Korean J Nutr.  2011 Feb;44(1):29-40. 10.4163/kjn.2011.44.1.29.

The Association between Bone Mineral Density, Bone Turnover Markers, and Nutrient Intake in Pre- and Postmenopausal Women

• Park J
• Choi M
• Lee S
• Choi Y
• Park Y

• KMID: 2268344
• DOI: http://doi.org/10.4163/kjn.2011.44.1.29

Abstract

The purpose of this study was to examine the association among bone mineral density (BMD), biochemical bone markers, nutrients, and salt intake in premenopausal and postmenopausal women. We evaluated 431 subjects who visited a health promotion center of a university hospital between January 2008 and July 2009. We excluded those who were taking medications or who had an endocrine disorder affecting osteoporosis. The subjects were divided into premenopausal (n = 283) and postmenopausal (n = 143) women. We evaluated the correlation among BMD of the lumbar spine, femoral neck, and total femoral, as well as biochemical bone markers, hormone, serum profiles, general characteristics, nutrient intakes, and food intake frequencies. From a stepwise multiple regression analysis, lumbar spine BMD was positively correlated with weight (p < 0.001) and negatively correlated with osteocalcin (OC)(p < 0.001), Femoral neck BMD was positively correlated with weight (p < 0.001) and negatively correlated with C-telopeptide (CTx) and alkaline phosphatase (ALP)(p < 0.001, p < 0.05). In premenopausal women, femoral total BMD was positively correlated with BMI (p < 0.001) and negatively correlated with CTx (p < 0.001). In postmenopausal women, lumbar spine BMD was positively correlated with calcium intake (p < 0.01) and negatively correlated with sodium intake (p < 0.01). Femoral neck and femoral total BMD were both positively correlated with weight (p < 0.001), and femoral neck BMD was negatively correlated with age and ALP (p < 0.001, p < 0.05). Femoral total BMD was negatively correlated with age and OC (p < 0.001, p < 0.01). These results suggest that reducing sodium intake may play an important role delaying bone resorption and preventing a decrease in BMD.

Keyword

bone mineral density (BMD); osteocalcin (OC); C-telopeptide (CTx); premenopausal women; postmenopausal women

MeSH Terms

Alkaline Phosphatase
Bone Density
Bone Resorption
Calcium
Collagen Type I
Eating
Female
Femur Neck
Health Promotion
Humans
Osteocalcin
Osteoporosis
Peptides
Sodium
Spine
Alkaline Phosphatase
Calcium
Collagen Type I
Osteocalcin
Peptides
Sodium

Reference

1. Korea National Statistical Office. Annual report of mortality statistics. 2005. Seoul:

2. Korea National Statistical Office. Population projection for Korea. 2007. Seoul:

3. Won HS. Effects of age-related changes in taste perception on nutritional status and validation of food frequency questionnaire for the Korean elderly [dissertation]. 1996. Seoul: Ewha Womans University.

4. Choi SN, Lee SY, Chung NY. Bone density and processed food intake behavior if middle aged and elderly women in the Seoul area. Korean J Food Cult. 2008. 23(6):681–692.

5. Avioli LV. The osteoporotic syndrome; Detection, prevention and treatment. 2000. 4th ed. Orlando, FL: Academic press.

6. Lee NJ. Age, Body weight, physical activity, dietary patterns, and acculturation may affect osteoporosis risk in postmenopausal Korean and Korean American women. Korean J Phys Educ. 2008. 47(2):361–369.

7. Kim MS, Koo JO. Comparative analysis of food habits and bone density risk factors between normal and risk women living in the seoul area. Korean J Community Nutr. 2008. 13(1):125–133.

8. Jang SN, Choi YH, Chol MG, Kang SH, Jeong JY, Choi YJ, Kim DH. Prevalance and associated factors of osteoporosis postmenopausal women in Chuncheon: HAS. J Prev Med Public Health. 2006. 39(5):389–396.

9. Kim YS, Yoon BK, Kim JY, Choi DS, Lee JH, Kim JH, Kim KW, Min YK. Effect of hormone replacement therapy on bone mineral density in Korean postmenopausal women over age of 60. J Korean Soc Menopause. 2007. 13(2):114–122.

10. Eastell R, Delmas PD, Hodgson SF, Eriksen EF, Mann KG, Riggs BL. Bone formation rate in older normal women: concurrent assessment with bone histomorphometry, calcium kinetics, and biochemical markers. J Clin Endocrinol Metab. 1988. 67:741–748.

11. Lee HS, Baik IK, Hong ES. Effect of nutrients intakes on development of osteoporosis in Korean postmenopausal women. J Korean Diet Assoc. 1996. 2(1):38–48.

12. Ribot C, Pouilles J, Bonneu M, Tremollieres F. Assessment of the risk of post-menopausal osteoporosis using clinical factors. Clin Endocrinol (Oxf). 1992. 36:225–228.

13. Chung YJ, Lee KM, Park JW, Chung SP. Fators which are related with BMD in premenopausal women. J Korean Acad Fam Med. 2001. 22:363–370.

14. Johansen JS, Riis BJ, Delmas PD, Christiansen C. Plasma BGP. An indicator of spontaneous bone loss and of effect of estrogen treatment in postmenopausal women. Eur J Clin Invest. 1988. 18:191–119.

15. Lee KM, Han SB, Kim JS, Baik KJ, Hong SB, Moon KH, Kang JS, Yoon SH. Bone mineral density and bone turnover makers in patients with femur fracture who visited the emergency department. J Korean Soc Traumatol. 2005. 18(2):87–93.

16. Lee CS, Yoon SC. The significance of serum C-telopeptide as a bone marker in chronic hemodialysis patients. Korean J Med. 2009. 76(4):443–450.

17. McKay HA, Petit MA, Khan KM, Schutz RW. Lifestyle determinants of bone mineral: a comparison between prepubertal Asian- and Caucasian-Canadian boys and girls. Calcif Tissue Int. 2000. 66(5):320–324.

18. NOF. OBRD~NRC. 1998.

19. Riggs BL, Melton LJ. The prevention and treatment of osteoporosis. N Engl J Med. 1992. 327:620–627.

20. Kakudo K. Introduction for special issue of calcitonin and calcitonin receptor. Cell Mol Biol. 2006. 1552(3):1–2.

21. Mcguigan FE, Murray L, Gallagher A, Davey-Smith G, Neville CE, Van't Hof R, Boreham C, Ralston SH. Genetic and environmental determinants of peak bone mass in young man and women. J Bone Miner Res. 2002. 17(7):1273–1279.

22. Anderson JJB. Nutritional advances in human bone metabolism introduction. J Nutr. 1996. 126:1150S–1152S.

23. Lamichhane AP. Osteoporosis-an update. J Nepal Med Assoc. 2005. 44(158):60–66.

24. Slemenda CW, Christian JC, Reed T, Reister TK, Williams CJ, Johnston CC Jr. Longterm bone loss in men: effects of genetic and environmental factors. Ann Intern Med. 1992. 117(4):286–291.

25. Yu CH, Kim HS, Lee JS, Kim JY. A study on Ca and P balance in Korean adult women. Korean J Nutr. 2001. 34(1):54–61.

26. Lee KS, Kim JM. Comparison of nutrients intake, bone density, total cholesterol and blood glucose in women living in Taegu City. J Korean Diet Assoc. 2003. 9(1):81–93.

27. Mizushima S, Tsuchida K, Yamori Y. Preventive nutritional factors in epidemiology: interaction between sodium and calcium. Clin Exp Pharmacol Physiol. 1999. 26:573–575.

28. Son SM, Heo KY. Salt intake and nutritional problems in Korea. Korean J Community Nutr. 2002. 7(3):381–390.

29. Metka M, Holzer G, Heytmanek G, Huber J. Hypergonadotropic hypogonadonadic amenorrfea and osteoporosis. Fertil Steril. 1992. 57:37–41.

30. Hamdy RC, Petak SM, Lenchik L. Which central dual X-ray absorptiometry skeletal sites and regions of interest should be used to determine the diagnosis of osteoporosis. J Clin Densitom. 2002. 5:Suppl. S11–S18.

31. Block G, Coyle LM, Hartman AM, Scoppa SM. HHHQ-DIETSYS analysis software, Ver.3.0. 1993. Bethesda, MD: National Cancer Institute.

32. Kim HY, Yang EJ. A Study on development and validation of food frequency questionnaire for Koreans. Korean J Nutr. 1998. 31(2):220–230.

33. Paek HY, Ryu JY, Choi JS, An YJ, Mun HK, Park YS, Lee HG, Kim YI. Development and validation of food frequency questionnaire for dietary assessment of Korean adults in rural area. Korean J Nutr. 1995. 28(9):914–922.

34. Lee SH. The association between dietary patterns and the risk of metabolic syndrome. 2005.

35. Sung CJ, Choi YH, Kim MH, Choi SH, Cho KO. A study of nutrient intake and serum levels of osteocalcin, Ca, P, and Mg and their correlation to bone mineral density in Korean postmenopausal women residing in rural areas. Korean J Community Nutr. 2002. 7(1):111–112.

36. Yu CH, Lee YS, Lee L, Kim SH, Lee SS, Jung Ik. Nutritional factors related to bone mineral density in the different age groups of Korean women. Korean J Nutr. 2002. 35(7):779–790.

37. Lee HJ, Lee HO. A study on the bone meniral density and related factors in Korean postmenopausal women. Korean J Nutr. 1999. 32(2):197–203.

38. Leon S, Marc AF. Clinical gynecologic endocrinology and infertility. 2005. 7th ed. Philadelphia, PA: Lippincott Williams & Wilkins;652.

39. Raisz LG. Pathogenesis of osteoporosis: concepts, conflicts, and prospects. J Clin Invest. 2005. 115:3318–3325.

40. Choi SH, Hwang DK, Song HR, Noh HJ, Kang JY, Choi DH, Choi HJ. Predictors for Lumbar bone mineral density in premenopausal and postmenopausal women in Korea. J Korean Soc Menopause. 2009. 15(2):101–109.

41. Riggs BL, Melton LJ 3rd. The prevention and treatment of osteoporosis. N Engl J Med. 1992. 327:620–627.

42. Braunwald E, Fauci AS, Kasper DL, Hauser SL, Longo DL, Jameson JL. Harrison's principles of internalmedicine. 2001. 15th ed. The McGraw-Hill Companies, Inc;2226–2227.

43. Weinstein RS, Manolagas SC. Apoptosis and osteoporosis. Am J Med. 2000. 108:153–164.

44. Turner RT, Riggs BL, Spelsberg TC. Skeletal effects of estrogen. Endocr Rev. 1994. 15:275–300.

45. Pacifici R. Estrogen, cytokines, and pathogenesis of postmenopausal osteoporosis. J Bone Miner Res. 1996. 11:1043–1051.

46. 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.

47. Frost HM. Obesity, and bone strength and "mass": A tutorial based on insights from a new paradigm. Bone. 1997. 21:211–214.

48. Hoover PA, Webber CE, Beaumont LF, Blake JM. Postmenopausal bone mineral density: Relationship to calcium intake, calcium absorption, residual estrogen, body composition, and physical activity. Can J Physiol Pharmacol. 1996. 74:911–917.

49. Rebuffé-Scrive M, Eldh J, Hafström LO, Björntorp P. Metabolism of mammary, abdominal, and femoral adipocytes in women before and after menopause. Metabolism. 1986. 35:792–797.

50. Carr MC. The emergence of the metabolic syndrome with menopause. J Clin Endocrinol Metab. 2003. 88:2404–2411.

51. 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.

52. Yamaguchi T, Sugimoto T, Yano S, Yamauchi M, Sowa H, Chen Q. Plasma lipids and osteoporosis in postmenopausal women. Endocr J. 2002. 49:211–217.

53. Parhami F, Jackson SM, Tintut Y, Le V, Balucan JP, Territo M. Atherogenic diet and minimally oxidized low density lipoprotein inhibit osteogenic and promote adipogenic differentiation of marrow stromal cells. J Bone Miner Res. 1999. 14:2067–2078.

54. Choi JH, Kim SK. Comparison of the dietary factors between normal and osteopenia groups by bone mineral density in Korean female college students. J Korean Soc Food Sci Nutr. 2008. 37(7):815–958.

55. Lee BK, Chang YK, Choi KS. Effect of nutrient intake on bone mineral density in postmenopausal women. Korean J Nutr. 1992. 25(7):642–655.

56. Gruchow HW, Sobocinski KA, Barboriak JJ. Calcium intake and the relationship of dietary sodium And potassium to blood pressure. Am J Clin Nutr. 1988. 48:1463–1470.

57. Jones G, Beard T, Parameswaran V, Greenaway T, Von Witt R. Apopulation-based study if the relationship between salt intake, bone resorption and bone mass. Eur J Clin Nutr. 1997. 51(8):561–565.

58. Kim JH. Determinants of bone mineral density in adult women living in community dwellings [Masterthesis]. 2002. Bucheon: The Catholic University.

59. Heaney RP, Recker RR, Stegman MR, Moy AJ. Calcium absorption in women: relationships to calcium intake, estrogen status, and age. J Bone Miner Res. 1989. 4(4):469–475.

60. Heaney RP. Nutritional factors in bone health in elderly subjects: methodological and contextual problems. Am J Clin Nutr. 1989. 50:1182–1189.

61. Yang YS, Noh HT. Predictors for Lumbar bone mineral density in premenopausal and postmenopausal women in Korea. Korean J Obstet Gynecol. 2008. 51:429–440.