Decreasing trend of bone mineral density in US multiethnic population: analysis of continuous NHANES 2005–2014
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.
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.
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.
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.
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.
KeywordsAging Bone mineral density DXA NHANES Trend
National Health and Nutrition Examination Survey
Body mass index
Centers for Disease Control and Prevention
Dual-energy X-ray absorptiometry
Chronic kidney disease
Glomerular filtration rate
Analysis of variance
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
- 1.Kanis JA (2007) WHO technical report. University of SheffieldGoogle Scholar
- 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
- 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
- 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
- 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.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.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
- 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.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
- 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
- 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
- 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
- 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
- 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.National Heart L, and Blood Institute (1998) Clinical guidelines on the identification, Evaluation, and Treatment of Overweight and Obesity in AdultsGoogle Scholar
- 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
- 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
- 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