Korean Journal of Family Medicine (가정의학회지)

The Korean Academy of Family Medicine (대한가정의학회)
권호 표지
DOI QR코드

DOI QR Code

Weight and Bone Mineral Density - The Summary of Epidemiological Evidence -

체중과 골밀도 -역학적 근거의 정리-

Park, Hyun-Ah;Kim, Hye-Jin;Kim, Tae-Jun;Park, Jin-Joo;Park, Jin-Kyun
박현아;김혜진;김태준;박진주;박진균

  • Published : 20090300
⟨ Previous Next ⟩

Abstract

Not only bone mineral density (BMD) is strongly associated with body weight, but also weight change influences BMD change. The weight change related bone change is more marked in women especially after menopause, in the elderly, in the underweight and in persons who have the history of weight cycling. Because of the health impacts of obesity, weight reduction has been often recommended in practices. Therefore various intervention methods have been tried to reduce the weight change related bone change such as hormone therapy, raloxifene, exercise, and calcium supplementation. This review summarizes the epidemiological evidences of the weight change related bone change and the associated factors.

체중은 골밀도에 영향을 미칠 뿐만 아니라, 체중변화 역시 골밀도 변화에 영향을 미친다. 체중변화로 인한 골밀도 변화는, 남성보다 여성에서, 폐경전 여성보다는 폐경후 여성에서, 나이가 많을수록, 비만도가 낮을 수록, 체중감소와 증가를 반복한 과거력이 있는 사람에서 더 크게 나타난다. 체중감소로 인한 골밀도 감소를 줄이기 위한 중재방법들로, 여성호르몬 치료, 랄록시펜, 운동, 칼슘보충제의 복용 등이 제시되고 있다. 본 종설에서는 체중과 골밀도, 골절의 관련성과 그 관련성에 영향을 미치는 요인들에 대해 지금까지 발표된 국내외 연구들을 정리해 보고자 한다.

Keywords

References

  1. Kasper DL, Braunwald E, Hauser S, Longo D, Jameson JL, Fauci AS. Harrison's principles of internal medicine. 16 ed. New York: McGraw-Hill Professional; 2004
  2. World Health Organization. Assessment of fracture risk and its application to screening for postmenopausal osteopososis : technical report series 843. Geneva: World Health Organizationl; 1994
  3. Edelstein SL, Barrett-Connor E. Relation between body size and bone mineral density in elderly men and women. Am J Epidemiol 1993; 138: 160-9 https://doi.org/10.1093/oxfordjournals.aje.a116842
  4. Wapniarz M, Lehmann R, Reincke M, Schonau E, Klein K, Allolio B. Determinants of radial bone density as measured by PQCT in pre- and postmenopausal women: the role of bone size. J Bone Miner Res 1997; 12: 248-54 https://doi.org/10.1359/jbmr.1997.12.2.248
  5. Babaroutsi E, Magkos F, Manios Y, Sidossis LS. Lifestyle factors affecting heel ultrasound in Greek females across different life stages. Osteoporos Int 2005; 16: 552-61 https://doi.org/10.1007/s00198-004-1720-4
  6. Kim CJ, Lee EJ, Kim HM, Kim HS, Lee EA, Kim YS, et al. Relationship between body composition and metabolic bone disease in Korean male adults. Korean J Bone Metab 2008; 15: 25-32
  7. Kim HK, Bae KM, Lim H, Oh CY. Bone mineral density of women in namwon: comparison by age, pre and postmenopausal status and body weight. J Korean Acad Fam Med 2001; 22: 171-7
  8. Han JH, Cho KH. Correlation between body composition and spinal bone density in young women. J Korean Acad Fam Med 2002; 23: 215-23
  9. Johnell O, O'Neill T, Felsenberg D, Kanis J, Cooper C, Silman AJ. Anthropometric measurements and vertebral deformities: European Vertebral Osteoporosis Study (EVOS) Group. Am J Epidemiol 1997; 146: 287-93 https://doi.org/10.1093/oxfordjournals.aje.a009269
  10. Ensrud KE, Lipschutz RC, Cauley JA, Seeley D, Nevitt MC, Scott J, et al. Body size and hip fracture risk in older women: a prospective study. Study of Osteoporotic Fractures Research Group. Am J Med 1997; 103: 274-80 https://doi.org/10.1016/S0002-9343(97)00025-9
  11. Youn KE, Lee SM, Kim Y, Park BJ. Physical activity and hip fracture in elderly people: a cohort study in Korea. Korean J Prev Med 2002; 35: 351-8
  12. Chang KY, Yang HJ, Shin YK, Park SH, Lee KH, Lee KY. The influences of obesity on bone mineral density in children. J Korean Soc Pediatr Endocrinol 2001; 6: 129-36
  13. Rourke KM, Brehm BJ, Cassell C, Sethuraman G. Effect of weight change on bone mass in female adolescents. J Am Diet Assoc 2003; 103: 369-72 https://doi.org/10.1016/S0002-8223(02)00087-1
  14. Shapses SA, Von Thun NL, Heymsfield SB, Ricci TA, Ospina M, Pierson RN Jr, et al. Bone turnover and density in obese premenopausal women during moderate weight loss and calcium supplementation. J Bone Miner Res 2001; 16: 1329-36 https://doi.org/10.1359/jbmr.2001.16.7.1329
  15. Hernandez CJ, Beaupr$\'{e}$ GS, 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: 843-7 https://doi.org/10.1007/s00198-003-1454-8
  16. Wing RR, Matthews KA , Kuller LH, Meilahn EN, Plantinga PL. Weight gain at the time of menopause. Arch Intern Med 1991; 151: 97-102 https://doi.org/10.1001/archinte.151.1.97
  17. Santoro N, Chervenak JL. The menopause transition. Endocrinol Metab Clin North Am 2004; 33: 627-36 https://doi.org/10.1016/j.ecl.2004.07.002
  18. Park HA, Lee JS, Kuller LH, Cauley JA. Effects of weight control during the menopausal transition on bone mineral density. J Clin Endocrinol Metab 2007; 92: 3809-15 https://doi.org/10.1210/jc.2007-1040
  19. Brot C, Jensen LB, S$\o$rensen OH. Bone mass and risk factors for bone loss in perimenopausal Danish women. J Intern Med 1997; 242: 505-11 https://doi.org/10.1111/j.1365-2796.1997.tb00024.x
  20. Nguyen TV, Sambrook PN, Eisman JA. Bone loss, physical activity, and weight change in elderly women: the Dubbo Osteoporosis Epidemiology Study. J Bone Miner Res 1998; 13: 1458-67 https://doi.org/10.1359/jbmr.1998.13.9.1458
  21. Dennison E, Eastell R, Fall CH, Kellingray S, Wood PJ, Cooper C. Determinants of bone loss in elderly men and women: a prospective population-based study. Osteoporos Int 1999; 10: 384-91 https://doi.org/10.1007/s001980050244
  22. Rubin CT, Lanyon LE. Regulation of bone mass by mechanical strain magnitude. Calcif Tissue Int 1985; 37: 411-7 https://doi.org/10.1007/BF02553711
  23. Shapses SA, Riedt CS. Bone, body weight, and weight reduction: what are the concerns? J Nutr 2006; 136: 1453-6 https://doi.org/10.1093/jn/136.6.1453
  24. Riedt CS, Cifuentes M, Stahl T, Chowdhury HA, Schlussel Y, Shapses SA. Overweight postmenopausal women lose bone with moderate weight reduction and 1 g/day calcium intake. J Bone Miner Res 2005; 20: 455-63 https://doi.org/10.1359/JBMR.041132
  25. Cummings SR, Nevitt MC, Browner WS, Stone K, Fox KM, Ensrud KE, et al. Risk factors for hip fracture in white women. Study of Osteoporotic Fractures Research Group. N Engl J Med 1995; 332: 767-73 https://doi.org/10.1056/NEJM199503233321202
  26. Langlois JA, Harris T, Looker AC, Madans J. Weight change between age 50 years and old age is associated with risk of hip fracture in white women aged 67 years and older. Arch Intern Med 1996; 156: 989-94 https://doi.org/10.1001/archinte.156.9.989
  27. Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of overweight and obesity in the United States, 1999-2004. JAMA 2006; 295: 1549-55 https://doi.org/10.1001/jama.295.13.1549
  28. Ministry of Health and Welfare. The third Korea national health and nutrition examination survey (KNHANES III). Seoul: Korea Centers for Disease Control and Prevention; 2005
  29. Ensrud KE, Fullman RL, Barrett -Connor E, Cauley JA, Stefanick ML, Fink HA, et al. Voluntary weight reduction in older men increases hip bone loss: the osteoporotic fractures in men study. J Clin Endocrinol Metab 2005; 90: 1998-2004 https://doi.org/10.1210/jc.2004-1805
  30. Hannan MT, Felson DT, Dawson-Hughes B, Tucker KL, Cupples LA, Wilson PW, et al. Risk factors for longitudinal bone loss in elderly men and women: the Framingham Osteoporosis Study. J Bone Miner Res 2000; 15: 710-20 https://doi.org/10.1359/jbmr.2000.15.4.710
  31. Anderson JW, Konz EC, Frederich RC, Wood CL. Long-term weight-loss maintenance: a meta-analysis of US studies. Am J Clin Nutr 2001; 74: 579-84 https://doi.org/10.1093/ajcn/74.5.579
  32. Fogelholm GM, Sievanen HT, Kukkonen-Harjula TK, Pasanen ME. Bone mineral density during reduction, maintenance and regain of body weight in premenopausal, obese women. Osteoporos Int 2001; 12: 199-206 https://doi.org/10.1007/s001980170130
  33. Fogelholm M, Siev$\"{a}$nen H, Heinonen A, Virtanen M, Uusi-Rasi K, Pasanen M, et al. Association between weight cycling history and bone mineral density in premenopausal women. Osteoporos Int 1997; 7: 354-8 https://doi.org/10.1007/BF01623777
  34. Ensrud KE, Ewing SK, Stone KL, Cauley JA, Bowman PJ, Cummings SR. Intentional and unintentional weight loss increase bone loss and hip fracture risk in older women. J Am Geriatr Soc 2003; 51: 1740-7 https://doi.org/10.1046/j.1532-5415.2003.51558.x
  35. Reid IR, Plank LD, Evans MC. Fat mass is an important determinant of whole body bone density in premenopausal women but not in men. J Clin Endocrinol Metab 1992; 75: 779-82 https://doi.org/10.1210/jc.75.3.779
  36. Chen Z, Lohman TG, Stini WA, Ritenbaugh C, Aickin M. Fat or lean tissue mass: which one is the major determinant of bone mineral mass in healthy postmenopausal women? J Bone Miner Res 1997; 12: 144-51 https://doi.org/10.1359/jbmr.1997.12.1.144
  37. Kim CJ, Won JC, Pak CY, Lee WY, Oh KW, Park SW, et al. Relationship between body composition and metabolic bone disease in perimenopausal Korean women. Korean J Bone Metab 2008; 15 Suppl 1: 14
  38. Zhao LJ, Liu YJ, Liu PY, Hamilton J, Recker RR, Deng HW. Relationship of obesity with osteoporosis. J Clin Endocrinol Metab 2007; 92: 1640-6 https://doi.org/10.1210/jc.2006-0572
  39. Hsu YH, Venners SA, Terwedow HA, Feng Y, Niu T, Li Z, et al. 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: 146-54 https://doi.org/10.1093/ajcn/83.1.146
  40. Jang SN, Choi YH, Choi MG, Kang SH, Jeong JY, Choi YJ, et al. Prevalence and associated factors of osteoporosis among postmenopausal women in Chuncheon: Hallym Aging Study (HAS). J Prev Med Public Health 2006; 39: 389-96
  41. Wang MC, Bachrach LK, Van Loan M, Hudes M, Flegal KM, Crawford PB. The relative contributions of lean tissue mass and fat mass to bone density in young women. Bone 2005; 37: 474- 81 https://doi.org/10.1016/j.bone.2005.04.038
  42. Douchi T, Kuwahata R, Matsuo T, Uto H, Oki T, Nagata Y. Relative contribution of lean and fat mass component to bone mineral density in males. J Bone Miner Metab 2003; 21: 17-21 https://doi.org/10.1007/s007740300003
  43. Sirola J, Rikkonen T, Tuppurainen M, Honkanen R, Jurvelin JS, Kroger H. Maintenance of muscle strength may counteract weight-loss-related postmenopausal bone loss: a population based approach. Osteoporos Int 2006; 17: 775-82 https://doi.org/10.1007/s00198-005-0054-1
  44. Sirola J, Rikkonen T, Tuppurainen M, Jurvelin JS, Kr$\"{o}$ger H. Association of grip strength change with menopausal bone loss and related fractures: a population-based follow-up study. Calcif Tissue Int 2006; 78: 218-26 https://doi.org/10.1007/s00223-005-0298-y
  45. Gerdhem P, Ringsberg KA , Akesson K, Obrant KJ. Influence of muscle strength, physical activity and weight on bone mass in a population-based sample of 1004 elderly women. Osteoporos Int 2003; 14: 768-72 https://doi.org/10.1007/s00198-003-1444-x
  46. Zhao LJ, Jiang H, Papasian CJ, Maulik D, Drees B, Hamilton J, et al. Correlation of obesity and osteoporosis: effect of fat mass on the determination of osteoporosis. J Bone Miner Res 2008; 23: 17-29 https://doi.org/10.1359/jbmr.070813
  47. Frost HM. Bone 'mass' and the 'mechanostat': a proposal. Anat Rec 1987; 219: 1-9 https://doi.org/10.1002/ar.1092190104
  48. Blain H, Vuillemin A, Teissier A, Hanesse B, Guillemin F, Jeandel C. Influence of muscle strength and body weight and composition on regional bone mineral density in healthy women aged 60 years and over. Gerontology 2001; 47: 207-12 https://doi.org/10.1159/000052800
  49. Matsumine H, Hirato K, Yanaihara T, Tamada T, Yoshida M. Aromatization by skeletal muscle. J Clin Endocrinol Metab 1986; 63: 717-20 https://doi.org/10.1210/jcem-63-3-717
  50. Sirola J, Kr$\"{o}$ger H, Honkanen R, Sandini L, Tuppurainen M, Jurvelin JS, et al. Risk factors associated with peri- and postmenopausal bone loss: does HRT prevent weight lossrelated bone loss? Osteoporos Int 2003; 14: 27-33 https://doi.org/10.1007/s00198-002-1318-7
  51. Lee DJ, Kim SM. Correlation of the bone mineral density and weight reduction therapy in estrogen replaced obese postmenopausal women. Korean J Obes 2001; 10: 306-13
  52. Ryan AS, Nicklas BJ, Dennis KE. Aerobic exercise maintains regional bone mineral density during weight loss in postmenopausal women. J Appl Physiol 1998; 84: 1305-10
  53. Daly RM, Dunstan DW, Owen N, Jolley D, Shaw JE, Zimmet PZ. Does high-intensity resistance training maintain bone mass during moderate weight loss in older overweight adults with type 2 diabetes? Osteoporos Int 2005; 16: 1703-12 https://doi.org/10.1007/s00198-005-1906-4
  54. Cussler EC, Going SB, Houtkooper LB, Stanford VA, Blew RM, Flint-Wagner HG, et al. Exercise frequency and calcium intake predict 4-year bone changes in postmenopausal women. Osteoporos Int 2005; 16: 2129-41 https://doi.org/10.1007/s00198-005-2014-1
  55. Reid IR, Legge M, Stapleton JP, Evans MC, Grey AB. Regular exercise dissociates fat mass and bone density in premenopausal women. J Clin Endocrinol Metab 1995; 80: 1764-8 https://doi.org/10.1210/jc.80.6.1764
  56. Gozansky WS, Van Pelt RE, Jankowski CM, Schwartz RS, Kohrt WM. Protection of bone mass by estrogens and raloxifene during exercise-induced weight Loss. J Clin Endocrinol Metab 2005; 90: 52-9 https://doi.org/10.1210/jc.2004-0275
  57. Ricci TA, Chowdhury HA, Heymsfield SB, Stahl T, Pierson RN Jr, Shapses SA. Calcium supplementation suppresses bone turnover during weight reduction in postmenopausal women. J Bone Miner Res 1998; 13: 1045-50 https://doi.org/10.1359/jbmr.1998.13.6.1045

Cited by

  1. 서울지역 20~30대 성인여성의 직업유무에 따른 골밀도와 영향요인: 제5기 국민건강영양조사자료 분석, 2010~2011 vol.20, pp.2, 2009, https://doi.org/10.14373/jkda.2014.20.2.110
  2. 한국 여성의 신체계측치 및 생화학 인자와 골밀도 관련성: 제4기(2008~2009)와 제5기(2010~2011) 국민건강영양조사 자료 분석 vol.20, pp.3, 2009, https://doi.org/10.14373/jkda.2014.20.3.157
  3. 한국 남성의 신체 및 생화학 인자와 골밀도 : 2008~2011년 국민건강영양조사를 바탕으로 vol.24, pp.6, 2009, https://doi.org/10.17495/easdl.2014.12.24.6.710
  4. 칼슘/비타민D 섭취와 택견운동이 노인 허약에 미치는 효과 vol.18, pp.3, 2009, https://doi.org/10.7586/jkbns.2016.18.3.185
  5. Association between body mass index and fragility fracture in postmenopausal women: a cross-sectional study using Korean National Health and Nutrition Examination Survey 2008-2009 (KNHANES IV) vol.21, pp.1, 2021, https://doi.org/10.1186/s12905-021-01209-4