Relationship between the Components of the Metabolic Syndrome and Measures of Bone Mineral Density in Post-Menopausal Women

Eman M. Alissa, Wafa A. Alnahdi, Nabeel Alama, Gordon A. Ferns

Faculty of Medicine, King AbdulAziz University, Jeddah, KSA.
Medical Education and Metabolic Medicine, Brighton and Sussex Medical School, University of Brighton, Brighton, UK.

DOI: 10.4236/jdm.2014.42023                

Abstract

Aim: To examine the association between individual components of metabolic syndrome (MetS) and bone mineral density (BMD) among postmenopausal women. Methods: A total of 177 postmenopausal women participated in a cross-sectional study. They were interviewed to collect anthropometric and demographic characteristics. BMD was measured and biochemical parameters were estimated in fasting blood samples. Univariate and multivariate analyses were used to examine the association between individual components of MetS and BMD. Results: Among 177 postmenopausal women, 116 (66%) had MetS. Women with MetS had significantly higher mean values of BMD and T scores at the total hip (P < 0.05) compared to women without MetS, which disappeared after adjustment for body weight, but not for age (P < 0.05). Features of the MetS other than waist circumference were not significantly related to BMD values at the three skeletal sites, except for diastolic blood pressure association with BMD at the femoral neck (r = 0.150, P < 0.05). BMD at the total hip was also positively associated with both of triglycerides (r = 0.157, P < 0.05) and fasting blood glucose (r = 0.193, P < 0.01). To identify the independent factors affecting the BMD at the 3 skeletal sites according to metabolic states, stepwise multiple linear regression analysis was performed. Conclusions: Body weight and osteocalcin were more strongly associated with bone mass than any other component of MetS in postmenopausal women. However, further studies seem to be needed to confirm their observation.

Keywords

Bone Mineral Density, Metabolic Syndrome, Osteocalcin, Postmenopausal Women

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Deen, D. (2004) Metabolic Syndrome: Time for Action. American Family Physician, 69, 2875-2882.
[2]	Tsuda, K., Nishio, I. and Masuyama, Y. (2001) Bone Mineral Density in Women with Essential Hypertension. American Journal of Hypertension, 14, 704-707. http://dx.doi.org/10.1016/S0895-7061(01)01303-6
[3]	Yamaguchi, T., Sugimoto, T., Yano, S., et al. (2002) Plasma Lipids and Osteoporosis in Postmenopausal Women. Endocrine Journal, 49, 211-217. http://dx.doi.org/10.1507/endocrj.49.211
[4]	Schwartz, A.V. (2003) Diabetes Mellitus: Does It Affect Bone. Calcified Tissue International, 73, 515-519. http://dx.doi.org/10.1007/s00223-003-0023-7
[5]	De Laet, C., Kanis, J.A., Oden, A., et al. (2005) Body Mass Index as a Predictor of Fracture Risk: A Meta-Analysis. Osteoporosis International, 16, 1330-1338. http://dx.doi.org/10.1007/s00198-005-1863-y
[6]	Jankowska, E.A., Rogucka, E. and Medras, M. (2001) Are General Obesity and Visceral Adiposity in Men Linked to Reduced Bone Mineral Content Resulting from Normal Ageing? A Population-Based Study. Andrologia, 33, 384-389. http://dx.doi.org/10.1046/j.1439-0272.2001.00469.x
[7]	Inaba, M. (2004) Secondary Osteoporosis: Thyrotoxicosis, Rheumatoid Arthritis, and Diabetes Mellitus. Journal of Bone and Mineral Metabolism, 22, 287-292. http://dx.doi.org/10.1007/s00774-004-0501-7
[8]	Reid, I.R., Evans, M.C., Cooper, G.J., et al. (1993) Circulating Insulin Levels Are Related to Bone Density in Normal Postmenopausal Women. The American Journal of Physiology, 265, E655-E659.
[9]	Rhee, E.J., Kim, Y.C., Lee, W.Y., et al. (2006) Comparison of Insulin Resistance and Serum High-Sensitivity C-Reactive Protein Levels According to the Fasting Blood Glucose Subgroups Divided by the Newly Recommended Criteria for Fasting Hyperglycemia in 10059 Healthy Koreans. Metabolism, 55, 183-187. http://dx.doi.org/10.1016/j.metabol.2005.08.010
[10]	Schett, G., Kiechl, S., Weger, S., et al. (2006) High-Sensitivity C-Reactive Protein and Risk of Nontraumatic Fractures in the Bruneck Study. Archives of Intern alMedicicne, 166, 2495-2501. http://dx.doi.org/10.1001/archinte.166.22.2495
[11]	Alberti, K.G., Zimmet, P. and Shaw, J. (2005) IDF Epidemiology Task Force Consensus Group. The Metabolic Syndrome—A New Worldwide Definition. Lancet, 366, 1059-1062. http://dx.doi.org/10.1016/S0140-6736(05)67402-8
[12]	Schneider, J.G., Von Eynatten, M., Schneider, S., et al. (2005) Low Plasma Adiponectin Levels Are Associated with Increased Hepatic Lipase Activity in Vivo. Diabetes Care, 28, 2181-2186. http://dx.doi.org/10.2337/diacare.28.9.2181
[13]	World Health Organization (1994) Assessment of Fracture Risk and Its Application to Screening for Postmenopausal Osteoporosis. Technical Support Series No. 843, WHO, Geneva.
[14]	Friedewald, W.T., Levy, R.I. and Fredrickson, D.S. (1972) Estimation of the Concentration of Low-Density Lipoprotein Cholesterol in Plasma without use of the Preparative Ultracentrifuge. Clinical Chemistry, 18, 499-502.
[15]	Grundy, S.M., Cleeman, J.I., Daniels, S.R., et al. (2005) Diagnosis and Management of the Metabolic Syndrome: An American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement: Executive Summary. Critical Pathways in Cardiology, 4, 198-203. http://dx.doi.org/10.1097/00132577-200512000-00018
[16]	Hwang, D.K. and Choi, H.J. (2010) The Relationship between Low Bone Mass and Metabolic Syndrome in Korean Women. Osteoporosis International, 21, 425-431. http://dx.doi.org/10.1007/s00198-009-0990-2
[17]	Kinjo, M., Setoguchi, S. and Solomon, D.H. (2007) Bone Mineral Density in Adults with the Metabolic Syndrome: Analysis in a Population-Based U.S. Sample. The Journal of Clinical Endocrinology & Metabolism, 92, 4161-4164. http://dx.doi.org/10.1210/jc.2007-0757
[18]	von Muhlen, D., Safii, S., Jassal, S.K., Svartberg, J. and Barrett-Connor, E. (2007) Associations between the Metabolic Syndrome and Bone Health in Older Men and Women: The Rancho Bernardo Study. Osteoporosis International, 18, 1337-1344. http://dx.doi.org/10.1007/s00198-007-0385-1
[19]	Kim, H.Y., Choe, J.W., Kim, H.K., Bae, S.J., Kim, B.J., et al. (2010) Negative Association between Metabolic Syndrome and Bone Mineral Density in Koreans, Especially in Men. Calcified Tissue International, 86, 350-358. http://dx.doi.org/10.1007/s00223-010-9347-2
[20]	Alissa, E.M., Qadi, S., Alhujali, N., Alshehri, A.M. and Ferns, G.A. (2011) Effect of Diet and Lifestyle Factors on Bone Health in Postmenopausal Women. Journal of Bone and Mineral Metabolism, 29, 725-735. http://dx.doi.org/10.1007/s00774-011-0274-8
[21]	Ardawi, M.S., Maimany, A.A., Bahksh, T.M., Nasrat, H.A.N., Milaat, W.A. and Al-Raddadi, R.M. (2005) Bone Mineral Density of the Spine and Femur in Healthy Saudis. Osteoporosis International, 16, 43-55. http://dx.doi.org/10.1007/s00198-004-1639-9
[22]	Fuleihan, G.E.H., Baddoura, R., Awada, H., Salam, N., Salamoun, M. and Rizk, P. (2002) Low Peak Bone Mineral Density in Healthy Lebanese Subjects. Bone, 31, 520-528. http://dx.doi.org/10.1016/S8756-3282(02)00845-1
[23]	Hmamouchi, I., Allali, F., Khazzani, H., Bennani1, L., El Mansouri1, L., Ichchou, L., et al. (2009) Low Bone Mineral Density Is Related to Atherosclerosis in Postmenopausal Moroccan Women. BMC Public Health, 9, 388-396. http://dx.doi.org/10.1186/1471-2458-9-388
[24]	Nguyen, T.V., Sambrook, P.N. and Eisman, J.A. (1998) Bone Loss, Physical Activity, and Weight Change in Elderly Women: The Dubbo Osteoporosis Epidemiology Study. Journal of Bone and Mineral Research, 13, 1458-1467. http://dx.doi.org/10.1359/jbmr.1998.13.9.1458
[25]	Felson, D.T., Zhang, Y., Hannan, M.T. and Anderson, J.J. (1993) Effects of Weight and Body Mass Index on Bone Mineral Density in Men and Women: The Framingham Study. Journal of Bone and Mineral Research, 8, 567-573. http://dx.doi.org/10.1002/jbmr.5650080507
[26]	Finkelstein, J.S., Brockwell, S.E., Mehta, V., Greendale, G.A., Sowers, M.F.R., Ettinger, B., et al. (2008) Bone Mineral Density Changes during the Menopause Transition in a Multiethnic Cohort of Women. The Journal of Clinical Endocrinology & Metabolism, 93, 861-868. http://dx.doi.org/10.1210/jc.2007-1876
[27]	Riggs, B.L., Khosla, S. and Melton 3rd, L.J. (2002) Sex Steroids and the Construction and Conservation of the Adult Skeleton. Endocrine Reviews, 23, 279-302. http://dx.doi.org/10.1210/edrv.23.3.0465
[28]	Mussolino, M.E. and Gillum, R.F. (2006) Bone Mineral Density and Hypertension Prevalence in Postmenopausal Women: Results from the Third National Health and Nutrition Examination Survey. Annals of Epidemiology, 16, 395-399.
[29]	Gotoh, M., Mizuno, K., Ono, Y. and Takahashi, M. (2005) High Blood Pressure, Bone-Mineral Loss and Insulin Resistance in Women. Hypertension Research, 28, 565-570. http://dx.doi.org/10.1291/hypres.28.565
[30]	Dennison, E.M., Syddall, H.E., Sayer, A.A., Martin, H.J. and Cooper, C. (2007) Lipid Profile, Obesity and Bone Mineral Density: The Hertfordshire Cohort Study. QJM: An International Journal of Medicine, 100, 297-303. http://dx.doi.org/10.1093/qjmed/hcm023
[31]	Bagger, Y.Z., Rasmussen, H.B., Alexandersen, P., Werge, T., Christiansen, C. and Tanko, L.B. (2007) Links between Cardiovascular Disease and Osteoporosis in Postmenopausal Women: Serum Lipids or Atherosclerosis per Se? Osteoporosis International, 18, 505-512. http://dx.doi.org/10.1007/s00198-006-0255-2
[32]	Gerdhem, P., Isaksson, A., Akesson, K. and Obrant, K.J. (2005) Increased Bone Density and Decreased Bone Turnover, but No Evident Alteration of Fracture Susceptibility in Elderly Women with Diabetes Mellitus. Osteoporosis International, 16, 1506-1512. http://dx.doi.org/10.1007/s00198-005-1877-5
[33]	Eastell, R. and Hannon, R.A. (2008) Biomarkers of Bone Health and Osteoporosis Risk. Proceedings of the Nutrition Society, 67, 157-162. http://dx.doi.org/10.1017/S002966510800699X
[34]	Hsu, Y.H., Venners, S.A., Terwedow, H.A., Feng, Y., Niu, T., Li, Z., et al. (2006) Relation of Body Composition, Fat Mass, and Serum Lipids to Osteoporotic Fractures and Bone Mineral Density in Chinese Men and Women. The American Journal of Clinical Nutrition, 83, 146-154.
[35]	Gerdhem, P., Ivaska, K.K., Alatalo, S.L., et al. (2004) Biochemical Markers of Bone Metabolism and Prediction of Fracture in Elderly Women. Journal of Bone and Mineral Research, 19, 386-393. http://dx.doi.org/10.1359/JBMR.0301244