DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20184403

The effect of body mass index on bone mineral density in postmenopausal women

Yusuf Serdar Gürlek, Ahmet Kalaycıoğlu, Beril Gurlek

Abstract


Background: The aim of this study was to evaluate the association between BMI and BMD among postmenopausal women.

Methods: A total of 121 healthy female patients, aged 65.67±8.59 years, previously menopaused, were enrolled. Subjects were divided into five subgroups according to their BMI. History of fracture and BMD were recorded and compared between groups.

Results: Among the 121 subjects, 77 (63.6%) individuals had a normal BMD, 32 (26.4%) had osteopenia, and 12 (9.9%) were diagnosed with osteoporosis. Mean of waist circumference was 96.1±8.52cm. The prevalence of fractures was 29.8% in this study. A simple correlation analysis revealed that waist circumference was negatively related to lumbar spine BMD (r= -0.374, p=0.03) and lumbar spine BMD T score (r= -0,352 p=0.002) whereas body weight was positively related to BMD of lumbar spine BMD (r=0.41, p=0.0001) and lumbar spine BMD T score (r=0,31 p=0.001). Age and years since menopause (YSM) were negatively correlated with BMD and T score (p=0.001, p=0.0001, respectively).

Conclusions: Even though higher BMI seems to have positive impact on bone density thanks to hormonal and mechanical reasons, increased waist circumference is a sign of a metabolic syndrome and systemic inflammation which are known as having negative effect on bone density. Therefore, postmenopausal women specifically with abdominal obesity should be evaluated for osteoporosis. 


Keywords


Body mass index, Bone mineral density, Obesity

Full Text:

PDF

References


World Health Organization. Research on the menopause in the 1990’s. Report of a WHO Scientific Group. World Health Organ Tech Rep Ser. 1996;866,12-14.

National Institutes of Health State-of-the-Science Conference statement: management of menopause-related symptoms. National Institutes of Health. Ann Intern Med. 2005 Jun 21;142(12 Pt 1):1003-13.

Hadjidakis DJ, Kokkinakis EP, Sfakianakis ME, Raptis SA. Bone density patterns after normal and premature menopause. Maturitas. 2003;44:279-86.

Sirola J, Kroger H, Honkanen R, Jurvelin JS, Sandini L, et al. Factors affecting bone loss around menopause in women without HRT: a prospective study. Maturitas. 2003;45:159-67.

Gallagher JC. Effect of early menopause on bone mineral density and fractures. Menopause. 2007;14:567-71.

Consensus development conference: diagnosis, prophylaxis, and treatment of osteoporosis. Am J Med. 1993;94(6):646-50.

Johnell O, Kanis JA, Oden A, Johansson H, De Laet C, Delmas P, et al. Predictive value of BMD for hip and other fractures. J Bone Mineral Res. 2005 Jul 1;20(7):1185-94.

Marshall D, Johnell O, Wedel H. Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ. 1996;312(7041):1254-59.

Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO study group. World Health Organ Tech Rep Ser. 1994;843:1-129.

Tuzun S, Eskiyurt N, Akarirmak U, Saridogan M, Senocak M, et al. Incidence of hip fracture and prevalence of osteoporosis in Turkey: the FRACTURK study. Osteoporos Int. 2012;23:949-55.

Tuzun S, Eskiyurt N, Akarirmak U, Saridogan M, Senocak M, et al. Incidence of hip fracture and prevalence of osteoporosis in Turkey: the FRACTURK study. Osteoporosis Int. 2012 Mar 1;23(3):949-55.

Turkish Statistical Institute (TUIK), Turkish Health Survey, 2017. Available at: http://www.tuik.gov.tr/PreHaberBultenleri.do?id=24573. Accessed 31 May 2017.

Greco EA, Fornari R, Rossi F, Santiemma V, Prossomariti G, Annoscia C, et al. Is obesity protective for osteoporosis? Evaluation of bone mineral density in individuals with high body mass index. Int J Clin Practice. 2010 May;64(6):817-20.

Kim KC, Shin DH, Lee SY, Im JA, Lee DC. Relation between obesity and bone mineral density and vertebral fractures in Korean postmenopausal women. Yonsei Med J. 2010 Nov 1;51(6):857-63.

WHO. Obesity: preventing and managing the global epidemic. Report of a WHO Consultation. WHO technical report series 894. Geneva: World Health Organization, 2000.

Rössner S. Obesity: the disease of the twenty-first century. Int J Obesity. 2002 Nov 28;26(S4):S2.

Hu FB. Overweight and obesity in women: health risks and consequences. J Women's Health. 2003 Feb 1;12(2):163-72.

Holecki M, Zahorska-Markiewicz B, Więcek A, Nieszporek T, Żak-Gołąb A. Obesity and bone metabolism. Endocrinol Poland. 2008;59(3):218-23.

Compston JE, Watts NB, Chapurlat R, Cooper C, Boonen S, Greenspan S, et al. Obesity is not protective against fracture in postmenopausal women: GLOW. Am J Med. 2011 Nov 1;124(11):1043-50.

Albala CE, Yanez M, Devoto EN, Sostin CE, Zeballos LO, Santos JL. Obesity as a protective factor for postmenopausal osteoporosis. Int J Obesity Related Metabolic Dis. 1996 Nov;20(11):1027-32.

Siris ES, Miller PD, Barrett-Connor E, Faulkner KG, Wehren LE, Abbott TA, et al. Identification and fracture outcomes of undiagnosed low bone mineral density in postmenopausal women: results from the national osteoporosis risk assessment. JAMA. 2001;286:2815-22.

Gnudi S, Sitta E, Lisi L. Relationship of body mass index with main limb fragility fractures in postmenopausal women. J Bone Mineral Metabolism. 2009 Jul 1;27(4):479-84.

Ensrud KE, Fullman RL, Barrett-Connor E, Cauley JA, Stefanick ML, Fink HA, et al. Voluntary weight reduction in older men increases hip bone loss: the osteoporotic fractures in men study. J Clin Endocrinol Metabolism. 2005 Apr 1;90(4):1998-2004.

Premaor MO, Pilbrow L, Tonkin C, Parker RA, Compston J. Obesity and fractures in postmenopausal women. J Bone Mineral Metabolism. 2010 Feb 1;25(2):292-7.

Haffner SM, Bauer RL. The association of obesity and glucose and insulin concentrations with bone density in premenopausal and postmenopausal women. Metabolism Clin Experimental. 1993 Jun 1;42(6):735-8.

Goulding A, Taylor RW. Plasma leptin values in relation to bone mass and density and to dynamic biochemical markers of bone resorption and formation in postmenopausal women. Calcified Tissue Int. 1998 Dec 1;63(6):456-8.

Tarquini B, Navari N, Perfetto F, Piluso A, Romano S, Tarquini R. Evidence for bone mass and body fat distribution relationship in postmenopausal obese women. Arch Gerontol Geriatrics. 1997 Jan 1;24(1):15-21.

Carrasco F, Ruz M, Rojas P, Csendes A, Rebolledo A, Codoceo J, et al. Changes in bone mineral density, body composition and adiponectin levels in morbidly obese patients after bariatric surgery. Obesity Surgery. 2009 Jan 1;19(1):41-6.

Hsu YH, Venners SA, Terwedow HA, Feng Y, Niu T, Li Z, et al. Relation of body composition, fat mass, and serum lipids to osteoporotic fractures and bone mineral density in Chinese men and women. Am J Clin Nutr. 2006;83:146-54.

Zhao LJ, Liu YJ, Liu PY, Hamilton J, Recker RR, Deng HW. Relationship of obesity with osteoporosis. J Clin Endocrinol Metab. 2007;92:1640-6.

Khosla S, Amin S, Orwoll E. Osteoporosis in men. Endocrine Rev. 2008 May 1;29(4):441-64.

De Laet C, Kanis JA, Odén A, Johanson H, Johnell O, Delmas P, et al. Body mass index as a predictor of fracture risk: a meta-analysis. Osteoporosis Int. 2005 Nov 1;16(11):1330-8.

Beck TJ, Petit MA, Wu G, LeBoff MS, Cauley JA, Chen Z. Does obesity really make the femur stronger? BMD, geometry, and fracture incidence in the women's health initiative‐observational study. J Bone Mineral Res. 2009 Aug;24(8):1369-79.

Himes CL, Reynolds SL. Effect of obesity on falls, injury, and disability. J Am Geriatr Soc. 2012 Jan;60(1):124-9.

Ong T, Sahota O, Tan W, Marshall L. A United Kingdom perspective on the relationship between body mass index (BMI) and bonehealth: a cross sectional analysis of data from the Nottingham Fracture Liaison Service. Bone. 2014 Feb;59:207-10.

Knapp KM, Welsman JR, Hopkins SJ, Fogelman I, Blake GM. Obesity increases precision errors in dual-energy X-ray absorptiometry measurements. J Clin Densitometry. 2012 Jul 1;15(3):315-9.

Robbins J, Schott AM, Azari R, Kronmal R. Body mass index is not a good predictor of bone density: results from WHI, CHS, and EPIDOS. J Clin Densitometry. 2006 Jul 1;9(3):329-34.

Palermo A, Tuccinardi D, Defeudis G, Watanabe M, D’Onofrio L, Lauria Pantano A, et al. BMI and BMD: the potential interplay between obesity and bone fragility. Int J Environmental Res Public Health. 2016 May 28;13(6):544.