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Non-linear pattern of age-specific bone mineral density and related factors in women: data from the 5th Korea National Health and Nutrition Examination Survey

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Abstract

Summary

Age-specific bone mineral density (BMD) of Korean women showed a nonlinear pattern. According to our study, this pattern could be mainly attributed to the nonlinear effects of body composition. Interventions targeting these factors in premenopausal women could be critical for achieving peak BMD.

Purpose

The patterns of age-specific bone mineral density (BMD) of femur and spine in women showed a non-unidirectional decrease, with ups and downs around the point of achieving peak BMD, that are not evident in men. We investigated the factors associated with these age-specific BMD in women using linear and nonlinear models.

Methods

A total of 4681 women recruited during the 5th Korean National Health and Nutrition Examination Survey 2010–2011 (KNHANES V) were included. A range of related factors were considered including body compositional, reproductive, and socio-behavioral factors. Age-specific BMD was demonstrated using a generalized additive model (GAM) with smoothing spline transformation.

Results

Age, lean body mass, fat mass, and age at menarche were significant predictors of BMD in premenopausal women. The GAM plot of BMD according to age revealed two peaks for total femur, femoral neck, and lumbar spine. After adjustment for body compositional factors, the peaks flattened. In the full model, the pattern for lumbar spine showed a single peak around the mid-40s. The GAM showed a generally better performance than the linear model for BMD at all three sites. Reduced models that included only lean body mass and fat mass best explained the variance of BMD in GAMs.

Conclusions

The BMD of Korean women in reproductive period could be largely attributed to the nonlinear effects of age and body compositional factors. Intervention targeting these factors could be critical for maintaining peak BMD.

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References

  1. Ahn S, Kim Y, Chun N, S L (2012) Incidence of Osteoporosis and Falls and Predictors of Fracture Risk in Postmenopausal Women. Korean J Women Health Nurs 18:237

    Article  Google Scholar 

  2. Ahn SKH, So H, Song R (2009) Influencing fear of falling in postmenopausal women. Korean J Women Health Nurs 15:344–352

    Article  Google Scholar 

  3. Islam S, Liu Q, Chines A, Helzner E (2009) Trend in incidence of osteoporosis-related fractures among 40- to 69-year-old women: analysis of a large insurance claims database, 2000-2005. Menopause 16:77–83

    Article  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

    Article  PubMed  CAS  Google Scholar 

  5. Sanchez-Riera L, Carnahan E, Vos T et al (2014) The global burden attributable to low bone mineral density. Ann Rheum Dis 73:1635–1645

    Article  PubMed  CAS  Google Scholar 

  6. Paganini-Hill A, Atchison KA, Gornbein JA, Nattiv A, Service SK, White SC (2005) Menstrual and reproductive factors and fracture risk: the Leisure World Cohort Study. J Womens Health (Larchmt) 14:808–819

    Article  Google Scholar 

  7. Schnatz PF, Barker KG, Marakovits KA, O'Sullivan DM (2010) Effects of age at first pregnancy and breast-feeding on the development of postmenopausal osteoporosis. Menopause 17:1161–1166

    Article  PubMed  Google Scholar 

  8. Lee EY, Kim D, Kim KM, Kim KJ, Choi HS, Rhee Y, Lim SK (2012) Age-related bone mineral density patterns in Koreans (KNHANES IV). J Clin Endocrinol Metab 97:3310–3318

    Article  PubMed  CAS  Google Scholar 

  9. Heaney RP, Abrams S, Dawson-Hughes B, Looker A, Marcus R, Matkovic V, Weaver C (2000) Peak bone mass. Osteoporos Int 11:985–1009

    Article  PubMed  CAS  Google Scholar 

  10. Kemmler W, Bebenek M, von Stengel S, Bauer J (2014) Peak-bone-mass development in young adults: effects of study program related levels of occupational and leisure time physical activity and exercise. A prospective 5-year study. Osteoporos Int 26:653–62

    Article  PubMed  Google Scholar 

  11. Yang YJ, Kim J (2014) Factors in relation to bone mineral density in Korean middle-aged and older men: 2008-2010 Korea National Health and Nutrition Examination Survey. Ann Nutr Metab 64:50–59

    Article  PubMed  CAS  Google Scholar 

  12. Yoon EH, Noh H, Lee HM, Hwang HS, Park HK, Park YS (2012) Bone mineral density and food-frequency in Korean adults: The 2008 and 2009 Korea National Health and Nutrition Examination Survey. Korean J Fam Med 33:287–295

    Article  PubMed  PubMed Central  Google Scholar 

  13. Mesner LD, Ray B, Hsu YH et al (2014) Bicc1 is a genetic determinant of osteoblastogenesis and bone mineral density. J Clin Invest 124:2736–2749

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  14. Imai Y, Youn MY, Kondoh S, Nakamura T, Kouzmenko A, Matsumoto T, Takada I, Takaoka K, Kato S (2009) Estrogens maintain bone mass by regulating expression of genes controlling function and life span in mature osteoclasts. Ann N Y Acad Sci 1173(Suppl 1):E31–39

    Article  PubMed  CAS  Google Scholar 

  15. Sowers MF, Hollis BW, Shapiro B, Randolph J, Janney CA, Zhang D, Schork A, Crutchfield M, Stanczyk F, Russell-Aulet M (1996) Elevated parathyroid hormone-related peptide associated with lactation and bone density loss. JAMA 276:549–554

    Article  PubMed  CAS  Google Scholar 

  16. Iwamoto J, Sato Y, Uzawa M, Matsumoto H (2012) Five-year follow-up of a woman with pregnancy and lactation-associated osteoporosis and vertebral fractures. Ther Clin Risk Manag 8:195–199

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  17. Rizzoli R, Bonjour JP (1996) Pregnancy-associated osteoporosis. Lancet 347:1274–1276

    Article  PubMed  CAS  Google Scholar 

  18. Alderman BW, Weiss NS, Daling JR, Ure CL, Ballard JH (1986) Reproductive history and postmenopausal risk of hip and forearm fracture. Am J Epidemiol 124:262–267

    PubMed  CAS  Google Scholar 

  19. Hoffman SGJ, Kelsey JL, Gammon MD, O'Brien LA (1993) Parity, lactation and hip fracture. Osteoporos Int 3:171–176

    Article  PubMed  CAS  Google Scholar 

  20. Kara G, Ozcakar L, Malas FU, Akinci A, Basgoze O (2010) Pregnancy-associated osteoporosis revisited. Arch Gynecol Obstet 281:777–778

    Article  PubMed  Google Scholar 

  21. Park HA (2013) The Korea national health and nutrition examination survey as a primary data source. Korean J Fam Med 34:79

    Article  PubMed  PubMed Central  Google Scholar 

  22. Berenson AB, Rahman M, Wilkinson G (2009) Racial difference in the correlates of bone mineral content/density and age at peak among reproductive-aged women. Osteoporos Int 20:1439–1449

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  23. Nguyen HT, von Schoultz B, Pham DM, Nguyen DB, Le QH, Nguyen DV, Hirschberg AL, Nguyen TV (2009) Peak bone mineral density in Vietnamese women. Arch Osteoporos 4:9–15

    Article  PubMed  PubMed Central  Google Scholar 

  24. Yazici S, Korkmaz U, Erkan M, Korkmaz N, Erdem Baki A, Alcelik A, Onder E, Ataoglu S (2011) The effect of breast-feeding duration on bone mineral density in postmenopausal Turkish women: a population-based study. Arch Med Sci 7:486–492

    Article  PubMed  PubMed Central  Google Scholar 

  25. Eskridge SL, Morton DJ, Kritz-Silverstein D, Barrett-Connor E, Wingard D, Wooten W (2010) Estrogen therapy and bone mineral density in African-American and Caucasian women. Am J Epidemiol 171:808–816

    Article  PubMed  PubMed Central  Google Scholar 

  26. Chapman DJ (2012) Longer cumulative breastfeeding duration associated with improved bone strength. J Hum Lact 28:18–19

    Article  PubMed  Google Scholar 

  27. Yang SOKY, Chung TH, Kim MC, Hyun WY, Kim ES, Yoo CI, Ham SY (2003) Normative bone mineral density by digital x-ray radiogrammetry in Korean Women. Korean J Bone Metab 10:169–174

    Google Scholar 

  28. Choi SPI, Joo N, Kim B (2008) Reference value for the t-score in osteoporosis diagnosis by health screening subjects. Korean J Bone Metab 15:67–76

    Google Scholar 

  29. Cho GJ, Park HT, Shin JH et al (2010) Age at menarche in a Korean population: secular trends and influencing factors. Eur J Pediatr 169:89–94

    Article  PubMed  Google Scholar 

  30. Ip S, Chung M, Raman G, Trikalinos TA, Lau J (2009) A summary of the Agency for Healthcare Research and Quality's evidence report on breastfeeding in developed countries. Breastfeed Med 4(Suppl 1):S17–30

    PubMed  Google Scholar 

  31. Schnatz PF, Marakovits KA, O'Sullivan DM (2010) Assessment of postmenopausal women and significant risk factors for osteoporosis. Obstet Gynecol Surv 65:591–596

    Article  PubMed  Google Scholar 

  32. Wiklund PK, Xu L, Wang Q et al (2012) Lactation is associated with greater maternal bone size and bone strength later in life. Osteoporos Int 23:1939–1945

    Article  PubMed  CAS  Google Scholar 

  33. Huo D, Lauderdale DS, Li L (2003) Influence of reproductive factors on hip fracture risk in Chinese women. Osteoporos Int 14:694–700

    Article  PubMed  Google Scholar 

  34. Robinson WR, Utz RL, Keyes KM, Martin CL, Yang Y (2013) Birth cohort effects on abdominal obesity in the United States: the Silent Generation, Baby Boomers and Generation X. Int J Obes (Lond) 37:1129–1134

    Article  CAS  Google Scholar 

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Conflict of interest

Seung-Ah Choe, Ja-Woon Shin, Joohon Sung, and Sung-il Cho declare that they have no conflict of interest.

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Authors and Affiliations

  1. Graduate School of Public Health, Seoul National University, Gwanak ro 1, Gwanak gu, Seoul, 151-742, South Korea

    Seung-Ah Choe, Ja-Woon Shin, Joohon Sung & Sung-il Cho

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  1. Seung-Ah Choe
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  2. Ja-Woon Shin
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  3. Joohon Sung
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  4. Sung-il Cho
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Correspondence to Sung-il Cho.

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Choe, SA., Shin, JW., Sung, J. et al. Non-linear pattern of age-specific bone mineral density and related factors in women: data from the 5th Korea National Health and Nutrition Examination Survey. Arch Osteoporos 10, 32 (2015). https://doi.org/10.1007/s11657-015-0236-1

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  • DOI: https://doi.org/10.1007/s11657-015-0236-1

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