The Effect of Obesity on Postmenopausal Bone Loss and the Risk of Osteoporosis

  • Claude Ribot
  • Florence Trémollières
  • Jean-Michel Pouillès
Part of the Advances in Nutritional Research book series (ANUR, volume 9)


Primary osteoporosis is the major cause of spine, wrist, rib and hip fractures in postmenopausal women and in the elderly (Consensus Development Conference, 1991; Kanis et al., 1992). Such fractures are a major health problem in industrialized countries and represent a high socio-economic cost since the incidence and morbidity are high. The aging population in industrialized countries and the increase in age-specific incidence noted in several epidemiological studies (Lewis et al.,1981; Obrant et al., 1989; Maggi et al., 1991; Cooper et al.,1992) indicate that there will be a significant increase in such fractures. This justifies preventive measures and improved characterization of the predisposing factors.


Bone Mineral Density Postmenopausal Woman Bone Loss Bone Mass Bone Mineral Content 
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  1. Aloia, J.F., McGowan, D.M., Vaswani, A.N., Ross, P., and Cohn, S.H., 1991, Relationship of menopause to skeletal and muscle mass, Am. J. Clin. Nutr. 53: 1378.Google Scholar
  2. Andersen, T., McNair, P., Fogh-Andersen, N., Nielsen, T.T., Hyldstrup, L., and Transbol, I., 1986, Increased parathyroid hormone as a consequence of changed complex. Binding of plasma calcium in morbid obesity, Metabolism 35: 147.CrossRefGoogle Scholar
  3. Bagur, A.C., and Mautalen, C.A., 1992, Risk for developing osteoporosis in untreated premature menopause, Calcif. Tissue Ins. 51: 4.CrossRefGoogle Scholar
  4. Bell, N.H., Epstein, S., Greene, A., Shary, J., Oesmann, M. J., and Shaw, S., 1985, Evidence for alteration of vitamin D endocrine system in obese subjects. J. Clin. Invest. 76: 370.CrossRefGoogle Scholar
  5. Bleau, G., Roberts, K.D., and Chapdelaine, A., 1974, The in vitro and in vivo uptake and metabolism of steroids in human adipose tissue, J. Clin. Endocrinol. Metab. 39: 236.CrossRefGoogle Scholar
  6. Bonjour, J.P., Theintz, G., Buchs, B., Slosman, D., and Rizzoli, R., 1991, Critical years and stages of puberty for spinal and femoral bone mass accumulation during adolescence, J. Clin. Endocrinol. Metab. 73: 555.CrossRefGoogle Scholar
  7. Brody, S., Carlström, K., Lagrelius, A., Lunel!, N.O., and Rosenberg, L., 1981, Adrenal steroids, bone mineral content and endometrial pathology in postmenopausal women, Acta Obstet. Gynecol. Scand. 60: 325.CrossRefGoogle Scholar
  8. Brody, S., Carlström, K., Lagrelius, A., Lunell, N.O., Möllerström, G., and Pouselle, A., 1987, Serum sex hormone binding globulin (SHBG), testosterone/SHBG index, endometrial pathology and bone mineral density in postmenopausal women, Acta Obstet. Gynecol. Scand. 66: 357.CrossRefGoogle Scholar
  9. Cauley, J.A., Gutal, J.P., Sandler, R.B., Laporte, R.E., Kuller, L.H., and Sashin, D., 1986, The relationship of endogenous estrogen to bone density and bone area in normal postmenopausal women, Am. J. Epidemiol. 124: 752.Google Scholar
  10. Cavanaugh, D.J., and Cann, C.E., 1988, Brisk walking does not stop bone loss in postmenopausal women, Bone 9: 201.CrossRefGoogle Scholar
  11. Chow, R.K., Harrison, J.E., amd Notarius, C., 1987, Effect of two randomised exercise programmes on bone mass of healthy postmenopausal women, Br. Med. J. 292: 607.Google Scholar
  12. Compston, J.E., 1992, Risk factors for osteoporosis, Clin. Endocrinol. 36: 223.CrossRefGoogle Scholar
  13. Consensus development conference: prophylaxis and treatment of osteoporosis, 1991, Osteoporosis Int. 1:114. Google Scholar
  14. Cooper, C., Shah, S.N., Hand, D.J., Adams, J., Compston, J.E., Davie, M., and Woolf, A., 1991, Screening for vertebral osteoporosis using individual risk factors, Osteoporosis Int. 2: 48.CrossRefGoogle Scholar
  15. Cooper, C., Atkinson, E.J., O’Fallon, W.M., and Melton, L.J., 1992, Incidence of clinically diagnosed vertebral fractures: a population-based study in Rochester, Minnesota, 19851989, J. Bone Min. Res. 7: 221.CrossRefGoogle Scholar
  16. Cummings, S.R., 1987, “Epidemiology of hip fractures,” in: Osteoporosis ( Christiansen, C., Johansen, J.S., Riis, B.J., eds.) pp. 40–44, Osteopress, Copenhagen.Google Scholar
  17. Cummings, S.R., Black, D.M., Nevitt, M.C., Browner, W.S., Cauley, J.A., Genant, H.K., Scott, J.C., Seeley, D.G., Steiger, P., and Vogt, T.M., 1990, Appendicular bone density and age predict hip fracture in women, JAMA 263: 665.CrossRefGoogle Scholar
  18. Dalsky, G.P., Stocke, K.S., Ehsani, A.A., Slatopolsky, E., Lee, W.C., and Birge, S.J., 1988, Weight-bearing exercise training and lumbar bone mineral content in postmenopausal women, Ann. Intern. Med. 108: 824.CrossRefGoogle Scholar
  19. Davidson, B.J., Ross, R.K., Paganini-Hill, A., Hammon, G.L., Siiteri, P.K., and Judd, H.L., 1982, Total and free estrogens and androgens in postmenopausal women with hip fractures, J. Clin. Endocrinol. Metab. 54: 115.CrossRefGoogle Scholar
  20. Dawson-Hughes, B., 1991, Calcium supplementation and bone loss: a review of controlled clinical trials, Am. J. Clin. Nutr. 54: 2745.Google Scholar
  21. Dawson-Hughes, B., Shipp, C., Sadowski, L., and Dallai, G., 1987, Bone density of the radius, spine, and hip in relation to percent of ideal body weight in postmenopausal women, Calcif. Tissue Int. 40: 310.CrossRefGoogle Scholar
  22. DeSimone, D.P., Stevens, J., Edwards, J., Shary, J., Gordon, L., and Bell, N.H., 1989, Influence of body habitus and race on bone mineral density of the midradius, hip, and spine in aging women, J. Bone Min. Res. 4: 827.CrossRefGoogle Scholar
  23. Frumar, A.M., Meldrum, D.R., and Geola, F., 1980, Relationship of fasting urinary calcium to circulating estrogen and body weight in postmenopausal women, J. Clin. Endocrinol. Metab. 50: 70.CrossRefGoogle Scholar
  24. Genant, H.K., Bayling, D.J., and Gallagher, J.C., 1989, Estrogens in the prevention of osteoporosis in postmenopausal women, Am. J. Obstet. Gynecol. 161:1842.Google Scholar
  25. Gilsanz, V., Gibbens, D.T., Roe, T.F., Carlson, M., Senac, M.O., Boechat, M.I., Huang, H.K., Schulz, E.E., Libanati, C.R., and Cann, C.C., 1988, Vertebral bone density in children: effect of puberty, Radiology 166: 847.Google Scholar
  26. Haarbo, J., Marslew, U., Gotfredsen, A., and Christiansen, C., 1991, Postmenopausal hormone replacement therapy prevents central distribution of body fat after menopause, Metabolism 40: 1323.CrossRefGoogle Scholar
  27. Haffner, S.M., Katz, M.S., and Dunn, J.F., 1991, Increased upper body and overall adiposity is associated with decreased sex hormone binding globulin in postmenopausal women, Int. J. Obesity 15: 471.Google Scholar
  28. Harris, S., Dallai, G.E., and Dawson-Hughes, B., 1992, Influence of body weight on rates of change in bone density of the spine, hip, and radius in postmenopausal women, Calcif. Tissue Int. 50: 19.CrossRefGoogle Scholar
  29. Hassager, C., and Christiansen, C., 1989, Influence of soft tissue body composition on bone mass and metabolism, Bone 10: 415.CrossRefGoogle Scholar
  30. Hayes, W.C., and Gerhart, T.N., 1985, “Biomechanics of bone: applications for assessment of bone strength,” in: Bone and Mineral Research 3, ( Peck, W.A., ed.), pp. 259–294, Elsevier Science Publishers, Amsterdam.Google Scholar
  31. Huddleson, A.L., Rockwell, D., Kulund, D.L., and Harrison, R.B., 1980, Bone mass in lifetime tennis athletes, JAMA 244: 1107.CrossRefGoogle Scholar
  32. Hui, S.L., Slemenda, C.W., and Johnston, C.C., 1989, Baseline measurement of bone mass predicts fracture in white women, Ann. Int. Med. 111:355.Google Scholar
  33. Hutchinson, T.A., Polansky, S.M., and Feinstein, A.R., 1979, Postmenopausal oestrogens protect against fractures of hip and distal radius, Lancet 2: 705.CrossRefGoogle Scholar
  34. Ismail, F., Epstein, S., Gorman, K., Posner, J., Windsor, L.A., Makler, T., and Movsowitz, C., 1989, The influence of exercise on bone mineral metabolism in the elderly, J.Bone Min. Res. 4 (S): S231 (abstract).Google Scholar
  35. Johansen, J.S., Riis, B.J., Hassager, C., Moen, M., Jacobson, J., and Christiansen, C., 1988, The effect of gonadotrophin releasing hormone agonist analog (Nafarelin) on bone metabolism, J. Clin. Endocrinol. Metab. 67: 701.CrossRefGoogle Scholar
  36. Johnston, C.C., Hui, S.L., Witt, R.M., Appledorn, R., Baker, R., and Longcope, C., 1985, Early menopausal changes in bone mass and sex steroids, J. Clin. Endocrino!. Metab. 61: 905.CrossRefGoogle Scholar
  37. Kanis, J.A., and Pitt, F.A., 1992, Epidemiology of osteoporosis, Bone 13: 57.CrossRefGoogle Scholar
  38. Katzman, D.K., Bachrach, L.K., Carter, D.R., and Marcus, R., 1991, Clinical and anthropometric correlates of bone mineral acquisition in healthy adolescent girls, J Clin. Endocrinol. Metab. 73: 1332.CrossRefGoogle Scholar
  39. Kelly, P.J., Hopper, J.L., Macaskill, G.T., Pocock, N.A., Sanbrook, P.N., and Eisman, J.A., 1991, Genetic factors in bone turnover, J. Clin. Endocrinol. Metab. 72: 808.CrossRefGoogle Scholar
  40. Kiel, D.P., Felson, D.T., Anderson, J.J., Wilson, P.W.F., and Moskowitz, M.A., 1987, Hip fracture and the use of estrogens in postmenopausal women, N. Engl. J. Med. 317: 1169.CrossRefGoogle Scholar
  41. Kin, K., Kushida, K., Yamazaki, K., Okamoto, S., and Inoue, T., 1991, Bone mineral density of the spine in normal Japanese subjects using dual-energy X-ray absorptiometry: effect of obesity and menopausal status, Calcif. Tissue Int. 49:101.Google Scholar
  42. Kirshner, M.A., Samojlik, E., Drejka, M., Szmal, E., Schneider, G., and Ertel, N.H., 1990, Androgen-estrogen metabolism in women with upper body versus lower body obesity, J.Clin. Endocrinol. Metab. 70: 473.CrossRefGoogle Scholar
  43. Kleerekopper, M., Peterson, E., Nelson, D., Tilley, B., Phillips, E., Schork, M.A., and Kuder, J., 1989, Identification of women at risk for developing postmenopausal osteoporosis with vertebral fractures: role of history and single photon absorptiometry, Bone and Mineral 7: 171.CrossRefGoogle Scholar
  44. Kreiger, N., Kelsey, J.L., Holfors, T.R., and O’Connor, T., 1982, An epidemiologic study of hip fracture in postmenopausal women, Am. J. Epidemiol. 116: 141.Google Scholar
  45. Lewis, A., 1981, Fracture of the neck of the femur: changing incidence, Br. Med. J. 283:1217. Ley, C.J., Lees, B., and Stevenson, J.C., 1992, Sex-and menopause-associated changes in body-fat distribution, Am. J. Clin. Nutr. 55: 950.Google Scholar
  46. Liel, Y., Edwards, J., Shary, J., Spicer, K.M., Gordon, L., and Bell, N.H., 1988, The effects of race and body habitus on bone mineral density of the radius, hip, and spine in premenopausal women, J. Clin. Endocrinol. Metab., 66: 1247.CrossRefGoogle Scholar
  47. Longcope, C., 1976, “The significance of steroid production by peripheral tissue,” in: Endocrinology of the Ovaries ( Longcope, C.. ed.), pp. 23–34, Paris.Google Scholar
  48. Longcope, C., Pratt, J.H., and Schneider, S.H., 1978, Aromatization of androgens by muscle and adipose tissue in vivo, J. Clin. Endocrinol. Metab. 46: 146.CrossRefGoogle Scholar
  49. Longcope, C., Hunter, R., and Franz, C.H., 1980, Steroid secretion by the postmenopausal ovary, Am. J. Obstet. Gynecol. 138: 564.Google Scholar
  50. Longcope, C., Baker, R.S., Hui, S.L., and Johnston, C.C., 1984, Estrogen dynamics in women with vertebral crush fractures, Maturitas 6: 309.CrossRefGoogle Scholar
  51. Longcope, C., Baker, R., and Johnston, C.C., 1986, Androgen and estrogen metabolism: relationship to obesity, Metabolism 35: 235.CrossRefGoogle Scholar
  52. McCormick, D.P., Ponder, S.W., Fawcett, H.D., and Palmer, J.L., 1991, Spinal bone density in 335 normal and obese children and adolescents: evidence for ethnic and sex differences, J. Bone Min. Res. 6: 507.CrossRefGoogle Scholar
  53. MacDonald, P.C., Edman, C.D., and Hemsell, D.L., 1978, Effect of obesity on conversion of androstenedione to estrone in postmenopausal women with and without endometrial cancer, Am. J. Obstet. Gynecol. 130: 448.Google Scholar
  54. Maggi, S., Kelsey, J.L., Litvak, J., and Heyse, S.P., 1991, Incidence of hip fracture in the elderly: a cross-national analysis, Osteoporosis Int. 1: 232.CrossRefGoogle Scholar
  55. Mazess, R.B., 1982, On aging bone loss, Clin. Orthop. 165: 239.Google Scholar
  56. Mazess, R.B., Barden, H.S., Ettinger, M., Johnston, C., Dawson-Hughes, B., Baran, D., Powell, M., and Notelevitz, M., 1987, Spine and femur density using dual-photon absorptiometry in US white women, Bone and Mineral 2: 211.Google Scholar
  57. Mazess, R.B., Barden, H.S., Drinca, P.J., Bauwens, S.F., Orwoll, E.S., and Bell, N.H., 1990, Influence of age and body weight on spine and femur bone mineral density in US white men, J. Bone Min. Res. 5: 645.CrossRefGoogle Scholar
  58. Meldrum, D.R., Davidson, B.J., Taturyn, I.V., and Judd, H.L., 1981, Changes in circulating steroids with aging in postmenopausal women, Obstet. Gynecol. 57: 624Google Scholar
  59. Melton, L.J., 1992, Predicting osteoporotic fractures: the state of the art, Bone and Mineral 17 (S): 72 (abstract).CrossRefGoogle Scholar
  60. Michel, B.A., Bloch, D.A., and Fries, J.F., 1989, Weight-bearing exercise, overexercise, and lumbar bone density over age 50 years, Arch. Intern. Med. 149: 2325.CrossRefGoogle Scholar
  61. Nelson, M.E., Meredith, C.N., Dawson-Hughes, B., and Evans, W.J., 1988, Hormone and bone mineral status in endurance-trained and sedentary postmenopausal women, J. Clin. Endocrinol. Metab. 66: 927.CrossRefGoogle Scholar
  62. Obrant, K.J., Bengner, U., Johnell, O., Nilsson, B.E., and Sembo, I., 1989, Increasing age-adjusted risk of fragility fractures: a sign of increasing osteoporosis in successive generations? Calcif. Tissue Int. 44: 157.CrossRefGoogle Scholar
  63. Orwoll, E.S., Ferar, J., Oviatt, S.K., McClung, M.R., and Huntington, K., 1989, The relationship of swimming exercise to bone mass in men and women, Arch. Intern. Med. 149: 2197.CrossRefGoogle Scholar
  64. Paganini-Hill, A., Ross, R.K., Gerkins, V.R., Henderson, B.E., Arthur, M., and Mack, T.M., 1981, Menopausal estrogen therapy and hip fractures, Ann. Int. Med. 95: 28.CrossRefGoogle Scholar
  65. Parfitt, A.M., 1982, The coupling of bone formation to bone resorption: a critical analysis for the concept and its relevance to the pathogenesis of osteoporosis, Metab. Bone Dis. Relat. Res. 4: 1.CrossRefGoogle Scholar
  66. Perel, E., and Killinger, D.W., 1979, The interconversion and aromatization of androgens by human adipose tissue, J. Steroid Biochem. 10: 623.CrossRefGoogle Scholar
  67. Poortman, J., Thijssen, H.H., and Schwartz, F., 1973, Androgen production and conversion to estrogen in normal postmenopausal women and in selected breast cancer patients, J. Clin. Endocrinol. Metab. 37: 101.CrossRefGoogle Scholar
  68. Pouilles, J.M., Ribot, C., Tremollieres, F., Bonneu, M., and Brun, S., 1991, Facteurs de risque de l’ostéoporose vertébrale. Résultats d’une étude chez 2,279 femmes adressées à une consultation de ménopause, Rev. Rhum. Mal. Osteoartic. 3: 169.Google Scholar
  69. Pouilles, J.M., Tremollieres, F., Vellas, B., Albarede, J.L., and Ribot, C., 1992, Fracture de l’extrémité supérieure du fémur chez la femme agée: rôle respectif de la chute et de la déminéralisation osseuse, Rev. Rhum. Mal. Osteoartic. 4: 241.Google Scholar
  70. Pruitt, L.A., Jackson, R.D., Bartels, R.L., and Lehnhard, H.J., 1992, Weight-training effects on bone mineral density in early postmenopausal women, J. Bone Min. Res. 7: 179.CrossRefGoogle Scholar
  71. Ribot, C., Tremollieres, F., Pouilles, J.M., Bonneu, M., Germain, F., and Louvet, J.P., 1987, Obesity and postmenopausal bone loss: the influence of obesity on vertebral density and bone turnover in postmenopausal women, Bone 8: 327.CrossRefGoogle Scholar
  72. Ribot, C., Tremollieres, F., Pouilles, J.M., Louvet, J.P., and Guiraud, R., 1988, Influence of the menopause and aging on spinal density in French women, Bone and Mineral 5: 89.CrossRefGoogle Scholar
  73. Ribot, C., Pouilles, J.M., Bonneu, M., and Tremollieres, F., 1992, Assessment of the risk of postmenopausal osteoporosis using clinical factors, Clin. Endocrinol. 36: 225.CrossRefGoogle Scholar
  74. Riggs, B.L., and Melton, L.J., 1983, Evidence for two distinct syndromes of involutional osteoporosis, Am. J. Med. 75: 889.CrossRefGoogle Scholar
  75. Riggs, B.L., and Melton, L.J., 1986, Involutional osteoporosis, N. Engl. J. Med. 314: 1676.CrossRefGoogle Scholar
  76. Rids, B.J., Christiansen, C., Deftos, L.J., and Catherwood, B.D., 1984, “The role of serum concentrations of estrogen on postmenopausal osteoporosis and bone turnover,” in: Osteoporosis ( Christiansen, C., Arnaud, C.D., Nordin, B.E.C., Parfitt, A.M., Peck, W.A., and Riggs, B.L., eds.), pp. 87–88, Glostrup: Department of Clinical Chemistry, Glostrup Hospital.Google Scholar
  77. Rizkallah, T.H., Tovell, H.M.M., and Kely, W.G., 1975, Production of estrone and fractional conversion of circulating androstenedione to estrone in women with endometrial carcinoma, J. Clin. Endocrinol. Metab. 40: 1045.CrossRefGoogle Scholar
  78. Samojlik, E., Kirshner, M.A., Silber, D., Schneider, G., and Ertel, N.H., 1984, Elevated production and metabolic clearance rates of androgen in morbidly obese women, J. Clin. Endocrinoe. Metab. 49: 949.CrossRefGoogle Scholar
  79. Schindler, A.E., Ebert, A., and Friedrich, E., 1972, Conversion of androstenedione to estrone by human fat tissue, J. Clin. Endocrinol. Metab. 35: 627.CrossRefGoogle Scholar
  80. Slemenda, C., Hui, S.L., Longcope, C., and Johnston, C.C., 1987, Sex steroids and bone mass: a study of changes about the time of menopause, J. Clin. Invest. 80: 1261.CrossRefGoogle Scholar
  81. Slemenda, C., Hui, S.L., Longcope, C., Wellman, H., and Johnston, C.C., 1990, Predictors of bone mass in perimenopausal women. A prospective study of clinical data using photon absorptiometry, Ann. Intern. Med 112: 96.CrossRefGoogle Scholar
  82. Smith, E.L., and Gilligan, C., 1991, Physical activity effects on bone metabolism, Cacif Tissue Int. 49: 550.Google Scholar
  83. Stepan, J.J., Pospichal, J., Presl, J., and Pacovsky, V., 1987, Bone loss and biochemical indices of bone remodeling in surgically induced postmenopausal women, Bone 8: 279.CrossRefGoogle Scholar
  84. Svendsen, O.L., Haarbo, J., Heitmann, B.L., Gotfredsen, A., Christiansen, C., 1991, Measurement of body fat in elderly subjects by dual-energy X-ray absorptiometry, bio-electrical impedance and anthropometry, Am. J. Clin. Nutr. 53: 1117.Google Scholar
  85. Thomas, K.A., Cook, S.D., Bennett, J.T., Whitecloud, T.S., and Rice, J.C., 1991, Femoral neck and lumbar spine bone mineral densities in a normal population 3–20 years of age, J. Pediatr. Orthop. 11: 48.CrossRefGoogle Scholar
  86. Trevisan, C., Ortolani, S., Bianchi, M.L., Caraceni, M.P., Ulivieri, F.M., Gandolini, G., and Polli, E.E., 1991, Age, time since menopause, and body parameters as determinants of female spinal bone mass: a mathematical model, Calcif. Tissue Int. 49: 1.CrossRefGoogle Scholar
  87. Van Hemert, A.M., Birkenhäger, J.C., De Jong, F.H., Vandenbroucke, J.P., and Valkenburg, H.A., 1989, Sex hormone binding globulin in postmenopausal women: a predictor of osteoporosis superior to endogenous oestrogens, Clin. Endocrinol. 31: 499.CrossRefGoogle Scholar
  88. Von Schoultz, B., and Carlström, K., 1989, On the regulation of sex hormone binding globulin; a challenge of an old dogma and outlines of an alternative mechanism, J. Steroid Biochem. 32: 327.CrossRefGoogle Scholar
  89. Wickham, C.A.C., Walsh, K., Cooper, C., Barker, D.J., Margetts, B.M., Morris, J., and Bruce, S.A., 1989, Dietary calcium, physical activity and risk of hip fracture: a prospective study, Br. Med. J. 299: 889.CrossRefGoogle Scholar
  90. Wild, R.A., Buchanan, J.R., Myers, C., Lloyd, T., and Demers, L.M., 1987, Adrenal androgens, sex hormone binding globulin and bone density in osteoporotic menopausal women, Maturitas 9: 55.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1994

Authors and Affiliations

  • Claude Ribot
    • 1
  • Florence Trémollières
    • 1
  • Jean-Michel Pouillès
    • 1
  1. 1.Endocrinology Department, Metabolic Bone Diseases UnitC.H.U. PurpanToulouseFrance

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