Risk Factors for Bone Mineral Density in Women: A Cross-Sectional Study

Parm, Ülle; Tamm, Anna-Liisa; Markus, Triin; Liiv, Kaido; Orav, Aivar; Jaansoo, Ester; Taimalu, Taimi; Aruots, Maire; Luts, Hannaliis

doi:10.2478/prolas-2025-0014

Abstract

Factors associated with bone mineral density (BMD) have been studied, but the results are conflicting. The aim was to identify health risks and protective factors for BMD in regularly physically active (PAG) and ³ 65-year-old (+65G) women and a control group (CG). 164 women (PAG = 33; +65G = 35; CG = 96) completed a questionnaire on diet recall, and blood analysis and DXA were used. For statistical analysis, the chi-squared test, Student’s t-test, and univariate and multivariable linear regression analysis were performed. PAG had lower and +65G higher levels of fat mass (FM), fat%, and body mass indices. PAG, +65G, and CG all received P% of the recommended daily amount of energy, 12%, 26%, and 26%, respectively, and there were micronutrient deficiencies in the diet (especially of vitamin D and calcium). BMD was positively associated with fat-free mass (FFM) and negatively with older age in all regions. FFM and FM were positively, and older age and additional calcium intake — negatively associated with whole body BMD. BMD is strongly related to body composition parameters and age. Women’s BMD needs to be addressed throughout the life cycle.

References

Amrein, K., Scherkl, M., Hoffmann, M., Neuwersch-Sommeregger, S., Köstenberger, M., Tmava Berisha, A., et al. (2020). Vitamin D deficiency 2.0: An update on the current status worldwide. Eur. J. Clin. Nutr., 74 (11), 1498–1513.
Search in Google Scholar Back to article
Bhatnagar, A., Kekatpure, A. L. (2022). Postmenopausal osteoporosis: A literature review. Cureus, 14 (9), e29367.
Search in Google Scholar Back to article
Bode, L. E., McClester Brown, M., Hawes, E. M. (2020). Vitamin D supplementation for extraskeletal indications in older persons. J. Amer. Med. Dir. Assoc., 21 (2), 164–171.
Search in Google Scholar Back to article
Capozzi, A., Scambia, G., Lello, S. (2020). Calcium, vitamin D, vitamin K2, and magnesium supplementation and skeletal health. Maturitas, 140, 55–63.
Search in Google Scholar Back to article
Chakhtoura, M., Bacha, D. S., Gharios, C., Ajjour, S., Assaad, M., Jabbour, Y., et al. (2022). Vitamin D supplementation and fractures in adults: A systematic umbrella review of meta-analyses of controlled trials. J. Clin. Endocrinol. Metab., 107 (3), 882–898.
Search in Google Scholar Back to article
Cohen, A., Shane, E. (2008). Treatment of premenopausal women with low bone mineral density. Curr. Osteoporos. Rep., 6 (1), 39–46.
Search in Google Scholar Back to article
de Souza Cardoso, C. K., Gondim Peixoto, M. D. R., Dos Santos Rodrigues, A. P., Rodrigues Mendonca, C., de Oliveira, C., Aparecida Silveira, E. (2020). Bone mineral density in severely obese women: Health risk and health protective risk factors in three different bone sites. Int. J. Environ. Res. Public Health, 17 (19), 7017.
Search in Google Scholar Back to article
Drake, A. J., Armstrong, D. W., Shakir, K. M. M. (2004). Bone mineral density and total bone mineral content in 18- to 22-year-old women. Bone, 34, 1037–1043.
Search in Google Scholar Back to article
Eesti täiskasvanute sotsiaalmeedia kasutamise uuring 2023. https://milos.ee/eestlaste-sotsiaalmeedia-kasutus/ (accessed 17.06.2024).
Search in Google Scholar Back to article
Eggersdorfer, M., Akobundu, U., Bailey, R. L., Shlisky, J., Beaudreault, A. R., Bergeron, G., et al. (2018). Hidden hunger: Solutions for America’s aging populations. Nutrients, 10 (9), 1210.
Search in Google Scholar Back to article
Eleni, A., Panagiotis, P. (2020). A systematic review and meta-analysis of vitamin D and calcium in preventing osteoporotic fractures. Clin. Rheumatol., 39 (12), 3571–3579.
Search in Google Scholar Back to article
Elgán, C., Dykes, A.-K., Samsioe, G. (2004). Bone mineral density changes in young women: A two year study. Gynecol. Endocrinol., 19 (4), 169–177.
Search in Google Scholar Back to article
Elhakeem, A., Heron, J., Tobias, J. H., Lawlor D. A. (2020). Physical activity throughout adolescence and peak hip strength in young adults. JAMA Netw Open, 3 (8), e2013463.
Search in Google Scholar Back to article
Fassio, A., Idolazzi, L., Rossini, M., Gatti, D., Adam, G., Giollo, A., et al. (2018). The obesity paradox and osteoporosis. Eat. Weight Disord., 23 (3), 293–302.
Search in Google Scholar Back to article
Gullberg, B., Johnell, O., Kanis, J. A. (1997). World-wide projections for hip fracture. Osteoporos. Int., 7, 407–413.
Search in Google Scholar Back to article
Hanafy, N. M., Elsehaimy, L. A., Alzokm, S. M., El-Raheem, S. I. (2022). Bone mineral density and risk factors of osteoporosis in children. Egypt. Rheumatol., 44 (3), 257–260.
Search in Google Scholar Back to article
International 2017, International Osteoporosis Foundation. Compendium of Osteoporosis. IOF; Nyon, Switzerland: 2017. chrome-extension: //efaidnbmnnnibpcajpcglclefindmkaj/https://www.osteoporosi.foundation/sites/iofbonehealth/files/2020-01/IOF-Compendium-of-Osteoporosis-web-V02.pdf.
Search in Google Scholar Back to article
Jones, G., Nguyen, T., Sambrook, P. N., Kelly, P. J., Gilbert, C., Eisman, J. A. (1994). Symptomatic fracture incidence in elderly men and women: The Osteoporosis Epidemiology Study (DOES). Osteoporo.s Int., 4, 277–282.
Search in Google Scholar Back to article
Jürimäe, J., Karvelyte, V., Remmel, L., Tamm, A.-L., Purge, P., Gruodyte-Raciene, R., et al. (2021). Serum sclerostin concentration is associated with specific adipose, muscle and bone tissue markers in lean adolescent females with increased physical activity. JPEM, 34 (6), 755–761.
Search in Google Scholar Back to article
Kapuš, O., Gaba, A., Lehnert, M. (2020). Relationships between bone mineral density, body composition, and isokinetic strength in postmenopausal women. Bone Rep., 12, 100255.
Search in Google Scholar Back to article
Kitagawa, T., Hiraya, K., Denda, T., Yamamoto, S. (2022). A comparison of different exercise intensities for improving bone mineral density in postmenopausal women with osteoporosis: A systematic review and meta-analysis. Bone Rep., 17, 101631.
Search in Google Scholar Back to article
Langsetmo, L., Hitchcock, C. L., Kingwell, E. J., Davison, K. S., Berger, C., Forsmo, S., et al. (2012). Physical activity, body mass index and bone mineral density-associations in a prospective population-based cohort of women and men: The Canadian Multicentre Osteoporosis Study (CaMos). Bone, 50 (1), 401–408.
Search in Google Scholar Back to article
Lee, S. J., Lee, J. Y., Sung, J. (2019). Obesity and bone health revisited: A Mendelian randomization study for Koreans. J. Bone Miner. Res., 34 (6), 1058–1067.
Search in Google Scholar Back to article
Macek, P., Terek-Derszniak, M., Zak, M., Biskup, M., Ciepiela, P., Krol, H., Smok-Kalwat, J., Gozdz, S. (2019). WHO recommendations on physical activity versus compliance rate within a specific urban population as assessed through IPAQ survey: A cross-sectional cohort study. BMJ Open., 9 (6), e028334.
Search in Google Scholar Back to article
Maya, J., Misra, M. The female athlete triad: review of current literature. (2022). Curr. Opin. Endocrinol. Diabetes Obes., 29 (1), 44–51.
Search in Google Scholar Back to article
Melton, L. J. 3^rd, Atkinson, E. J., O’Fallon, W. M., Wahner, H. W., Riggs, B. L. (1993). Long-term fracture prediction by bone mineral assessed at different skeletal sites. J. Bone Miner. Res., 8 (10), 1227–1233.
Search in Google Scholar Back to article
Muthayya, S., Rah, J. H., Sugimoto, J. D., Roos, F. F., Kraemer, K., Black, R. E. (2013). The global hidden hunger indices and maps: An advocacy tool for action. PLoS One, 8 (6), e67860.
Search in Google Scholar Back to article
Ozpak Akkus, O., Atalay, B. (2020). Post-menopausal osteoporosis: Do body composition, nutritional habits, and physical activity affect bone mineral density? Nutr. Hosp., 37 (5), 977–983.
Search in Google Scholar Back to article
Parm, Ü., Tamm, A.-L., Aasmäe, T., Orav, A., Jaansoo, E., Lohu, K., et al. (2022). Regular and long-term effects of a commercial diet on bone mineral density. Dietetics, 1, 78–87.
Search in Google Scholar Back to article
Pepe, J., Body, J. J., Hadji, P., McCloskey, E., Meier, C., Obermayer-Pietsch, B., et al. (2020). Osteoporosis in premenopausal women: A clinical narrative review by the ECTS and the IOF. J. Clin. Endocrinol. Metab., 105 (8), 2487–2506.
Search in Google Scholar Back to article
Prevention and management of osteoporosis: Report of a WHO scientific group. WHO Technical Report Series. (2003). https://iris.who.int/handle/10665/42841 (accessed 14.08.2025)
Search in Google Scholar Back to article
Remmel, L., Jürimäe, J., Tamm, A.-L., Purge, P., Tillmann, V. (2021). The associations of body image perception with serum resistin levels in highly trained adolescent Estonian rhythmic gymnasts. Nutrients, 13, 3147.
Search in Google Scholar Back to article
Rondanelli, M., Faliva, M., Barrile, G. C., Cavioni, A., Mansueto, F., Mazzola, G., et al. (2021). Nutrition, physical activity, and dietary supplementation to prevent bone mineral density loss: a food pyramid. Nutrients, 14 (1), 74.
Search in Google Scholar Back to article
Rääsk, T., Mäestu, J., Lätt, E., Jürimäe, J., Jürimäe, T., Vainik, U. & Konstabel, K. (2017). Comparison of IPAQ-SF and two other physical activity questionnaires with accelerometer in adolescent boys. PLoS One, 12 (1), e0169527.
Search in Google Scholar Back to article
Sakka, S. D., Cheung, M. S. (2020). Management of primary and secondary osteoporosis in children. Ther. Adv. Musculoskelet. Dis., 2 (12). doi: 10.1177/1759720x20969262.
Search in Google Scholar Back to article
Salari, N., Darvishi, N., Bartina, Y., Larti, M., Kiaei, A., Hemmati, M., et al. (2021). Global prevalence of osteoporosis among the world older adults: A comprehensive systematic review and meta-analysis. J. Orthop. Surg. Res., 16, 669.
Search in Google Scholar Back to article
Sipilä, S., Törmäkanga, T., Sillanpää, E., Aukee, P., Kujala, U. M., Kovanen, V., et al. (2020). Muscle and bone mass in middle-aged women: Role of menopausal status and physical activity. J. Cachexia Sarcopenia Muscle, 11 (3), 698–709.
Search in Google Scholar Back to article
Tamaki, J., Iki, M., Sato, Y., Kajita, E., Kagamimori, S., Kagawa, Y., et al. (2010). Smoking among premenopausal women is associated with increased risk of low bone status: The JPOS study. J. Bone Miner. Metab., 28 (3), 320–327.
Search in Google Scholar Back to article
Tamoliene, V., Remmel, L., Gruodyte-Raciene, R., Jürimäe, J. (2021). Relationships of bone mineral variables with body composition, blood hormones and training volume in adolescent female athletes with different loading patterns. Int. J. Environ. Res. Public Health, 18 (12), 6571.
Search in Google Scholar Back to article
Tatangelo, G., Watts, J., Lin, K., Connaughton, C., Abimanyi-Ochom, J., Borgström, F., et al. (2019). The cost of osteoporosis, osteopenia, and associated fractures in Australia in 2017. J. Bone Miner. Res., 34 (4), 616–625.
Search in Google Scholar Back to article
The Nutridata System for Research, version 12. National Institute for Health Develeopment. https://asp.nutridata.ee (accessed 14.08.2025).
Search in Google Scholar Back to article
Tobias, J. H., Gould, V., Brunton, L., Deere, K., Rittweger, J., Lipperts, M., et al. (2014). Physical activity and bone: May the force be with you. Front. Endocrinol (Lausanne), 5, 20.
Search in Google Scholar Back to article
Tu, K. N., Lie, J. D., Wan, C. K. V., Cameron, M., Austel, A., Nguyen, J. K., et al. (2018). Osteoporosis: a review of treatment options. PT, 43 (2), 92104. PMID: 29386866.
Search in Google Scholar Back to article
Watts, N. B., Binkley, N., Owens, C. D., Al-Hendy, A., Puschec, E. E., Shebley, M., et al. (2021). Bone mineral density changes associated with pregnancy, lactation, and medical treatments in premenopausal women and effects later in life. J. Womens Health, 30 (10), 1416–1430.
Search in Google Scholar Back to article
Wright, N. C., Looker, A. C., Saag, K. G., Curtis, J. R., Delzell, E. S., Randall, S., et al. (2014). The recent prevalence of osteoporosis and low bone mass in the United States based on bone mineral density at the femoral neck or lumbar spine. J. Bone Miner. Res., 29 (11), 2520–2526.
Search in Google Scholar Back to article
Yasunaga, A., Park, H., Watanabe, E., Togo, F., Park, S., Shephard, R. J., et al. (2007). Development and evaluation of the physical activity questionnaire for elderly Japanese: The Nakanojo study. J. Aging Phys. Act., 15, 398–411.
Search in Google Scholar Back to article

Risk Factors for Bone Mineral Density in Women: A Cross-Sectional Study

Abstract

Paradigm

My account