) Age-related bone mineral density, accumulated bone loss rate and prevalence of osteoporosis at multiple skeletal sites in Chinese women. Osteoporos Int 13:669–676
El-Desouki M (1995) Bone mineral density of the spine and femur in the normal Saudi population. Saudi Med J 16:30–35
Ghannam NN, Hammami MM, Bakheet SM, Khan BA (1999) Bone mineral density of the spine and femur in healthy Saudi females: relation to vitamin D status, pregnancy, and lactation. Calcif Tissue Int 65:23–28
Prentice A, Parsons TJ, Cole TJ (1994) Uncritical use of bone mineral density in absorptiometry may lead to size-related artifacts in the identification of bone mineral determinants. Am J Clin Nutr 60:837–842
Engelke K, Gluer CC, Genant HK (1995) Factors influencing short-term precision of dual X-ray bone absorptiometry (DXA) of spine and femur. Calcif Tissue Int 56:19–25
Gossain VV, Rao DS, Carella MJ, Divine G, Rovner DR (1999) Bone mineral density (BMD) in obesity effect of weight loss. J Med 30:367–376
Fogelholm GM, Sievanen HT, Kukkonen-Harjula TK, Pasanen ME (2001) Bone mineral density during reduction, maintenance and regain of body weight in premenopausal, obese women. Osteoporos Int 12:199–206
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
Meyer HE, Tverdal A, Falch JA (1995) Body height, body mass index, and fatal hip fractures: 16 years’ follow-up of 674,000 Norwegian women and men. Epidemiology 6:299–305
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Wu, XP., Liao, EY., Liu, SP. et al. Relationship of body surface area with bone density and its risk of osteoporosis at various skeletal regions in women of mainland China. Osteoporos Int 15, 751–759 (2004). https://doi.org/10.1007/s00198-004-1608-3
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DOI: https://doi.org/10.1007/s00198-004-1608-3