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Relation of body composition, fat mass, and serum lipids to osteoporotic fractures and bone mineral density in Chinese men and women^1,2,3

From the Program for Population Genetics, Harvard School of Public Health, Boston, MA (Y-HH, SAV, HAT, YF, and JDB); the Division of Preventive Medicine, Department of Medicine, Brigham and Women Hospital, Harvard Medical School, Boston, MA (TN); Anhui Medical University, Institute of Medicine, Anhui, China (ZL and XX); the Department of Biostatistics, Harvard School of Public Health, Boston, MA (NL); the San Francisco Coordinating Center, University of California, San Francisco, CA (SRC); the Beth Israel Deaconess Medical Center, Boston, MA (MLB); the Maine Center for Osteoporosis Research and Education, St Joseph Hospital, Bangor, ME (CJR); and the Center for Population Genetics, School of Public Health, University of Illinois at Chicago (XX)

Background: Higher fat mass may be an independent risk factor for osteoporosis and osteoporotic fractures.

Objective: We aimed to determine the independent contribution of fat mass to osteoporosis and to estimate the risk of osteoporotic fractures in relation to body weight, lean mass, and other confounders.

Design: This was a community-based, cross-sectional study of 7137 men, 4585 premenopausal women, and 2248 postmenopausal women aged 25–64 y. Total-body and hip bone mineral content (BMC) and bone mineral density (BMD) and body composition were measured by dual-energy X-ray absorptiometry. Serum lipids were measured. Sex- and menopause-specific multiple generalized linear models were applied.

Results: Across 5-kg strata of body weight, fat mass was significantly inversely associated with BMC in the whole body and total hip. When we compared the highest quartile with the lowest quartile of percentage fat mass in men, premenopausal women, and postmenopausal women, the adjusted odds ratios (95% CIs) of osteoporosis defined by hip BMD were 5.2 (2.1, 13.2), 5.0 (1.7, 15.1), and 6.9 (4.3, 11.2), respectively. Significant linear trends existed for higher risks of osteoporosis, osteopenia, and nonspine fractures with higher percentage fat mass. Significant negative relations were found between whole-body BMC and cholesterol, triacylglycerol, LDL, and the ratio of HDL to LDL in all groups.

Conclusions: Risks of osteoporosis, osteopenia, and nonspine fractures were significantly higher for subjects with higher percentage body fat independent of body weight, physical activity, and age. Thus, fat mass has a negative effect on bone mass in contrast with the positive effect of weight-bearing itself.

Key Words: Bone mineral density • osteoporosis • fracture • body composition • lipids

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