Association of adiposity indices with bone density and bone
turnover in the Chinese population
Received: 29 November 2016 /Accepted: 4 May 2017 /Published online: 29 May 2017
International Osteoporosis Foundation and National Osteoporosis Foundation 2017
Summary Associations of adiposity indices with bone mineral
density (BMD) and bone turnover markers were evaluated in
Chinese participants. Body mass index, fat mass, and lean
mass are positively related to BMD in both genders.
Subcutaneous fat area was proved to be negatively associated
with BMD and positively correlated with osteocalcin in post-
Introduction Obesity is highly associated with osteoporosis,
but the effect of adipose tissue on bone is contradictory. Our
study aimed to assess the associations of adiposity indices
with bone mineral density (BMD) and bone turnover markers
(BTMs) in the Chinese population.
Methods Our study recruited 5215 participants from the
Shanghai area, evaluated related anthropometric and bio-
chemical traits in all participants, tested serum BTMs, calcu-
lated fat distribution using magnetic resonance imaging (MRI)
images and image analysis software, and tested BMD with
dual-energy X-ray absorptiometry.
Results When controlled for age, all adiposity indices were pos-
itively correlated with BMD of all sites for both genders. As for
the stepwise regression analysis,bodymassindex(BMI),fat
mass, and lean mass were protective for BMD in both genders.
However, subcutaneous fat area (SFA) was detrimental for BMD
of the L1–4 and femoral neck (β ±SE−0.0742 ± 0.0174;
p =2.11E−05; β ±SE−0.0612 ± 0.0147; p = 3.07E−05).
Adiposity indices showed a negative correlation with BTMs
adjusting for age, especially with osteocalcin. In the stepwise
regression analysis, fat mass was negatively correlated with
osteocalcin (β ±SE−8.8712 ± 1.4902; p = 4.17E−09) and lean
mass showed a negative correlation with N-terminal procollagen
of type I collagen (PINP) for males (β ±SE−0.3169 ± 0.0917;
p = 0.0006). In females, BMI and visceral fat area (VFA) were all
negatively associated with osteocalcin (β ±SE
−0.4423 ± 0.0663; p = 2.85E−11; β ±SE−7.1982 ± 1.1094;
p = 9.95E−11), while SFA showed a positive correlation with
osteocalcin (β ± SE: 5.5993 ± 1.1753; p = 1.98E−06).
Conclusion BMI, fat mass, and lean mass are proved to be
beneficial for BMD in both males and postmenopausal fe-
males. SFA is negatively associated with BMD and positively
correlated with osteocalcin in postmenopausal females.
Keywords Adiposity indices
Bone mineral density
Osteoporosis is a systemic skeletal disorder characterized
by reduced bone mass, deteriorated bone structure,
Jie Wang and Dandan Yan contributed equally to this article.
Electronic supplementary material The online version of this article
(doi:10.1007/s00198-017-4081-5) contains supplementary material,
which is available to authorized users.
* C. Hu
* Z. Zhang
Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes
Mellitus, Shanghai Clinical Center for Diabetes, Shanghai Jiao Tong
University Affiliated Sixth People’s Hospital, Shanghai 200233,
Department of Osteoporosis, Metabolic Bone Disease and Genetic
Research Unit, Shanghai Jiao Tong University Affiliated Sixth
People’s Hospital, Shanghai 200233, China
Shanghai Jiao Tong University Affiliated Sixth People’s Hospital,
South Campus, Shanghai 201499, China
Osteoporos Int (2017) 28:2645–2652