Osteoporosis is a disease with a high burden of morbidity. For its accurate diagnosis, using indigenous data as reference standards is needed. However, normative data on bone density is lacking in India. Therefore, we aimed to determine the reference range for bone density for the healthy population of north India.
Osteoporosis is a major public health problem around the globe including India, resulting in significant morbidity, mortality, and health care burden. However, the reference values used for its diagnosis are largely based on data from the western population, which may lead to over- or underdiagnosis of osteoporosis in Indians. Our study aimed to determine the reference range for bone mineral density for the healthy population of India.
This is a cross-sectional study of 825 subjects (men 380, women 445) (median age: 41 years, IQR 32–55 years), recruited by a house-to-house survey. The population was stratified into decade-wise groups and biochemical measurements including renal and liver function tests, glycated hemoglobin, serum calcium, 25-hydroxyvitamin D, parathyroid hormone, and bone mineral density were performed in all the subjects. The T-scores for men aged > 50 years and post-menopausal women were calculated based on the data generated from this study in young men and women aged 20–40 years.
According to the BMD manufacturer’s data, which is based on the western population, 70% of the Indian men (> 50 years) and 48% of the post-menopausal Indian women had osteopenia while 18% of the men and 25% of the women had osteoporosis. However, according to the re-calculated T-scores from the current study, only 56% and 7.2% of men and 33% and 5% of women had osteopenia and osteoporosis, respectively. An age-related decline in bone mineral density, as seen in the western population, was also seen in both Indian men and women.
We have established a reference database for BMD in healthy Indian adult population, which may have clinical implications for the diagnosis and intervention strategies for the management of osteoporosis.
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Kanis JA (2007) WHO Technical Report. University of Sheffield66, UK
Johnell O, Kanis JA (2006) An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int 17:1726–1733
Leibson CL, Tosteson ANA, Gabriel SE, Ransom JE, Melton LJ III (2002) Mortality, disability, and nursing home use for persons with and without hip fracture: a population-based study. J Am Geriatr Soc 50:1644–1650
Kanis JA, Delmas P, Burckhardt P, Cooper C, Torgerson D (1997) Guidelines for diagnosis and management of osteoporosis. The European Foundation for Osteoporosis and Bone Disease. Osteoporos Int 7:390–406
Compston JE, McClung MR, Leslie WD (2019) Osteoporosis. Lancet 393:364–376
Bolland MJ, Grey AB, Gamble GD, Reid IR (2010) Effect of osteoporosis treatment on mortality: a meta-analysis. J Clin Endocrinol Metab 95:1174–1181
Tosteson ANA, Burge R, Marshall D, Lindsay R (2008) Therapies for treatment of osteoporosis in US women: cost-effectiveness and budget impact considerations. Am J Manag Care 14:605–615
Kanis JA, Melton LJ, Christiansen C et al (1994) The diagnosis of osteoporosis. J Bone Miner Res 9:1137–1141
(1997) Standardization of proximal femur bone mineral density (BMD) measurements by DXA. International Committee for Standards in Bone Measurement. Bone 21:369–370
Khadilkar AV, Mandlik RM (2015) Epidemiology and treatment of osteoporosis in women: an Indian perspective. Int J Womens Health 7:841–850
Malhotra N, Mithal A (2008) Osteoporosis in Indians. Indian J Med Res 127:263–268
Shatrugna V, Ammini AC, Tandon N et al Population based reference standards of Peak Bone Mineral Density of Indian males and females – an ICMR multi-centre task force study. 34
Makker A, Mishra G, Singh BP, Tripathi A, Singh MM (2008) Normative bone mineral density data at multiple skeletal sites in Indian subjects. Arch Osteoporos 3:25–37
Marwaha RK, Tandon N, Kaur P, Sastry A, Bhadra K, Narang A, Arora S, Mani K (2012) Establishment of age-specified bone mineral density reference range for Indian females using dual-energy X-ray absorptiometry. J Clin Densitom 15:241–249
Patni R (2010) Normal BMD values for Indian females aged 20–80 years. J Midlife Health 1:70–73
Aggarwal A, Ram S, Garg A, Pal R, Bhansali A, Singh P et al (2019) Metabolic bone profile of healthy adult north indian population from Chandigarh Urban Bone Epidemiological Study (CUBES). Indian J Clin Biochem. https://doi.org/10.1007/s12291-019-00857-6
Kish L (1949) A procedure for objective respondent selection within the household. J Am Stat Assoc 44:380–387
Horowitz GL, Clinical and Laboratory Standards Institute (2010) Defining, establishing, and verifying reference intervals in the clinical laboratory: approved guideline
Sözen T, Özışık L, Başaran NÇ (2017) An overview and management of osteoporosis. Eur J Rheumatol 4:46–56
Blake GM, Fogelman I (2007) The role of DXA bone density scans in the diagnosis and treatment of osteoporosis. Postgrad Med J 83:509–517
Cummings SR, Black DM, Nevitt MC et al (1993) Bone density at various sites for prediction of hip fractures. The Study of Osteoporotic Fractures Research Group. Lancet 341:72–75
Zengin A, Prentice A, Ward KA (2015) Ethnic differences in bone health. Front Endocrinol (Lausanne) 6:24
Leslie WD (2012) Ethnic differences in bone mass—clinical implications. J Clin Endocrinol Metab. 97:4329–4340
Pal R, Aggarwal A, Singh T, Sharma S, Khandelwal N, Garg A et al (2020) Diagnostic cut-offs, prevalence, and biochemical predictors of sarcopenia in healthy Indian adults: the Sarcopenia-Chandigarh Urban Bone Epidemiological Study (Sarco-CUBES). Eur Geriatr Med. https://doi.org/10.1007/s41999-020-00332-z
El Maghraoui A, Roux C (2008) DXA scanning in clinical practice. QJM 101:605–617
Maalouf G, Salem S, Sandid M, Attallah P, Eid J, Saliba N, Nehmé I, Johnell O (2000) Bone mineral density of the Lebanese reference population. Osteoporos Int 11:756–764
Yeh L-R, Chen CK-H, Lai P-H (2004) Normal bone mineral density in anteroposterior, lateral spine and hip of Chinese men in Taiwan: effect of age change, body weight and height. J Chin Med Assoc 67:287–295
Larijani B, Hossein-Nezhad A, Mojtahedi A, Pajouhi M, Bastanhagh MH, Soltani A, Mirfezi SZ, Dashti R (2005) Normative data of bone Mineral Density in healthy population of Tehran, Iran: a cross sectional study. BMC MusculoskeletDisord 6:38
Tamayo J, Díaz R, Lazcano-Ponce E, Muñoz M, Huitrón G, Halley E, Díaz-Montiel JC, Mudgal J, Hernández-Ávila M, Salmerón J (2009) Reference values for areal bone mineral density among a healthy Mexican population. Salud Publica Mex 51(Suppl 1):S56–S83
Lee K-S, Bae S-H, Lee SH, Lee J, Lee DR (2014) New reference data on bone mineral density and the prevalence of osteoporosis in korean adults aged 50 years or older: the Korea National Health and Nutrition Examination Survey 2008-2010. J Korean Med Sci 29:1514–1522
Kumar A, Sharma AK, Mittal S, Kumar G (2016) The relationship between body mass index and bone mineral density in premenopausal and postmenopausal North Indian Women. J ObstetGynaecol India 66:52–56
Mohamad N-V, Soelaiman I-N, Chin K-Y (2016) A concise review of testosterone and bone health. Clin Interv Aging 11:1317–1324
Araujo AB, Travison TG, Leder BZ, McKinlay JB (2008) Correlations between serum testosterone, estradiol, and sex hormone-binding globulin and bone mineral density in a diverse sample of men. J Clin Endocrinol Metab 93:2135–2141
Shetty S, Kapoor N, Naik D, et al (2014) Osteoporosis in healthy south Indian males and the influence of life style factors and vitamin D status on bone mineral density. J Osteoporos
Marwaha RK, Tandon N, Garg MK, Kanwar R, Narang A, Sastry A, Saberwal A, Bhadra K, Mithal A (2011) Bone health in healthy Indian population aged 50 years and above. Osteoporos Int 22:2829–2836
Kamineni V, Latha AP, Ramathulasi K (2016) Association between serum 25-hydroxyvitamin D levels and bone mineral density in normal postmenopausal women. J Mid-life Health 7:163
Alkhenizan A, Mahmoud A, Hussain A, Gabr A, Alsoghayer S, Eldali A (2017) The relationship between 25 (OH) D levels (vitamin D) and bone mineral density (BMD) in a Saudi population in a community-based setting. PLoS ONE 12:e0169122
Nguyen TV, Sambrook PN, Eisman JA (1998) Bone loss, physical activity, and weight change in elderly women: the Dubbo Osteoporosis Epidemiology Study. J Bone Miner Res 13:1458–1467
New SA, Bolton-Smith C, Grubb DA, Reid DM (1997) Nutritional influences on bone mineral density: a cross-sectional study in premenopausal women. Am J Clin Nutr 65:1831–1839
Oktem O, Kucuk M, Ozer K, Sezen D, Durmusoglu F (2010) Relation of body fat distribution to femoral neck bone density and endometrial thickness in postmenopausal women. Gynecol Endocrinol 26:440–444
The authors acknowledge the incessant efforts of Anil Saini, Pradeep, Sunil, Harwinder Singh Saini, Rashi Goel, Anmol, Seema Dahiya, Aman Puri, Shalu, Chandana Dutta, Ashutosh Kumar Arya, and Dr. Reetu Nahar, who had been an integral part of the Chandigarh Urban Bone Epidemiological Study (CUBES) since its inception. The authors also acknowledge the Indian Society of Bone and Mineral Research (ISBMR) for providing intellectual support.
Conflicts of interest
The study was approved by the Institute Ethical Committee, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
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Aggarwal, A., Pal, R., Bhadada, S.K. et al. Bone mineral density in healthy adult Indian population: the Chandigarh Urban Bone Epidemiological Study (CUBES). Arch Osteoporos 16, 17 (2021). https://doi.org/10.1007/s11657-020-00868-4
- Bone mineral density
- Healthy population