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Decreasing trend of bone mineral density in US multiethnic population: analysis of continuous NHANES 2005–2014

  • Y. Xu
  • Q. Wu
Original Article

Abstract

Summary

Studies examining recent bone mineral density (BMD) trends in the US population are limited. In our study, we found that age-adjusted mean BMD among US men and women was stable from 2005 to 2010, but then declined in 2013–2014. We also explored factors associated with decreasing BMD in recent years.

Introduction

Osteoporosis prevalence in the USA declined between 1988 and 2006, while the declining trend in hip fracture may have plateaued in 2013–2014. We aimed to examine whether there has been a corresponding change in BMD trajectory for the US population.

Methods

Continuous National Health and Nutrition Examination Survey (NHANES) data from 2005–2006 to 2013–2014 were analyzed to examine BMD trends among US men and women aged 30 years and older and among different race/ethnicity subgroups. ANOVA and Bonferroni adjustments were used to examine the differences in mean BMD, and multiple linear regressions adjusting for potential confounding effects were employed to examine BMD trends.

Results

After age standardization, the mean BMD of the femur neck for the first three NHANES cycles was stable (all p > 0.1) in both men and women, but significantly decreased in 2013–2014, from 0.864 g/cm2 to 0.846 g/cm2 (p = 0.0025) in men and from 0.789 to 0.771 g/cm2 (p = 0.03) in women. The overall mean femur neck BMD in 2013–2014 was significantly lower than that in earlier survey cycles in both men and women, even after adjusting for multiple covariates, including age, race, physical activity, previous fracture, BMI, and other variables. Similar results were observed in subgroup analyses of race and sensitivity analyses.

Conclusions

Age-adjusted mean BMD decreased in 2013–2014 in both men and women, and this significant decrease was also observed in sensitivity and subgroup analyses. The decreased BMD in 2013–2014 still remained significant even after being adjusted for multiple potentially confounding effects.

Keywords

Aging Bone mineral density DXA NHANES Trend 

Abbreviations

NHANES

National Health and Nutrition Examination Survey

BMI

Body mass index

CDC

Centers for Disease Control and Prevention

DXA

Dual-energy X-ray absorptiometry

CKD

Chronic kidney disease

GFR

Glomerular filtration rate

ANOVA

Analysis of variance

Notes

Acknowledgments

Research reported in this publication was supported by the Knowledge Fund of the University of Nevada, Las Vegas, from the Nevada Governor’s Office, and the National Institute on Minority Health and Health Disparities of the National Institutes of Health under Award Number R15MD010475. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Nevada Governor’s Office and the National Institutes of Health.

Compliance with ethical standards

Conflicts of interest

None.

Supplementary material

198_2018_4648_MOESM1_ESM.docx (16 kb)
ESM 1 (DOCX 15 kb)

References

  1. 1.
    Kanis JA (2007) WHO technical report. University of SheffieldGoogle Scholar
  2. 2.
    National Osteoporosis Foundation (2014) 54 million Americans affected by osteoporosis and low bone mass. https://www.nof.org/news/54-million-americans-affected-by-osteoporosis-and-low-bone-mass/. Accessed 06/02 2017
  3. 3.
    Riggs BL, Melton LJ 3rd (1995) The worldwide problem of osteoporosis: insights afforded by epidemiology. Bone 17(5 Suppl):505s–511sCrossRefPubMedGoogle Scholar
  4. 4.
    Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A (2007) Incidence and economic burden of osteoporosis-related fractures in the United States, 2005-2025. J Bone Miner Res 22(3):465–475.  https://doi.org/10.1359/jbmr.061113 CrossRefPubMedGoogle Scholar
  5. 5.
    Looker AC, Melton LJ 3rd, Harris TB, Borrud LG, Shepherd JA (2010) Prevalence and trends in low femur bone density among older US adults: NHANES 2005-2006 compared with NHANES III. J Bone Miner Res 25(1):64–71.  https://doi.org/10.1359/jbmr.090706 CrossRefPubMedGoogle Scholar
  6. 6.
    Michael Lewiecki E, Wright NC, Curtis JR, Siris E, Gagel RF, Saag KG, Singer AJ, Steven PM, Adler RA (2017) Hip fracture trends in the United States, 2002 to 2015. Osteoporos Int 29:717–722.  https://doi.org/10.1007/s00198-017-4345-0 CrossRefPubMedGoogle Scholar
  7. 7.
    Office of the Surgeon General (US) (2004) Bone health and osteoporosis: a report of the surgeon general. Assessing the Risk of Bone Disease and FractureGoogle Scholar
  8. 8.
    Looker AC, Sarafrazi Isfahani N, Fan B, Shepherd JA (2017) Trends in osteoporosis and low bone mass in older US adults, 2005-2006 through 2013-2014. Osteoporos Int 28(6):1979–1988.  https://doi.org/10.1007/s00198-017-3996-1 CrossRefPubMedGoogle Scholar
  9. 9.
    Coughlan T, Dockery F (2014) Osteoporosis and fracture risk in older people. Clin Med (Lond) 14(2):187–191.  https://doi.org/10.7861/clinmedicine.14-2-187 CrossRefGoogle Scholar
  10. 10.
    Diab DL, Watts NB (2013) Postmenopausal osteoporosis. Curr Opin Endocrinol Diabetes Obes 20(6):501–509.  https://doi.org/10.1097/01.med.0000436194.10599.94 CrossRefPubMedGoogle Scholar
  11. 11.
    Altman DG, Royston P (2006) The cost of dichotomising continuous variables. BMJ : British Medical Journal 332(7549):1080–1080CrossRefPubMedGoogle Scholar
  12. 12.
    Centers for Disease Control and Prevention (CDC) (2017) About NHANES. https://www.cdc.gov/nchs/nhanes/about_nhanes.htm. Accessed 11/27 2017
  13. 13.
    NIH Osteoporosis and Related Bone Diseases National Rescource Center (2015) Osteoporosis: Peak Bone Mass in Women. https://www.bones.nih.gov/health-info/bone/osteoporosis/bone-mass. Accessed 06/02 2017
  14. 14.
    Centers for Disease Control and Prevention (CDC) (2009) Dual Energy X-ray Absorptiometry - Femur (DXXFEM_D). https://wwwn.cdc.gov/Nchs/Nhanes/2005-2006/DXXFEM_D.htm. Accessed 06/02 2017
  15. 15.
    Kanis JA, McCloskey EV, Johansson H, Oden A, Melton LJ 3rd, Khaltaev N (2008) A reference standard for the description of osteoporosis. Bone 42(3):467–475.  https://doi.org/10.1016/j.bone.2007.11.001 CrossRefPubMedGoogle Scholar
  16. 16.
    Marshall D, Johnell O, Wedel H (1996) Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ 312(7041):1254–1259CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Klotzbuecher CM, Ross PD, Landsman PB, Abbott TA 3rd, Berger M (2000) Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res 15(4):721–739.  https://doi.org/10.1359/jbmr.2000.15.4.721 CrossRefPubMedGoogle Scholar
  18. 18.
    KDOQI Clinical Practice Guidelines and Clinical Practice Recommendations for Anemia in Chronic Kidney Disease (2006) Am. J Kidney Dis 47(5 Suppl 3):S11–S145.  https://doi.org/10.1053/j.ajkd.2006.03.010
  19. 19.
    Nam H-S, Kweon S-S, Choi J-S, Zmuda JM, Leung PC, Lui L-Y, Hill DD, Patrick AL, Cauley JA (2013) Racial/ethnic differences in bone mineral density among older women. J Bone Miner Metab 31(2):190–198.  https://doi.org/10.1007/s00774-012-0402-0 CrossRefPubMedGoogle Scholar
  20. 20.
    Orchard TS, Larson JC, Alghothani N, Bout-Tabaku S, Cauley JA, Chen Z, LaCroix AZ, Wactawski-Wende J, Jackson RD (2014) Magnesium intake, bone mineral density, and fractures: results from the Women’s Health Initiative observational study. Am J Clin Nutr 99(4):926–933.  https://doi.org/10.3945/ajcn.113.067488 CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Mackey DC, Lui L, Cawthon PM et al (2007) High-trauma fractures and low bone mineral density in older women and men. JAMA 298(20):2381–2388.  https://doi.org/10.1001/jama.298.20.2381 CrossRefPubMedGoogle Scholar
  22. 22.
    Lodder M, de Jong Z, Kostense P, Molenaar E, Staal K, Voskuyl A, Hazes J, Dijkmans B, Lems W (2004) Bone mineral density in patients with rheumatoid arthritis: relation between disease severity and low bone mineral density. Ann Rheum Dis 63(12):1576–1580.  https://doi.org/10.1136/ard.2003.016253 CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Dhanwal DK (2011) Thyroid disorders and bone mineral metabolism. Indian J Endocrinol Metab 15(Suppl2):S107–S112.  https://doi.org/10.4103/2230-8210.83339 CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Lim LS, Fink HA, Kuskowski MA, Cauley JA, Ensrud KE (2005) Diuretic use and bone mineral density in older USA men: the osteoporotic fractures in men (MrOS) study. Age Ageing 34(5):504–507.  https://doi.org/10.1093/ageing/afi133 CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Lewiecki EM (2010) Bisphosphonates for the treatment of osteoporosis: insights for clinicians. Ther Adv Chronic Dis 1(3):115–128.  https://doi.org/10.1177/2040622310374783 CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    National Institute of Diabetes and Digestive and Kidnay Disease Mineral & Bone Disorder in Chronic Kidney Disease. https://www.niddk.nih.gov/health-information/kidney-disease/chronic-kidney-disease-ckd/mineral-bone-disorder. Accessed 04/09/2018
  27. 27.
    Thrailkill KM, Lumpkin CK, Bunn RC, Kemp SF, Fowlkes JL (2005) Is insulin an anabolic agent in bone? Dissecting the diabetic bone for clues. Am J Phys Endocrinol Metab 289(5):E735–E745.  https://doi.org/10.1152/ajpendo.00159.2005 CrossRefGoogle Scholar
  28. 28.
    Rexhepi S, Bahtiri E, Rexhepi M, Sahatciu-Meka V, Rexhepi B (2015) Association of body weight and body mass index with bone mineral density in women and men from Kosovo. Materia Socio-Medica 27(4):259–262.  https://doi.org/10.5455/msm.2015.27.259-262 CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Gartlehner G, Patel SV, Feltner C, Weber RP, Long R, Mullican K, Boland E, Lux L, Viswanathan M (2017) Hormone therapy for the primary prevention of chronic conditions in postmenopausal women: evidence report and systematic review for the US preventive services task force. JAMA 318(22):2234–2249.  https://doi.org/10.1001/jama.2017.16952 CrossRefPubMedGoogle Scholar
  30. 30.
    Ertungealp E, Seyisoglu H, Erel CT, Senturk LM, Gezer A (1999) Changes in bone mineral density with age, menopausal status and body mass index in Turkish women. Climacteric 2(1):45–51CrossRefPubMedGoogle Scholar
  31. 31.
    Prior JC, Kirkland SA, Joseph L, Kreiger N, Murray TM, Hanley DA, Adachi JD, Vigna YM, Berger C, Blondeau L, Jackson SA, Tenenhouse A, the CaMos Research Group f (2001) Oral contraceptive use and bone mineral density in premenopausal women: cross-sectional, population-based data from the Canadian multicentre osteoporosis study. CMAJ 165(8):1023–1029PubMedPubMedCentralGoogle Scholar
  32. 32.
    National Heart L, and Blood Institute (1998) Clinical guidelines on the identification, Evaluation, and Treatment of Overweight and Obesity in AdultsGoogle Scholar
  33. 33.
    Kahende JW, Adhikari B, Maurice E, Rock V, Malarcher A (2009) Disparities in health care utilization by smoking status—NHANES 1999–2004. Int J Environ Res Public Health 6(3):1095–1106.  https://doi.org/10.3390/ijerph6031095 CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    U.S. Food & Drug Administration (2017) Postmarket drug safety information for patients and providers. https://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/default.htm. Accessed 06/02 2017
  35. 35.
    Nash D, Magder L, Lustberg M et al (2003) Blood lead, blood pressure, and hypertension in perimenopausal and postmenopausal women. JAMA 289(12):1523–1532.  https://doi.org/10.1001/jama.289.12.1523 CrossRefPubMedGoogle Scholar
  36. 36.
    Wirth KE, Tchetgen Tchetgen EJ (2014) Accounting for selection bias in association studies with complex survey data. Epidemiology 25(3):444–453.  https://doi.org/10.1097/ede.0000000000000037 CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Rivadeneira F, Zillikens MC, De Laet CE, Hofman A, Uitterlinden AG, Beck TJ, Pols HA (2007) Femoral neck BMD is a strong predictor of hip fracture susceptibility in elderly men and women because it detects cortical bone instability: the Rotterdam study. J Bone Miner Res 22(11):1781–1790.  https://doi.org/10.1359/jbmr.070712 CrossRefPubMedGoogle Scholar
  38. 38.
    Kamei T, Aoyagi K, Matsumoto T, Ishida Y, Iwata K, Kumano H, Murakami Y, Kato Y (1999) Age-related bone loss: relationship between age and regional bone mineral density. Tohoku J Exp Med 187(2):141–147CrossRefPubMedGoogle Scholar
  39. 39.
    Shin M-H, Zmuda JM, Barrett-Connor E, Sheu Y, Patrick AL, Leung PC, Kwok A, Kweon S-S, Nam H-S, Cauley JA, for the Osteoporotic Fractures in Men research G (2014) Race/ethnic differences in associations between bone mineral density and fracture history in older men. Osteoporos Int 25 (3):837–845. doi: https://doi.org/10.1007/s00198-013-2503-6
  40. 40.
    Drake MT, Clarke BL, Khosla S (2008) Bisphosphonates: mechanism of action and role in clinical practice. Mayo Clinic proceedings Mayo Clinic 83(9):1032–1045CrossRefPubMedCentralGoogle Scholar
  41. 41.
    Wysowski DK (2009) Reports of esophageal cancer with oral bisphosphonate use. N Engl J Med 360(1):89–90.  https://doi.org/10.1056/NEJMc0808738 CrossRefPubMedGoogle Scholar
  42. 42.
    Schilcher J, Michaelsson K, Aspenberg P (2011) Bisphosphonate use and atypical fractures of the femoral shaft. N Engl J Med 364(18):1728–1737.  https://doi.org/10.1056/NEJMoa1010650 CrossRefPubMedGoogle Scholar
  43. 43.
    Rosen CJ (2005) Clinical practice. Postmenopausal osteoporosis. N Engl J Med 353(6):595–603.  https://doi.org/10.1056/NEJMcp043801 CrossRefPubMedGoogle Scholar
  44. 44.
    Kanis JA, Burlet N, Cooper C, Delmas PD, Reginster JY, Borgstrom F, Rizzoli R (2008) European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int 19(4):399–428.  https://doi.org/10.1007/s00198-008-0560-z CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Rudman D, Drinka PJ, Wilson CR, Mattson DE, Scherman F, Cuisinier MC, Schultz S (1994) Relations of endogenous anabolic hormones and physical activity to bone mineral density and lean body mass in elderly men. Clin Endocrinol 40(5):653–661CrossRefGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2018

Authors and Affiliations

  1. 1.Nevada Institute of Personalized MedicineUniversity of Nevada, Las VegasLas VegasUSA
  2. 2.Department of Environmental and Occupational Health, School of Community Health SciencesUniversity of Nevada, Las VegasLas VegasUSA

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