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Original Article

Effect of diet and lifestyle habits on bone density inpostmenopausal women

Nafiseh Goodarzizadeh a, Alireza Shahrjerdi b, Mohsen Najafi c, Azin Yousefi d,*aDepartment of Food Science and Nutrition, University of Mysore, IndiabDepartment of Life Sciences, University of Mumbai, IndiacDepartment of Medicine, Islamic Azad University, Sari Branch, Sari, IrandDepartment of Nutrition, Islamic Azad University, Sari Branch, Sari, Iran

a r t i c l e i n f o

Article history:

Received 31 January 2013

Accepted 5 February 2013

Available online 7 March 2013

Keywords:

Postmenopausal

Lifestyle habits

Bone density

Osteoporosis

Body mass index

* Corresponding author. Tel.: þ98 9392032280E-mail address: azinyousefi@gmail.com (

0974-6943/$ e see front matter Copyright ªhttp://dx.doi.org/10.1016/j.jopr.2013.02.006

a b s t r a c t

Aim: The present study aimed to assess the effect of diet and lifestyle habits on bone

density in postmenopausal women.

Materials and methods: A total of 200 women between 45 to 65 years old suspected to osteo-

porosis were recruited for this study. A cross-sectional hospital-based study has been per-

formed to investigate200osteoporosis suspectedwomen.Datacollected for this study included

filling questionnaires through personal interviews, use of case records, files and documents.

Multiple logistic regression was used to estimate the association between osteoporosis and

its risk factors and obtaining the odds- ratio of each of the risk factors. All statistical analyses

were performed using statistical software SPSS version 13.0 (SPSS Inc, Chicago).

Results: The study showed that out of total 200 women who underwent the BMD

(bone mineral density) assessment, 14.5% had osteoporosis and 37% had osteopenia. The

bone mineral density decreased with advancing age and duration of menopause and 48.5%

had normal BMD. Seventy-five percent of the women had two or more risk factors. Risk

factors were Postmenopausal (AOR ¼ 2.55), hysterectomy (AOR ¼ 2.18), low calcium intake

(AOR ¼ 1.95), cigarette smoking (AOR ¼ 1.29) and family history of osteoporosis

(AOR ¼ 1.48). By logistic regression, antiresorptive therapy found to be a positives predictor

and negative predictors were exercise (AOR ¼ 0.38), calcium supplemental (AOR ¼ 0.61) and

hormone replacement therapy (AOR ¼ 0.47).

Conclusion: Findings showed a high prevalence of osteoporosis and osteopenia among

women with advancing age, during menopause and post menopause indicating an

increased risk of fractures in older women.

Copyright ª 2013, JPR Solutions; Published by Reed Elsevier India Pvt. Ltd. All rights

reserved.

1. Introduction

Menopause is the stage of a woman’s life, typically between

the ages of 45 and 55, when she stops having menstrual

.A. Yousefi).2013, JPR Solutions; Publi

periods. The transition from a reproductive stage to meno-

pause occurs naturally over a period of years, but it can also be

brought on suddenly by any medical procedure that damages

or removes the ovaries.1 Menopause is also called as change of

shed by Reed Elsevier India Pvt. Ltd. All rights reserved.

j o u rn a l o f p h a rma c y r e s e a r c h 6 ( 2 0 1 3 ) 3 0 9e3 1 2310

life and is the opposite of the menarche. Some women expe-

rience common symptoms of menopause, such as hot flashes

and mood swings, while other women experience few or no

symptoms at all. Postmenopausal is defined formally as the

time after which a woman has experienced twelve consec-

utive months of amenorrhea (lack of menstruation) without

a period. The average length of the postmenopausal has been

increasing. With greater longevity, a woman will soon be

postmenopausal on the average a third of her life.2 Osteopo-

rosis is a multi factorial and silent epidemic disease which is

the first fourth major threat to health in twenty first century.

Osteoporosis has even more mortality than most cancers.3,4

There is no other pernicious disease in whole medical his-

tory which has not been paid enough attention to 50% of

women aged >45 and 90% of women aged >75 in U.S have

osteoporosis respectively and anticipated to have more than

4.5 million hip fractures until 2050.5,6 The major risk factors

for osteoporosis are well documented. They include female

sex, white or Asian ethnicity, positive family history, post-

menopausal status, null parity, short stature and small bones,

leanness, sedentary lifestyle, low calcium intake, smoking,

alcohol abuse, and high caffeine, protein, or phosphate intake.

Endocrine disorders, gastrointestinal disorders and certain

medications can also increase risk.7,8

Hence anX-ray cannot reliablymeasure bone density but is

useful to identify spinal fractures. In the early stages of bone

loss, usually have no pain or other symptoms. One of the best

and most common ways to monitor bone health is by having

a bone mineral density (BMD) test. If don’t already have

osteoporosis but could be at risk, a BMD can help doctor to

predict likelihood of having a fracture. Repeated BMD tests

allow the doctor to compare the results and see if patients are

losing bone ormaintaining it. A BMD is also used to confirman

osteoporosis diagnosis; in fact, it’s the only test than can di-

agnose osteoporosis. Dual energy X-ray absorptiometry (DXA,

formerly DEXA) is considered the gold standard for the diag-

nosis of osteoporosis.9e11 Bone densitometry is a safe, fast,

and exact test. By the way DXA is an expensive detection tool

and could not be use as a screening method to all population

thus our study aim to identify the high risk group and their

associated osteoporosis risk factors which is notable when

will be apply in future public health policy and programs.12

Osteoporosis is a substantial cause of morbidity and mor-

tality and affects 25 million Americans, predominantly post-

menopausal women.13 The National Osteoporosis Foundation

estimates direct and indirect costs associated with this dis-

order to be $18 billion, with $7 billion related to hip fractures

alone.10,14 White women aged 50 years have a 40% chance of

sustaining an osteoporosis-related fracture during the

remainder of their lifetimes.15,16 Hip fracture is of particular

concern because of the 20% chance of excess mortality within

1 year of the event.7 Osteoporosis is an extremely important

problem in primary care wheremost postmenopausal women

are seen for physician visits. Among the 20 million women

nationally with osteoporosis, only 4 million have been diag-

nosed with this disorder. About 1.3 million osteoporotic frac-

tures occur each year in the United States.14 The present study

has been taken up to assess the effect of these risk factors and

lifestyle on BMD of the study group and consequent aware-

ness plane for the target population to prevent osteoporosis.

2. Subjects and methods

2.1. Study design

A cross-sectional hospital-based study has been performed to

investigate 200 osteoporosis suspected women aged 45e65

referring to Atieh Hospital in Tehran, Iran. It is a questionnaire

based study which involves data on dietary habit, medication,

physical activity, and lifestyle (such as smoking, alcohol, tea,

coffee, and soda consumption).

2.2. Data collection

Data collected for this study included filling questionnaires

through personal interviews, use of case records, files and

documents. The questionnaire covered the following factors

and information: demographic characteristics (including age,

marital status), menstrual and obstetrical history (menarche

age, age of menopause, parity and abortion) and medical

condition and medication. Medical condition included (his-

tory of endocrine disorders like diabetes and thyroid, heart

disease, kidney, asthma, and other related medical problem).

Moreover, any disorders and discomfort related to bone and

joint that needs treatment or rest were also included in the

present study. Medication included most common related

drugs and supplements like: calcium supplementation, hor-

mone replacement therapy (HRT) and steroids with at least

lowest available therapeutic and/or preventive dose that were

used continuously 6months or more for calcium and HRT and

one month or more for steroids. Nutrition questionnaire: life

time food frequency questionnaire and food habits. Physical

activity, exercises, self-imagination, reporting physical activ-

ity and standing on feet (exercises at about 20e30 min daily

which was repeated 3 times a week). Habits: alcohol con-

sumption, smoking and tobacco use.

Anthropometric characters: height, weight, BMI (weight

and height were used to be measured and recorded in all BMD

centers before measurement of bone density). Weight less

than 60 kg and BMI less than 26 have been shown as risk

factors of osteoporosis. Height less than 155 cm has been

shown as a risk factor of osteoporosis in subjects. Early

menopause (before 45 years old), late menarche (after 14

years) and postmenopausal duration more than 5 years were

shown as significant risk factors.

2.3. Study subject and size

Study subject has enrolled women between 45 and 65 old

suspected to osteoporosis. Thus we expect number of 200

participants according to previous record.

2.4. Statistical analysis

We have initially described characteristics of our study pop-

ulation which involves: demographic (age, gender, marital

status, resident place, ethnic/race.else), socioeconomic

(family size, household income .else), information on

osteoporosis risk factor, subsequently the cross tabling of

each explanatory variable by outcome variable (BDML), using

Table 1 e Percentage of women affected by the differentosteoporosis risk factors.

Osteoporosis risk factors Yes (%) No (%)

Physical inactivity 39 61

Menopausal 83 17

Spending more than 15 min

under sunshine daily

79.5 20.5

Family history of osteoporosis 26.5 73.5

Cigarette smoking 21 79

High use of caffeine, tea & soda 33.5 66.5

Use of steroid 51.5 48.5

Low calcium intake 27.5 72.5

Hysterectomy 23 77

Alcohol advice 1.5 98.5

The women were predominantly

either married

79 21

Table 3 e Result of multiple regression analysis on therisk factors of osteoporosis for the study population.

Risk factors Odds-ratio

Age at menopause (more than 55 years) 2.55

Hysterectomy (more than 10 years) 2.18

Low calcium intake 1.95

Family history of osteoporosis 1.48

High use of caffeine 1.34

High use of soda 1.32

Cigarette smoking 1.29

High use of tea 1.07

Calcium supplemental 0.61

Spending more than 15 min under sunshine daily 0.52

HRT (Hormone replacement therapy) 0.47

Exercise (more than 20e30 min daily

which was repeated 3 times a week)

0.38

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Chi-square test to find significant association, and finally we

used multiple logistic regression to estimate the association

between osteoporosis and its risk factors and obtaining the

odds- ratio of each of the risk factors. All statistical analyses

were performed using SPSS for windows version 13.0 (SPSS

Inc, Chicago).

3. Results and discussion

This study was limited to postmenopausal women between

the ages of 45e65 years, since this age range can take best

benefit from prevention strategies. Two hundred women met

the study. Seventy-five percent of thewomenhad two ormore

risk factors. Table 1 depicts the percentage of women influ-

enced by any osteoporosis risk factor. Only 11% of the women

who had four or more risk factors had received any

osteoporosis-specific intervention. The prevention of disease,

including osteoporosis should constitute a principle of prac-

tice for primary care physicians. The study showed that out of

total 200 women who underwent the BMD (bone mineral

density) assessment, 14.5% had osteoporosis and 37% had

osteopenia. The bone mineral density decreased with

advancing age and duration of menopause and 48.5% had

normal BMD. Distribution of subjects with respect to the

prevention strategies used by women under study is shown in

Table 2. To sum up the risk factors mentioned in this study

such as steroid, Postmenopausal hysterectomy, low calcium

intake, family history of osteoporosis, high use of caffeine &

soda & tea, and cigarette smoking increased the risk of

osteoporosis while the factors such as exercise, calcium

Table 2 e Distribution of subjects with respect to theprevention strategies used by subjects.

Use of prevention strategies Yes (%) No (%)

Had never taken supplemental calcium & vit. D 65 35

Hormone replacement therapy 21.5 78.5

Raloxifene (Evista) 3.5 96.5

Alendronate (Fosamax) 6 94

Weight-bearing exercise 16.5 83.5

supplemental, sunshine and hormone replacement therapy,

obviously led to reduction of the risk of osteoporosis. Risk

factors were Postmenopausal (AOR ¼ 2.55), hysterectomy

(AOR ¼ 2.18), low calcium intake (AOR ¼ 1.95), cigarette

smoking (AOR ¼ 1.29) and family history of osteoporosis

(AOR ¼ 1.48) (Table 3). By logistic regression, the positives

predictors of antiresorptive therapy, and negative predictors

were exercise (AOR ¼ 0.38), calcium supplemental

(AOR ¼ 0.61) and hormone replacement therapy (AOR ¼ 0.47)

(Table 3).

4. Conclusion

In conclusion, our data showed a high prevalence of osteo-

porosis and osteopenia among women with advancing age,

during menopause and post menopause. This will in turn

increase the risk of fractures in older women. This will be

a notice for the health care professionals to take the pre-

venting factors into consideration and alarms nutritionists

and dieticians to help the target group for changing their food

habits and lifestyle.

Conflicts of interest

All authors have none to declare.

Acknowledgment

The authors would like to thank to the staff of the Atieh

Hospital for their generous support. We also thank the sub-

jects who actively participated in the study and sincerely

supported our research.

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