J Korean Acad Nurs.  2014 Oct;44(5):504-514. 10.4040/jkan.2014.44.5.504.

Bone Mineral Density, Biochemical Bone Turnover Markers and Factors associated with Bone Health in Young Korean Women

• Park YJ
• Lee SJ
• Shin NM
• Shin H
• Kim YK
• Cho Y
• Jeon S
• Cho I

• KMID: 2129540
• DOI: http://doi.org/10.4040/jkan.2014.44.5.504

Abstract

PURPOSE
This study was done to assess the bone mineral density (BMD), biochemical bone turnover markers (BTMs), and factors associated with bone health in young Korean women.
METHODS
Participants were 1,298 women, ages 18-29, recruited in Korea. Measurements were BMD by calcaneus quantitative ultrasound, BTMs for Calcium, Phosphorus, Osteocalcin, and C-telopeptide cross-links (CTX), body composition by physical measurements, nutrients by food frequency questionnaire and psychosocial factors associated with bone health by self-report.
RESULTS
The mean BMD (Z-score) was -0.94. 8.7% women had lower BMD (Z-score< or =-2) and 14.3% women had higher BMD (Z-score< or = 0) than women of same age. BTMs were not significantly different between high-BMD (Z-score> or =0) and low-BMD (Z-score<0) women. However, Osteocalcin and CTX were higher in women preferring caffeine intake, sedentary lifestyle and alcoholic drinks. Body composition and Calcium intake were significantly higher in high-BMD. Low-BMD women reported significantly higher susceptibility and barriers to exercise in health beliefs, lower bone health self-efficacy and promoting behaviors.
CONCLUSION
Results of this study indicate that bone health of young Korean women is not good. Development of diverse strategies to intervene in factors such as exercise, nutrients, self-efficacy, health beliefs and behaviors, shown to be important, are needed to improve bone health.

Keyword

Bone density; Biochemical markers; Body composition; Nutrients; Women

MeSH Terms

Adolescent
Alcohol Drinking
Asian Continental Ancestry Group
Biological Markers/*metabolism
Body Composition
Bone Density
Bone and Bones/*metabolism/radiography/ultrasonography
Calcium/metabolism
Collagen Type I/metabolism
Female
Health Promotion
Humans
Knowledge
Life Style
Osteocalcin/metabolism
Peptides/metabolism
Phosphorus/metabolism
Republic of Korea
Self Efficacy
Women/*psychology
Young Adult
Biological Markers
Calcium
Collagen Type I
Peptides
Osteocalcin
Phosphorus

Reference

1. Shin CS, Choi HJ, Kim MJ, Kim JT, Yu SH, Koo BK, et al. Prevalence and risk factors of osteoporosis in Korea: A community-based cohort study with lumbar spine and hip bone mineral density. Bone. 2010; 47(2):378–387. http://dx.doi.org/10.1016/j.bone.2010.03.017.

2. Kim KH, Lee K, Ko YJ, Kim SJ, Oh SI, Durrance DY, et al. Prevalence, awareness, and treatment of osteoporosis among Korean women: The Fourth Korea National Health and Nutrition Examination Survey. Bone. 2012; 50(5):1039–1047. http://dx.doi.org/10.1016/j.bone.2012.02.007.

3. NIH Consensus Development Panel on Osteoporosis Prevention Diagnosis and Therapy. Osteoporosis prevention, diagnosis, and therapy. JAMA. 2001; 285(6):785–795.

4. Hernandez CJ, BeaupréGS , Carter DR. A theoretical analysis of the relative influences of peak BMD, age-related bone loss and menopause on the development of osteoporosis. Osteoporos Int. 2003; 14(10):843–847. http://dx.doi.org/10.1007/s00198-003-1454-8.

5. Bonjour JP, Chevalley T, Rizzoli R, Ferrari S. Gene-environment interactions in the skeletal response to nutrition and exercise during growth. Med Sport Sci. 2007; 51:64–80. http://dx.doi.org/10.1159/0000103005.

6. Rizzoli R, Bianchi ML, Garabedian M, McKay HA, Moreno LA. Maximizing bone mineral mass gain during growth for the prevention of fractures in the adolescents and the elderly. Bone. 2010; 46(2):294–305. http://dx.doi.org/10.1016/j.bone.2009.10.005.

7. Robinson ML, Winters-Stone K, Gabel K, Dolny D. Modifiable lifestyle factors affecting bone health using calcaneus quantitative ultrasound in adolescent girls. Osteoporos Int. 2007; 18(8):1101–1107. http://dx.doi.org/10.1007/s00198-007-0359-3.

8. Choi HJ. Risk factors and assessment of low bone mass in the young adult female. Korean J Fam Med. 2009; 30(12):924–933. http://dx.doi.org/10.4082/kjfm.2009.30.12.924.

9. Koo JO, Ahn HS, Yoo SY. Study of bone mineral density, body composition and dietary habits of 20-30 years women. Korean J Community Nutr. 2008; 13(4):489–498.

10. Cho DS, Lee JY. Bone mineral density and factors affecting in female college students. Korean J Women Health Nurs. 2008; 14(4):297–305. http://dx.doi.org/10.4069/kjwhn.2008.14.4.297.

11. Kim MS, Koo Jo. Analysis of factors affecting bone mineral density with different age among adult women in Seoul area. Korean J Community Nutr. 2007; 12(5):559–568.

12. McLeod KM, Johnson CS. A systematic review of osteoporosis health beliefs in adult men and women. J Osteoporos. 2011; 2011:197454. http://dx.doi.org/10.4061/2011/197454.

13. Waller J, Eriksson O, Foldevi M, Kronhed AC, Larsson L, Löfman O, et al. Knowledge of osteoporosis in a Swedish municipality-a prospective study. Prev Med. 2002; 34(4):485–491. http://dx.doi.org/10.1006/pmed.2002.1007.

14. Park YJ, Lee SJ, Shin NM, Kang HC, Kim SH, Kim T, et al. Structural model for osteoporosis preventive behaviors in postmenopausal women: Focused on their own BMD awareness. Korean J Adult Nurs. 2013; 25(5):527–538.

15. Champion VL, Skinner CS. The health belief model. In : Glanz K, Rimer BK, Viswanath K, editors. Health behavior and health education: Theory, research, and practice. 4th ed. San Francisco, CA: Jossey-Bass;2008. p. 45–65.

16. Kim KK, Horan M, Gendler P, Patel M. Osteoporosis health belief, selfefficacy, and knowledge tests. In : Redman BK, editor. Measurement tools in patient education. New York, NY: Springer Publishing Company;1998. p. 307–318.

17. Bandura A. The explanatory and predictive scope of self-efficacy theory. J Soc Clin Psychol. 1986; 4(3):359–373. http://dx.doi.org/10.1521/jscp.1986.4.3.359.

18. Horan ML, Kim KK, Gendler P, Froman RD, Patel MD. Development and evaluation of the osteoporosis self-efficacy scale. Res Nurs Health. 1998; 21(5):395–403.

19. Chon MY, Jeon HW, Kim MH. Bone mineral density and factors influencing bone mineral density in college women. Korean J Women Health Nurs. 2012; 18(3):190–199. http://dx.doi.org/10.4069/kjwhn.2012.18.3.190.

20. Yoon JS, Lee MJ. Calcium status and bone mineral density by the level of sodium intake in young women. Korean J Community Nutr. 2013; 18(2):125–133. http://dx.doi.org/10.5720/kjcn.2013.18.2.125.

21. Bae YJ, Yeon JY. Evaluation of sodium intake and relationship between sodium intake and the bone mineral density of female university students. J East Asian Soc Diet Life. 2011; 21(5):625–636.

22. Zittermann A, Geppert J, Baier S, Zehn N, Gouni-Berthold I, Berthold HK, et al. Short-term effects of high soy supplementation on sex hormones, bone markers, and lipid parameters in young female adults. Eur J Nutr. 2004; 43(2):100–108. http://dx.doi.org/10.1007/s00394-004-0447-5.

23. Kim DY. Biochemical markers of bone turnover. Korean J Nucl Med. 1999; 33(4):341–351.

24. Chang SF, Hong CM, Yang RS. Cross-sectional survey of women in Taiwan with first-degree relatives with osteoporosis: Knowledge, health beliefs, and preventive behaviors. J Nurs Res. 2007; 15(3):224–232.

25. Estok PJ, Sedlak CA, Doheny MO, Hall R. Structural model for osteoporosis preventing behavior in postmenopausal women. Nurs Res. 2007; 56(3):148–158. http://dx.doi.org/10.1097/01.NNR.0000270031.64810.0c.

26. The Korean Nutrition Society. Dietary reference intakes for Koreans. Seoul: Author;2010.

27. Kwon SM, Lee BK, Kim HS. Relation between nutritional factors and bone status by broadband ultrasound attenuation among college students. J Korean Soc Food Sci Nutr. 2009; 38(11):1551–1558. http://dx.doi.org/10.3746/jkfn.2009.38.11.1551.

28. Howe TE, Shea B, Dawson LJ, Downie F, Murray A, Ross C, et al. Exercise for preventing and treating osteoporosis in postmenopausal women. Cochrane Database Syst Rev. 2011; 7:CD000333. http://dx.doi.org/10.1002/14651858.CD000333.pub2.

29. Marrone JA, Maddalozzo GF, Branscum AJ, Hardin K, Cialdella-Kam L, Philbrick KA, et al. Moderate alcohol intake lowers biochemical markers of bone turnover in postmenopausal women. Menopause. 2012; 19(9):974–979. http://dx.doi.org/10.1097/gme.0b013e31824ac071.

30. Berg KM, Kunins HV, Jackson JL, Nahvi S, Chaudhry A, Harris KA Jr, et al. Association between alcohol consumption and both osteoporotic fracture and bone density. Am J Med. 2008; 121(5):406–418. http://dx.doi.org/10.1016/j.amjmed.2007.12.012.

31. Song MS, Yoo YK, Choi CH, Kim NC. Effects of nordic walking on body composition, muscle strength, and lipid profile in elderly women. Asian Nurs Res. 2013; 7(1):1–7.