Abstract
Objectives
To examine the association between body composition (fat mass, lean mass and body mass index, BMI) and bone health (bone mineral density, BMD and fracture risk) in urban black South African women.
Design
A cross sectional study examining associations between body composition, dietary intake (food frequency questionnaire), habitual physical activity (Activity energy expenditure (AEE) measured using an accelerometer with combined heart rate monitor and physical activity questionnaire) and bone health (BMD using dual-energy X ray absorptiometry, DXA and fracture risk).
Setting
Urban community dwellers from Ikageng in the North-West Province of South Africa.
Participants
One hundred and eighty nine (189) healthy postmenopausal women aged ≥43 years.
Results
Fat mass and lean mass were significantly associated with BMD and fracture risk when adjusted for potential confounders. However, lean mass and not fat mass remained significantly associated with femoral neck BMD (β = 0.49, p <0.001), spine BMD (β = 0.48, p< 0.0001) and hip BMD (β = 0.59, p< 0.0001). Lean mass was also negatively associated with fracture risk (β = −0.19 p =0.04) when both lean and fat mass were in the same model.
Conclusion
Lean mass and fat mass were positively associated with femoral neck, spine and hip BMDs and negatively associated with fracture risk in urban black South African women. Our finding suggests that increasing lean mass rather than fat mass is beneficial to bone health. Our study emphasises the importance of positive lifestyle changes, intake of calcium from dairy and adequate weight to maintain and improve bone health of postmenopausal women.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Rosen CJ, Bouxsein ML. Mechanisms of Disease: is osteoporosis the obesity of bone? Nat Clin Pract Rheumatol 2006;2:35–43
Kanis JA, on behalf of the WHO scientific group. Assessment of osteoporosis at the primary health-care level. Technical report. WHO Collaborating Centre, University of Sheffield, UK 2008;1 339
WHO: Obesity and overweight http://www.who.int/mediacentre/factsheets/fs311/en/. Accessed 15 November 2013
Shisana O, Labadarios D, Rehle T, Simbayi L, Zuma K, Dhansay A, et a. South African National Health and Nutrition Examination Survey (SANHANES-1). HSRC Press; Cape Town 2013;136–140
Ravn P, Cizza G, Bjarnason NH, Thompson D, Daley M, Wasnich RD, McClung M, Hosking D, Yates AJ, Christiansen C. Low body mass index is an important risk factor for low bone mass and increased bone loss in early postmenopausal women. J Bone Miner Res 1999;14:1622–1627
Felson DT, Zhang Y, Hannan MT, Anderson JJ. Effects of weight and body mass index on bone mineral density in men and women: the Framingham study. J Bone Miner Res 1993;8:567–573
Asomaning K, Bertone-Johnson E, Nasca PC, Hooven F, Pekow PS. The Association between Body Mass Index and Osteoporosis in Patients Referred for a Bone Mineral Density Examination. J Womens Health 2006;15:1028–1034
Tanaka S, Kuroda T, Saito M, Shiraki M. Overweight/obesity and underweight are both risk factors for osteoporotic fractures at different sites in Japanese postmenopausal women. Osteoporos Int 2013;24:69–76
Ong T, Sahota O, Tan W, Marshall L. A United Kingdom perspective on the relationship between body mass index (BMI) and bone health: A cross sectional analysis of data from the Nottingham Fracture Liaison Service. Bone 2014;59:207–210
Namwongprom S, Rojanasthien S, Mangklabruks A, Soontrapa S, Wongboontan C, Ongphiphadhanakul B. Effect of fat mass and lean mass on bone mineral density in postmenopausal and perimenopausal Thai women. Int J Womens health 2013;5:87–92
Park J, Song YM, Sung J, Kim YS, Kim T, Cho S, Lee K. The association between fat and lean mass and bone mineral density: The Healthy Twin Study. Bone 2012;50:1006–1011
Liu Y, Xu Y, Wen Y, Guan K, Ling W, He L, Su Y, Chen Y. Association of Weight-Adjusted Body Fat and Fat Distribution with Bone Mineral Density in Middle-Aged Chinese Adults: A Cross-Sectional Study. PLoS ONE 2013;8 (5): e63339. doi:10.1371/journal.pone.0063339
Hsu Y, Venners SA, Terwedow HA, Feng Y, Niu T, Li Z, Laird N, Brain JD, Cummings SR, Bouxsein ML, Rosen CJ, Xu X. Relation of body composition, fat mass, and serum lipids to osteoporotic fractures and bone mineral density in Chinese men and women. Am J Clin Nutr 2006;83:146–154
Nur H, Toraman NF, Arica Z, Sarier N, Samur A. The relationship between body composition and bone mineral density in postmenopausal Turkish women. Rheumatol Int 2013;33:607–612
Vorster HJ, Venter CS, Kruger MC, Vorster HH, Kruger HS. Impact of urbanisation on risk factors for osteoporosis in postmenopausal black South African women. J Endocrin Metab Diabet S Afr 2002;7:92–99
Kruger MC, De Winter RM, Becker PJ, Vorster HH. Changes in markers of bone turnover following urbanisation of black South African women. J Endocrinol Metab Diabet S Afr 2004;9:8–14
Kruger MC, Kruger IM, Wentzel-Viljoen E, Kruger A. Urbanization of black South African women may increase risk of low bone mass due to low vitamin D status, low calcium intake, and high bone turnover. Nutr Res 2011;31:748–758
Chantler S, Dickie K, Goedecke JH, Levitt NS, Lambert EV, Evans J, Joffe Y, Micklesfield LK. Site-specific differences in bone mineral density in black and white premenopausal South African women. Osteoporos Int 2012;23:533–5
George JA., Micklesfield L, Norris S, Crowther N. The association between body composition, 25 (OH) D and PTH, and bone mineral density in black African and Asian Indian population groups. J Clin Endocrinol Metab, 2014. http://dx.doi.org/10.1210/jc.2013-3968
Micklesfield LK, Gray J, Taliep MS. Bone mineral density and body composition of South African cricketers. J Bone Mineral Metab 2012;30(2):232–237.
Teo K, Chow CK, Vaz M, Rangarajan S, Yusuf S (2009) The Prospective Urban Rural Epidemiology (PURE) study: Examining the impact of societal influences on chronic noncommunicable diseases in low-, middle-, and high-income countries. Am Heart J 2009;158:1–7
Marfell-Jones M, Olds T, Stewart A, Carter L. International standards for anthropometric assessment. Australia: The international society for the advancement of Kinanthropometry, 2006
Kanis JA, Adachi JD, Cooper C, Harvey N, Clark P, Cummings SR, Diaz-Curiel M, Hiligsmann M, Papaioannou A, Pierroz DD, Silverman SL, Szulc P, and the Epidemiology and Quality of Life Working Group of IOF. Standardising the descriptive epidemiology of osteoporosis: Recommendations from the Epidemiology and Quality of Life Working Group of IOF. Osteoporos Int 2013;24:2763–2764
Hough S, Ascott-Evans B, Brown SL. NOFSA guideline for the diagnosis and management of osteoporosis: Guideline abstract. J Endocrinol, Metab Diabet S Afr 2010;15(3):107–108
Venter CS, MacIntyre UE & Vorster HH. The development and testing of a food portion photograph book for use in an African population. J Hum Nutr Dietet 2000;13:205–218
Wentzel-Viljoen E, Laubscher R, Kruger A. Using different approaches to assess the reproducibility of a culturally sensitive quantified food frequency questionnaire. S Afr J Clin Nutr 2011;24:143–148
Kruger HS, Venter CS, Steyn HS. A standardised physical activity questionnaire for a population in transition: the Thusa study. Afr J Phys Health Education Recreat Dance 2000;6:54–64
Wolmarans P, Danster N, Dalton A, Rossouw K, Schonfeldt H (eds). Condensed food composition tables for South Africa. Medical Research Council, Parow Valley, Cape Town 2010;1–126
Black DM, Steinbuch M, Palermo L, Dargent-Molina P, Lindsay R, Hoseyni MS, Johnell O. An assessment tool for predicting fracture risk in postmenopausal women. Osteoporos Int 2001;12:519–528
Thandrayen K, Norris SA, Micklesfield, LK, & Pettifor JM. Fracture patterns and bone mass in South African adolescent- mother pairs: The birth to twenty cohort. Osteoporos Int 2014;25(2):693–700.
Assah FK, Ekelund U, Brage S, Wright A, Mbanya JC, Wareham NJ (2011) Accuracy and validity of a combined heart rate and motion sensor for the measurement of free-living physical activity energy expenditure in adults in Cameroon. Int J Epidemiol 2011;40(1):112–120
Miles J & Shevlin M (2001) Applying regression and correlation: a guide for students and researchers. Sage, London, 2001
Gjesdal CG, Eide GE, Tell GS, Brun JG, Halse JI (2008) Impact of lean mass and fat mass on bone mineral density: The Hordaland Health Study. Maturitas 2008;59:191–200
Cui LH. Shin M, Lee Y, Choi J, Kweon S, Park K, Chung E & Nam H (2007) Relative contribution of body composition to bone mineral density at different sites in men and women of South Korea. J Bone Mineral Metab 2007;25(3):165–171.
Law MR, Hackshaw AK. A meta-analysis of cigarette smoking, bone mineral density and risk of hip fracture: Recognition of a major effect. BMJ 1997;315(7112):841–846.
Daniel M, Martin AD, Drinkwater DT. Cigarette smoking, steroid hormones, and bone mineral density in young women. Calcif Tissue Int 1992;50(4):300–305.
Bjarnason NH, Christiansen C. The influence of thinness and smoking on bone loss and response to hormone replacement therapy in early postmenopausal women. J Clin Endocrinol Metab 2000;85(2):590–596.
Ward KD, Klesges RC. A meta-analysis of the effects of cigarette smoking on bone mineral density. Calcif Tissue Int 2001;68(5):259–270.
Van der Voordt DJM, Dinant GJ, Geusens PP. Risk factors for osteoporosis related to their outcome: Fractures. Osteoporos Int 2001;12:630–638
De Laet, C, Kanis JA, McCloskey EV, Odén A, Johanson H, Johnell O, Delmas P, Eisman JA, Kroger H, Fujiwara S, Garnero P, Mellstrom D, Melton III, L.J, Meunier PJ, Reeve J, Silman A, Tenenhouse A, Pols HAP. Body mass index as a predictor of fracture risk: A meta-analysis. Osteoporos Int 2005;16:1330–1338
Wortsman J, Matsuoka LY, Chen TC, Lu Z, Holick MF. Decreased bioavailability of vitamin D in obesity. Am J Clin Nutr 2000;72:690–693
Young KA, Norris JM, Engelman CD, Langefeld CD, Hairston KG, Haffner SM, Bryer-Ash M. Association of plasma vitamin D levels with adiposity in Hispanic and African Americans. J Clin Endocrinol Metab 2009;94:3306–3313
Tieland M, Van Loon LJC, De Groot LCPGM, Brouwer-Brolsma EM, Nienaber-Rousseau C. Low vitamin D status is associated with reduced muscle mass and impaired physical performance in frail elderly people. Eur J Clin Nutr 2013;67:1050–1055
Minghetti PP, Norman AW. 1,25(OH)2-vitamin D3 receptors: gene regulation and genetic circuitry. Federation of Am Soc for Experimental Biol J 1988;2:3043–3053
NIH. Calcium: Dietary supplements fact sheets, 2013. http://ods.od.nih.gov/factsheets/Calcium-HealthProfessional. Accessed 10th February 2014
Pedrera-Zamorano J, Calderon-García JF, Roncero-Martin R, Mañas-Nuñez P, Moran JM & Lavado-Garcia J. The protective effect of calcium on bone mass in postmenopausal women with high selenium intake. J Nutr Health Aging 2012;16(9):743–748.
Heaney RP. Dairy and bone health. J Am Coll Nutr 2009;28:82S–90S
Lötters FJB, Lenoir-Wijnkoop I, Rocher E, Fardellone P, Rizzoli R, Poley MJ. Dairy foods and osteoporosis: An example of assessing the health-economic impact of food products. Osteoporos Int 2013;24:139–150
Gunn CA, Weber JL, Kruger MC. Diet, weight, cytokines and bone health in postmenopausal women. J Nutr Health Aging 2014;18 (5):479–486
Coin A, Perissinotto E, Enzi G, Zamboni M, Inelmen EM, Frigo AC, Manzato E, Busetto L, Buja A, Sergi G. Predictors of low bone mineral density in the elderly: the role of dietary intake, nutritional status and sarcopenia. Eur J Clin Nutr 2008;62:802–809
Stewart KJ, Deregis JR, Turner KL, Bacher AC, Sung, Hees PS, Tayback M, Ouyang P. Fitness, fatness and activity as predictors of bone mineral density in older persons. J Intern Med 2002;252:381–388
Camhi SM, Katzmarzyk PT. Total and femoral neck bone mineral density and physical activity in a sample of men and women. Appl Physiol Nutr Metab 2012;37:947–954
Saraví FD, Sayegh F. Bone mineral density and body composition of adult premenopausal women with three levels of physical activity. J Osteoporos doi. org/10.1155/2013/953271, 2013
Morseth B, Emaus N, Wilsgaard T, Jacobsen BK, Jørgensen, L. Leisure time physical activity in adulthood is positively associated with bone mineral density 22 years later. The Tromsø study. Eur J Epidemiol 2010;25:325–331
Pisciottano MVC, Szejnfeld VL, Castro CHDM, Pinto SS. The relationship between lean mass, muscle strength and physical ability in independent healthy elderly women from the community. J Nutr Health Aging 2014;18(5):554–8
Muir JM, Ye C, Bhandari M, Thabane L, Adachi JD. The effect of regular physical activity on bone mineral density in post-menopausal women aged 75 and over: A retrospective analysis from the Canadian multicentre osteoporosis study. BMC Musculoskelet Disord, 2013;doi: 10.1186/1471-2474-14-253
Ray WA, Griffin MR, Downey W, Melton LJ. Long-term use of thiazide diuretics and risk of hip fracture. Lancet 1989;1:687–690
Feskanich D, Willett WC, Stampfer MJ, Colditz GA. A prospective study of thiazide use and fractures in women. Osteoporos Int 1997;7:79–84
Recker RR, Davies KM, Hinders SM, et al. Bone gain in young adult women. J Am Med Association 1992;268:2403–2408.
Lloyd R, Hind K, Carroll S, Cooke C, Micklesfield LK, Truscott JG, Parr B, Davies S. A pilot investigation of load-carrying on the head and bone mineral density in premenopausal, black African women. J Bone Miner Metab 2010;28:185–190
Micklesfield LK, van der Merwe L, Lambert EV. Lifestyle questionnaire to evaluate risk for reduced bone mineral density in women. Clin J Sports Med 2005;15(5):340–348
Looker AC, Orwoll ES, Johnston CCJ., Lindsay RL, Wahner HW, Dunn WL, Calvo MS, Harris TB, Heyse SP. Prevalence of low femoral bone density in older U.S. adults from NHANES III. J Bone Miner Res 1997;12:1761–1768
Micklesfield LK, Norris SA, Pettifor JM. Ethnicity and bone: A South African perspective (report). J Bone Mineral Metab 2011;(3):257–267
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Sotunde, O.F., Kruger, H.S., Wright, H.H. et al. Lean mass appears to be more strongly associated with bone health than fat mass in urban black South African women. J Nutr Health Aging 19, 628–636 (2015). https://doi.org/10.1007/s12603-015-0492-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12603-015-0492-1