LETTER TO EDITOR

The Influence of Weight Status on Radial Bone Mineral Densityin Lebanese Women

Rawad El Hage • Falah Bachour • Amer Sebaaly •

Majed Issa • Eddy Zakhem • Ghassan Maalouf

Received: 26 October 2013 / Accepted: 30 November 2013

� Springer Science+Business Media New York 2013

Abstract The aim of this study was to investigate the

influence of the weight-status (obese, overweight and

normal-weight) on bone mineral density of the forearm in

Lebanese women. 3,989 Lebanese women (1,138 obese,

1,570 overweight and 1,281 normalweight) aged from 19 to

92 years old participated in this study. Weight and height

were measured, and body mass index (BMI) was calcu-

lated. BMD of the ultra-distal (UD) radius, the 1/3 radius

and the total radius was measured by DXA (GE Healthcare

Lunar Prodigy). In the whole population, body weight was

positively correlated to UD Radius BMD (r = 0.41;

P \ 0.001), 1/3 radius BMD (r = 0.35; P \ 0.001) and

total radius BMD (r = 0.48; P \ 0.001) while age was

negatively correlated to UD BMD (r = -0.42; P \ 0.001),

1/3 Radius BMD (r = -0.52; P \ 0.001) and total radius

BMD (r = -0.42; P \ 0.001). Using multiple linear

regression analysis models, age and weight explained

36 %, 41 % and 42 of the UD radius BMD, 1/3 radius

BMD and total radius BMD variances respectively. UD

radius BMD, 1/3 radius BMD and total radius BMD values

were significantly different among the three groups

(P \ 0.001). UD Radius BMD, 1/3 radius BMD and total

radius BMD values were higher in obese and overweight

women compared to normal-weight women (P \ 0.001)

and in obese women compared to overweight women

(P \ 0.001). These differences among the three groups

remained significant after adjusting for age and height

(P \ 0.001). This study suggests that obesity is associated

with higher UD radius, 1/3 radius and total radius BMD

values in Lebanese women. Thus, obesity seems to be

protective against forearm osteopenia in Lebanese women.

Keywords Ageing � Obesity � Osteoporosis

Obesity has become a serious international public health

problem because of its high prevalence and its serious

health complications [1–4]. Obesity is associated with

several serious diseases such as type 2 diabetes mellitus,

hypertension, coronary heart disease, and some cancers [1–

4]. In contrast, there is some evidence to suggest a pro-

tective effect of obesity against osteoporosis, especially in

women [5–7]. In fact, it has been shown that in adult and

elderly women, body weight and body mass index (BMI)

are positive predictors of bone mineral density (BMD) of

weight-bearing sites such as the lumbar spine and the hip

[5–7]. Mechanical and hormonal factors are responsible for

these associations [5–9]. However, little is known con-

cerning the effects of body weight and BMI on BMD of

non-weight-bearing bones such as the forearm. In Lebanese

subjects, peak BMD values are lower compared to Amer-

ican/Western values [10]. The aim of this study was to

investigate the influence of the weight-status (obese,

overweight, and normal weight) on BMD of the forearm in

Lebanese women.

A total of 3,989 Lebanese women (1,138 obese, 1,570

overweight, and 1,281 normal weight) aged from 19 to

92 years old participated in this study (Table 1). Weight

and height were measured, and BMI was calculated. BMD

The authors state that they have no conflict of interest.

R. E. Hage (&) � E. Zakhem

Department of Physical Education, Faculty of Arts and Social

Sciences, University of Balamand, P.O. Box 100, Tripoli,

Lebanon

e-mail: rawadelhage21@hotmail.com

F. Bachour � A. Sebaaly � M. Issa � G. Maalouf

Bellevue University Medical Center, Faculty of Medicine, Saint

Joseph University, Mansourieh, Lebanon

123

Calcif Tissue Int

DOI 10.1007/s00223-013-9822-7

of the ultradistal (UD) radius, the 1/3 radius, and the total

radius was measured by dual-energy X-ray absorptiometry

(DXA; GE Healthcare Lunar Prodigy). The T score for the

total radius was calculated using the following formula:

T score = (subject’s BMD - peak mean BMD/SD of peak

BMD). Peak BMD was provided by the densitometer’s

software (U.S./European reference data). The means and

standard deviations were calculated for all the clinical data

and for the bone measurements. Associations between

clinical and bone data were given as Pearson correlation

coefficients. Multiple linear regression analysis models

were used to test the relationship between DXA variables

with age and weight, and r2 were reported. BMD values

were compared among the three groups using a one-way

analysis of variance. BMD values were also compared

among the three groups after adjustment for age and height

using a one-way analysis of covariance. Odds ratios for

BMI and age were estimated using logistic regression with

osteoporosis defined as a radius T score of -2.5 or less as

the dependent variable. Data were analyzed with SPSS

version 16.0 (IBM, Armonk, NY).

In the whole population, body weight was positively

correlated to UD radius BMD (r = 0.41; P \ 0.001), 1/3

radius BMD (r = 0.35; P \ 0.001), and total radius BMD

(r = 0.48; P \ 0.001), while age was negatively correlated

to UD BMD (r = -0.42; P \ 0.001), 1/3 radius BMD

(r = -0.52; P \ 0.001), and total radius BMD (r = -0.42;

P \ 0.001). Using multiple linear regression analysis

models, age and weight explained 36, 41, and 42 % of the

UD radius BMD, 1/3 radius BMD, and total radius BMD

variances, respectively. UD radius BMD, 1/3 radius BMD,

and total radius BMD values were significantly different

among the three groups (P \ 0.001) (Table 2). UD radius

BMD, 1/3 radius BMD, and total radius BMD values were

higher in obese and overweight women compared to nor-

mal-weight women (P \ 0.001) and in obese women

compared to overweight women (P \ 0.001). These dif-

ferences among the three groups remained significant after

adjusting for age and height (P \ 0.001).

This study suggests that obesity is associated with

higher UD radius, 1/3 radius, and total radius BMD values

in Lebanese women. Thus, obesity seems to be protective

against forearm osteopenia in Lebanese women.

References

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Table 1 Clinical characteristics and crude forearm BMD values of the study population

Characteristic Obese (n = 1138) Overweight (n = 1570) Normal weight (n = 1281)

Age (y) 62.9 ± 9.6a 61.6 ± 6.8b 56.8 ± 12.6c

Weight (kg) 80.8 ± 11.0a 66.5 ± 6.8d 55.7 ± 6.5c

Height (cm) 154.0 ± 6.9a 155.7 ± 7.0d 157.2 ± 7.1c

BMI (kg/m2) 34.0 ± 3.6a 27.4 ± 1.4d 22.5 ± 1.8c

UD radius BMD (g/cm2) 0.396 ± 0.077a 0.371 ± 0.075d 0.347 ± 0.078c

1/3 radius BMD (g/cm2) 0.742 ± 0.117a 0.722 ± 0.116d 0.707 ± 0.124c

Total radius BMD (g/cm2) 0.580 ± 0.095a 0.558 ± 0.093d 0.539 ± 0.100c

Total forearm BMD (g/cm2) 0.554 ± 0.093a 0.534 ± 0.093d 0.516 ± 0.098c

UD radius T score -0.99 ± 1.69a -1.55 ± 1.61d -2.04 ± 1.72c

1/3 radius T score -1.04 ± 1.30a -1.28 ± 1.26d -1.42 ± 1.39c

Total radius T score -1.02 ± 1.54a -1.39 ± 1.49d -1.67 ± 1.63c

BMD bone mineral density, BMI body mass index, UD ultradistala Obese different from normal weight, P \ 0.001b Overweight different from obese, P \ 0.01c Normal weight different from overweight, P \ 0.001d Overweight different from obese, P \ 0.001

Table 2 Predictors of osteoporosis (T score -2.5 or less) at the total

radius by multiple logistic regression

Variable Odds ratio 95 % confidence interval P

Constant 0.001 0.0005–0.0023 \0.001

Age (year) 1.153 1.140–1.165 \0.001

BMI (kg/m2) 0.881 0.863–0.899 \0.001

BMI body mass index

R. E. Hage et al.: Weight Status and Bone Mineral Density

123

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