Differential contributions of lean and fat mass on bone mineral density in Asian women of reproductive age: the Singapore Preconception Study of Long-Term Maternal and Child Outcomes study

The relationships between fat mass (FM), lean mass (LM), and bone mass are complex with significant implications for obesity, sarcopenia, and osteoporosis later in life. While greater LM is associated with higher BMD, the association between FM and BMD is less clear. Such relationships warrant further investigation, especially in Asians, who have a higher risk of metabolic diseases and osteoporotic fractures compared to Western populations. This study investigated the associations of LM, FM, and modifiable risk factors with BMD in Asian women aged 18-45 yr. A total of 191 women from the Singapore Preconception Study of Long-Term Maternal and Child Outcomes (S-PRESTO) cohort study underwent DXA scanning at the first study visit for BMD and body composition measurements. LM, FM, and four body composition phenotypes derived from dichotomizing LM and FM were related to cohort-specific Z-scores of BMD at FN (BMD<sub>FN</sub>), LS (BMD<sub>LS</sub>), and whole body (BMD<sub>WB</sub>). Adjusting for covariates, LM showed positive associations with Z-BMD<sub>FN</sub>, [β (95%CI)], [0.38 (0.22, 0.55)], Z-BMD<sub>LS</sub> [0.43 (0.25, 0.62)], and Z-BMD<sub>WB</sub>, [0.63 (0.44, 0.81)]. Fat mass by contrast showed an inverse association only with Z-BMD<sub>WB</sub>, [-0.39 (-0.58, -0.20)]. Compared to women with healthy body composition (higher LM-lower FM), women with lower LM-higher FM had similar BMI, mean (SD) 20.9 (1.5) kg/m<sup>2</sup> but disproportionately higher percent fat, 38.4 (2.2%), and lower Z-BMD<sub>FN</sub> [-0.58 (-0.97, -0.18)], Z-BMD<sub>LS</sub> [-0.41 (-0.81, 0.00)], and Z-BMD<sub>WB</sub> [-0.66 (-1.06, -0.25)]. Chinese women had lower BMD than Malay women. Physical activity and education attainment were positively, while the age of menarche was negatively associated with BMD. These findings in young women underscore the importance of early interventions recognizing ethnic differences in BMD to improve lifecourse musculoskeletal health. Most importantly, intervention strategies for Asian women should focus on healthy body composition beyond BMI, with a goal to preserve or increase LM.

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JBMR Plus
Published
2025-04-07
DOI
https://doi.org/10.1093/jbmrpl/ziaf054
Citations
1
Primary Topic
Bone health and osteoporosis research
Type
article
Field-Weighted Citation Impact
1.72

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article

Differential contributions of lean and fat mass on bone mineral density in Asian women of reproductive age: the Singapore Preconception Study of Long-Term Maternal and Child Outcomes study

Jun Shi Lai, Andrea Cremaschi, Yap Seng Chong, Jonathan Y. Bernard et al.
1 citations
JBMR Plus
Bone health and osteoporosis research
1.72
article

Differential contributions of lean and fat mass on bone mineral density in Asian women of reproductive age: the Singapore Preconception Study of Long-Term Maternal and Child Outcomes study

Jun Shi Lai, Andrea Cremaschi, Yap Seng Chong, Jonathan Y. Bernard, Nicholas C. Harvey, Maria De Iorio, Natarajan Padmapriya, Falk Müller‐Riemenschneider, Cuilin Zhang, Melvin Khee‐Shing Leow, Mya Thway Tint, Seng Bin Ang, K.R. Godfrey, Jerry Kok Yen Chan, Peter D Gluckman, Johan G Eriksson
article en
1 citations

Abstract

The relationships between fat mass (FM), lean mass (LM), and bone mass are complex with significant implications for obesity, sarcopenia, and osteoporosis later in life. While greater LM is associated with higher BMD, the association between FM and BMD is less clear. Such relationships warrant further investigation, especially in Asians, who have a higher risk of metabolic diseases and osteoporotic fractures compared to Western populations. This study investigated the associations of LM, FM, and modifiable risk factors with BMD in Asian women aged 18-45 yr. A total of 191 women from the Singapore Preconception Study of Long-Term Maternal and Child Outcomes (S-PRESTO) cohort study underwent DXA scanning at the first study visit for BMD and body composition measurements. LM, FM, and four body composition phenotypes derived from dichotomizing LM and FM were related to cohort-specific Z-scores of BMD at FN (BMD<sub>FN</sub>), LS (BMD<sub>LS</sub>), and whole body (BMD<sub>WB</sub>). Adjusting for covariates, LM showed positive associations with Z-BMD<sub>FN</sub>, [β (95%CI)], [0.38 (0.22, 0.55)], Z-BMD<sub>LS</sub> [0.43 (0.25, 0.62)], and Z-BMD<sub>WB</sub>, [0.63 (0.44, 0.81)]. Fat mass by contrast showed an inverse association only with Z-BMD<sub>WB</sub>, [-0.39 (-0.58, -0.20)]. Compared to women with healthy body composition (higher LM-lower FM), women with lower LM-higher FM had similar BMI, mean (SD) 20.9 (1.5) kg/m<sup>2</sup> but disproportionately higher percent fat, 38.4 (2.2%), and lower Z-BMD<sub>FN</sub> [-0.58 (-0.97, -0.18)], Z-BMD<sub>LS</sub> [-0.41 (-0.81, 0.00)], and Z-BMD<sub>WB</sub> [-0.66 (-1.06, -0.25)]. Chinese women had lower BMD than Malay women. Physical activity and education attainment were positively, while the age of menarche was negatively associated with BMD. These findings in young women underscore the importance of early interventions recognizing ethnic differences in BMD to improve lifecourse musculoskeletal health. Most importantly, intervention strategies for Asian women should focus on healthy body composition beyond BMI, with a goal to preserve or increase LM.

JBMR PlusVol. 9(6)
Agency for Science, Technology and Research (SG), IE University (ES), University of Helsinki (FI), Harvard University (US), University of Auckland (NZ), Inserm (FR), National University of Singapore (SG), Université Paris Cité (FR), Helsinki University Hospital (FI), Tan Tock Seng Hospital (SG), University Hospital Southampton NHS Foundation Trust (GB), Institute for Human Development (IN), Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement (FR), Sorbonne Paris Cité (FR), KK Women's and Children's Hospital (SG), NIHR Southampton Biomedical Research Centre (GB), Duke-NUS Medical School (SG), Primary Health Care (QA), Berlin Institute of Health at Charité - Universitätsmedizin Berlin (DE), MRC Lifecourse Epidemiology Unit (GB), National University Health System (SG), Folkhälsans Forskningscentrum (FI), University of Southampton (GB), Charité - Universitätsmedizin Berlin (DE), Singapore Management University (SG)
University Hospital Southampton NHS Foundation Trust, National Institute for Health and Care Research, British Heart Foundation, University of Southampton, European Commission, National Research Foundation, Agency for Science, Technology and Research, National Institute for Health Research Southampton Biomedical Research Centre, Medical Research Council, National Medical Research Council, Erasmus+, Precursory Research for Embryonic Science and Technology
Good health and well-being
Openalex Percentile: Top 20%
Bone health and osteoporosis research
1.72
DOIOpen Access PDFOpenAlex
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