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Published in: Archives of Osteoporosis 1/2021

01-12-2021 | Osteoporosis | Original Article

Bone mineral density in healthy adult Indian population: the Chandigarh Urban Bone Epidemiological Study (CUBES)

Authors: Anshita Aggarwal, Rimesh Pal, Sanjay Kumar Bhadada, Sant Ram, Abhilasha Garg, Anil Bhansali, Priyanka Singh, J. S. Thakur, Tulika Singh, Naresh Sachdeva, Sudhaker D. Rao

Published in: Archives of Osteoporosis | Issue 1/2021

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Abstract

Summary

Osteoporosis is a disease with a high burden of morbidity. For its accurate diagnosis, using indigenous data as reference standards is needed. However, normative data on bone density is lacking in India. Therefore, we aimed to determine the reference range for bone density for the healthy population of north India.

Introduction

Osteoporosis is a major public health problem around the globe including India, resulting in significant morbidity, mortality, and health care burden. However, the reference values used for its diagnosis are largely based on data from the western population, which may lead to over- or underdiagnosis of osteoporosis in Indians. Our study aimed to determine the reference range for bone mineral density for the healthy population of India.

Methods

This is a cross-sectional study of 825 subjects (men 380, women 445) (median age: 41 years, IQR 32–55 years), recruited by a house-to-house survey. The population was stratified into decade-wise groups and biochemical measurements including renal and liver function tests, glycated hemoglobin, serum calcium, 25-hydroxyvitamin D, parathyroid hormone, and bone mineral density were performed in all the subjects. The T-scores for men aged > 50 years and post-menopausal women were calculated based on the data generated from this study in young men and women aged 20–40 years.

Results

According to the BMD manufacturer’s data, which is based on the western population, 70% of the Indian men (> 50 years) and 48% of the post-menopausal Indian women had osteopenia while 18% of the men and 25% of the women had osteoporosis. However, according to the re-calculated T-scores from the current study, only 56% and 7.2% of men and 33% and 5% of women had osteopenia and osteoporosis, respectively. An age-related decline in bone mineral density, as seen in the western population, was also seen in both Indian men and women.

Conclusion

We have established a reference database for BMD in healthy Indian adult population, which may have clinical implications for the diagnosis and intervention strategies for the management of osteoporosis.
Literature
1.
go back to reference Kanis JA (2007) WHO Technical Report. University of Sheffield66, UK Kanis JA (2007) WHO Technical Report. University of Sheffield66, UK
2.
go back to reference Johnell O, Kanis JA (2006) An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int 17:1726–1733CrossRef Johnell O, Kanis JA (2006) An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int 17:1726–1733CrossRef
3.
go back to reference Leibson CL, Tosteson ANA, Gabriel SE, Ransom JE, Melton LJ III (2002) Mortality, disability, and nursing home use for persons with and without hip fracture: a population-based study. J Am Geriatr Soc 50:1644–1650CrossRef Leibson CL, Tosteson ANA, Gabriel SE, Ransom JE, Melton LJ III (2002) Mortality, disability, and nursing home use for persons with and without hip fracture: a population-based study. J Am Geriatr Soc 50:1644–1650CrossRef
4.
go back to reference Kanis JA, Delmas P, Burckhardt P, Cooper C, Torgerson D (1997) Guidelines for diagnosis and management of osteoporosis. The European Foundation for Osteoporosis and Bone Disease. Osteoporos Int 7:390–406CrossRef Kanis JA, Delmas P, Burckhardt P, Cooper C, Torgerson D (1997) Guidelines for diagnosis and management of osteoporosis. The European Foundation for Osteoporosis and Bone Disease. Osteoporos Int 7:390–406CrossRef
5.
go back to reference Compston JE, McClung MR, Leslie WD (2019) Osteoporosis. Lancet 393:364–376CrossRef Compston JE, McClung MR, Leslie WD (2019) Osteoporosis. Lancet 393:364–376CrossRef
6.
go back to reference Bolland MJ, Grey AB, Gamble GD, Reid IR (2010) Effect of osteoporosis treatment on mortality: a meta-analysis. J Clin Endocrinol Metab 95:1174–1181CrossRef Bolland MJ, Grey AB, Gamble GD, Reid IR (2010) Effect of osteoporosis treatment on mortality: a meta-analysis. J Clin Endocrinol Metab 95:1174–1181CrossRef
7.
go back to reference Tosteson ANA, Burge R, Marshall D, Lindsay R (2008) Therapies for treatment of osteoporosis in US women: cost-effectiveness and budget impact considerations. Am J Manag Care 14:605–615PubMed Tosteson ANA, Burge R, Marshall D, Lindsay R (2008) Therapies for treatment of osteoporosis in US women: cost-effectiveness and budget impact considerations. Am J Manag Care 14:605–615PubMed
8.
go back to reference Kanis JA, Melton LJ, Christiansen C et al (1994) The diagnosis of osteoporosis. J Bone Miner Res 9:1137–1141CrossRef Kanis JA, Melton LJ, Christiansen C et al (1994) The diagnosis of osteoporosis. J Bone Miner Res 9:1137–1141CrossRef
9.
go back to reference (1997) Standardization of proximal femur bone mineral density (BMD) measurements by DXA. International Committee for Standards in Bone Measurement. Bone 21:369–370 (1997) Standardization of proximal femur bone mineral density (BMD) measurements by DXA. International Committee for Standards in Bone Measurement. Bone 21:369–370
10.
go back to reference Khadilkar AV, Mandlik RM (2015) Epidemiology and treatment of osteoporosis in women: an Indian perspective. Int J Womens Health 7:841–850CrossRef Khadilkar AV, Mandlik RM (2015) Epidemiology and treatment of osteoporosis in women: an Indian perspective. Int J Womens Health 7:841–850CrossRef
11.
go back to reference Malhotra N, Mithal A (2008) Osteoporosis in Indians. Indian J Med Res 127:263–268PubMed Malhotra N, Mithal A (2008) Osteoporosis in Indians. Indian J Med Res 127:263–268PubMed
12.
go back to reference Shatrugna V, Ammini AC, Tandon N et al Population based reference standards of Peak Bone Mineral Density of Indian males and females – an ICMR multi-centre task force study. 34 Shatrugna V, Ammini AC, Tandon N et al Population based reference standards of Peak Bone Mineral Density of Indian males and females – an ICMR multi-centre task force study. 34
13.
go back to reference Makker A, Mishra G, Singh BP, Tripathi A, Singh MM (2008) Normative bone mineral density data at multiple skeletal sites in Indian subjects. Arch Osteoporos 3:25–37CrossRef Makker A, Mishra G, Singh BP, Tripathi A, Singh MM (2008) Normative bone mineral density data at multiple skeletal sites in Indian subjects. Arch Osteoporos 3:25–37CrossRef
14.
go back to reference Marwaha RK, Tandon N, Kaur P, Sastry A, Bhadra K, Narang A, Arora S, Mani K (2012) Establishment of age-specified bone mineral density reference range for Indian females using dual-energy X-ray absorptiometry. J Clin Densitom 15:241–249CrossRef Marwaha RK, Tandon N, Kaur P, Sastry A, Bhadra K, Narang A, Arora S, Mani K (2012) Establishment of age-specified bone mineral density reference range for Indian females using dual-energy X-ray absorptiometry. J Clin Densitom 15:241–249CrossRef
15.
go back to reference Patni R (2010) Normal BMD values for Indian females aged 20–80 years. J Midlife Health 1:70–73PubMed Patni R (2010) Normal BMD values for Indian females aged 20–80 years. J Midlife Health 1:70–73PubMed
17.
go back to reference Kish L (1949) A procedure for objective respondent selection within the household. J Am Stat Assoc 44:380–387CrossRef Kish L (1949) A procedure for objective respondent selection within the household. J Am Stat Assoc 44:380–387CrossRef
18.
go back to reference Horowitz GL, Clinical and Laboratory Standards Institute (2010) Defining, establishing, and verifying reference intervals in the clinical laboratory: approved guideline Horowitz GL, Clinical and Laboratory Standards Institute (2010) Defining, establishing, and verifying reference intervals in the clinical laboratory: approved guideline
19.
go back to reference Sözen T, Özışık L, Başaran NÇ (2017) An overview and management of osteoporosis. Eur J Rheumatol 4:46–56CrossRef Sözen T, Özışık L, Başaran NÇ (2017) An overview and management of osteoporosis. Eur J Rheumatol 4:46–56CrossRef
20.
go back to reference Blake GM, Fogelman I (2007) The role of DXA bone density scans in the diagnosis and treatment of osteoporosis. Postgrad Med J 83:509–517CrossRef Blake GM, Fogelman I (2007) The role of DXA bone density scans in the diagnosis and treatment of osteoporosis. Postgrad Med J 83:509–517CrossRef
21.
go back to reference Cummings SR, Black DM, Nevitt MC et al (1993) Bone density at various sites for prediction of hip fractures. The Study of Osteoporotic Fractures Research Group. Lancet 341:72–75CrossRef Cummings SR, Black DM, Nevitt MC et al (1993) Bone density at various sites for prediction of hip fractures. The Study of Osteoporotic Fractures Research Group. Lancet 341:72–75CrossRef
22.
go back to reference Zengin A, Prentice A, Ward KA (2015) Ethnic differences in bone health. Front Endocrinol (Lausanne) 6:24CrossRef Zengin A, Prentice A, Ward KA (2015) Ethnic differences in bone health. Front Endocrinol (Lausanne) 6:24CrossRef
23.
go back to reference Leslie WD (2012) Ethnic differences in bone mass—clinical implications. J Clin Endocrinol Metab. 97:4329–4340CrossRef Leslie WD (2012) Ethnic differences in bone mass—clinical implications. J Clin Endocrinol Metab. 97:4329–4340CrossRef
24.
go back to reference Pal R, Aggarwal A, Singh T, Sharma S, Khandelwal N, Garg A et al (2020) Diagnostic cut-offs, prevalence, and biochemical predictors of sarcopenia in healthy Indian adults: the Sarcopenia-Chandigarh Urban Bone Epidemiological Study (Sarco-CUBES). Eur Geriatr Med. https://doi.org/10.1007/s41999-020-00332-z Pal R, Aggarwal A, Singh T, Sharma S, Khandelwal N, Garg A et al (2020) Diagnostic cut-offs, prevalence, and biochemical predictors of sarcopenia in healthy Indian adults: the Sarcopenia-Chandigarh Urban Bone Epidemiological Study (Sarco-CUBES). Eur Geriatr Med. https://​doi.​org/​10.​1007/​s41999-020-00332-z
25.
go back to reference El Maghraoui A, Roux C (2008) DXA scanning in clinical practice. QJM 101:605–617CrossRef El Maghraoui A, Roux C (2008) DXA scanning in clinical practice. QJM 101:605–617CrossRef
26.
go back to reference Maalouf G, Salem S, Sandid M, Attallah P, Eid J, Saliba N, Nehmé I, Johnell O (2000) Bone mineral density of the Lebanese reference population. Osteoporos Int 11:756–764CrossRef Maalouf G, Salem S, Sandid M, Attallah P, Eid J, Saliba N, Nehmé I, Johnell O (2000) Bone mineral density of the Lebanese reference population. Osteoporos Int 11:756–764CrossRef
27.
go back to reference Yeh L-R, Chen CK-H, Lai P-H (2004) Normal bone mineral density in anteroposterior, lateral spine and hip of Chinese men in Taiwan: effect of age change, body weight and height. J Chin Med Assoc 67:287–295PubMed Yeh L-R, Chen CK-H, Lai P-H (2004) Normal bone mineral density in anteroposterior, lateral spine and hip of Chinese men in Taiwan: effect of age change, body weight and height. J Chin Med Assoc 67:287–295PubMed
28.
go back to reference Larijani B, Hossein-Nezhad A, Mojtahedi A, Pajouhi M, Bastanhagh MH, Soltani A, Mirfezi SZ, Dashti R (2005) Normative data of bone Mineral Density in healthy population of Tehran, Iran: a cross sectional study. BMC MusculoskeletDisord 6:38CrossRef Larijani B, Hossein-Nezhad A, Mojtahedi A, Pajouhi M, Bastanhagh MH, Soltani A, Mirfezi SZ, Dashti R (2005) Normative data of bone Mineral Density in healthy population of Tehran, Iran: a cross sectional study. BMC MusculoskeletDisord 6:38CrossRef
29.
go back to reference Tamayo J, Díaz R, Lazcano-Ponce E, Muñoz M, Huitrón G, Halley E, Díaz-Montiel JC, Mudgal J, Hernández-Ávila M, Salmerón J (2009) Reference values for areal bone mineral density among a healthy Mexican population. Salud Publica Mex 51(Suppl 1):S56–S83CrossRef Tamayo J, Díaz R, Lazcano-Ponce E, Muñoz M, Huitrón G, Halley E, Díaz-Montiel JC, Mudgal J, Hernández-Ávila M, Salmerón J (2009) Reference values for areal bone mineral density among a healthy Mexican population. Salud Publica Mex 51(Suppl 1):S56–S83CrossRef
30.
go back to reference Lee K-S, Bae S-H, Lee SH, Lee J, Lee DR (2014) New reference data on bone mineral density and the prevalence of osteoporosis in korean adults aged 50 years or older: the Korea National Health and Nutrition Examination Survey 2008-2010. J Korean Med Sci 29:1514–1522CrossRef Lee K-S, Bae S-H, Lee SH, Lee J, Lee DR (2014) New reference data on bone mineral density and the prevalence of osteoporosis in korean adults aged 50 years or older: the Korea National Health and Nutrition Examination Survey 2008-2010. J Korean Med Sci 29:1514–1522CrossRef
31.
go back to reference Kumar A, Sharma AK, Mittal S, Kumar G (2016) The relationship between body mass index and bone mineral density in premenopausal and postmenopausal North Indian Women. J ObstetGynaecol India 66:52–56CrossRef Kumar A, Sharma AK, Mittal S, Kumar G (2016) The relationship between body mass index and bone mineral density in premenopausal and postmenopausal North Indian Women. J ObstetGynaecol India 66:52–56CrossRef
32.
go back to reference Mohamad N-V, Soelaiman I-N, Chin K-Y (2016) A concise review of testosterone and bone health. Clin Interv Aging 11:1317–1324CrossRef Mohamad N-V, Soelaiman I-N, Chin K-Y (2016) A concise review of testosterone and bone health. Clin Interv Aging 11:1317–1324CrossRef
33.
go back to reference Araujo AB, Travison TG, Leder BZ, McKinlay JB (2008) Correlations between serum testosterone, estradiol, and sex hormone-binding globulin and bone mineral density in a diverse sample of men. J Clin Endocrinol Metab 93:2135–2141CrossRef Araujo AB, Travison TG, Leder BZ, McKinlay JB (2008) Correlations between serum testosterone, estradiol, and sex hormone-binding globulin and bone mineral density in a diverse sample of men. J Clin Endocrinol Metab 93:2135–2141CrossRef
34.
go back to reference Shetty S, Kapoor N, Naik D, et al (2014) Osteoporosis in healthy south Indian males and the influence of life style factors and vitamin D status on bone mineral density. J Osteoporos Shetty S, Kapoor N, Naik D, et al (2014) Osteoporosis in healthy south Indian males and the influence of life style factors and vitamin D status on bone mineral density. J Osteoporos
35.
go back to reference Marwaha RK, Tandon N, Garg MK, Kanwar R, Narang A, Sastry A, Saberwal A, Bhadra K, Mithal A (2011) Bone health in healthy Indian population aged 50 years and above. Osteoporos Int 22:2829–2836CrossRef Marwaha RK, Tandon N, Garg MK, Kanwar R, Narang A, Sastry A, Saberwal A, Bhadra K, Mithal A (2011) Bone health in healthy Indian population aged 50 years and above. Osteoporos Int 22:2829–2836CrossRef
36.
go back to reference Kamineni V, Latha AP, Ramathulasi K (2016) Association between serum 25-hydroxyvitamin D levels and bone mineral density in normal postmenopausal women. J Mid-life Health 7:163CrossRef Kamineni V, Latha AP, Ramathulasi K (2016) Association between serum 25-hydroxyvitamin D levels and bone mineral density in normal postmenopausal women. J Mid-life Health 7:163CrossRef
37.
go back to reference Alkhenizan A, Mahmoud A, Hussain A, Gabr A, Alsoghayer S, Eldali A (2017) The relationship between 25 (OH) D levels (vitamin D) and bone mineral density (BMD) in a Saudi population in a community-based setting. PLoS ONE 12:e0169122CrossRef Alkhenizan A, Mahmoud A, Hussain A, Gabr A, Alsoghayer S, Eldali A (2017) The relationship between 25 (OH) D levels (vitamin D) and bone mineral density (BMD) in a Saudi population in a community-based setting. PLoS ONE 12:e0169122CrossRef
38.
go back to reference Nguyen TV, Sambrook PN, Eisman JA (1998) Bone loss, physical activity, and weight change in elderly women: the Dubbo Osteoporosis Epidemiology Study. J Bone Miner Res 13:1458–1467CrossRef Nguyen TV, Sambrook PN, Eisman JA (1998) Bone loss, physical activity, and weight change in elderly women: the Dubbo Osteoporosis Epidemiology Study. J Bone Miner Res 13:1458–1467CrossRef
39.
go back to reference New SA, Bolton-Smith C, Grubb DA, Reid DM (1997) Nutritional influences on bone mineral density: a cross-sectional study in premenopausal women. Am J Clin Nutr 65:1831–1839CrossRef New SA, Bolton-Smith C, Grubb DA, Reid DM (1997) Nutritional influences on bone mineral density: a cross-sectional study in premenopausal women. Am J Clin Nutr 65:1831–1839CrossRef
40.
go back to reference Oktem O, Kucuk M, Ozer K, Sezen D, Durmusoglu F (2010) Relation of body fat distribution to femoral neck bone density and endometrial thickness in postmenopausal women. Gynecol Endocrinol 26:440–444CrossRef Oktem O, Kucuk M, Ozer K, Sezen D, Durmusoglu F (2010) Relation of body fat distribution to femoral neck bone density and endometrial thickness in postmenopausal women. Gynecol Endocrinol 26:440–444CrossRef
Metadata
Title
Bone mineral density in healthy adult Indian population: the Chandigarh Urban Bone Epidemiological Study (CUBES)
Authors
Anshita Aggarwal
Rimesh Pal
Sanjay Kumar Bhadada
Sant Ram
Abhilasha Garg
Anil Bhansali
Priyanka Singh
J. S. Thakur
Tulika Singh
Naresh Sachdeva
Sudhaker D. Rao
Publication date
01-12-2021
Publisher
Springer London
Published in
Archives of Osteoporosis / Issue 1/2021
Print ISSN: 1862-3522
Electronic ISSN: 1862-3514
DOI
https://doi.org/10.1007/s11657-020-00868-4

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