Body Composition and Bone

Mineral Density in Egyptian

Overweight Women

Omar Hussein*, Moushira Erfan**, Safenaz Youssif**

* Radiology Department, Faculty of Medicine Ain Shams University, **
Biological Anthropology Department, Medical Research Division, NRC

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 The human body is composed of a variety of
different tissue types; adipose tissue (fat), lean
tissues including muscles & organs and bone.

 Body Composition is a technical term used to

describe the different components that when
taken together make up a person's body weight.

 Accurate assessment of body composition is

important for providing fundamental whole body
descriptive characteristics.

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Methods of body composition
assessment
Radiological assessment
 Dual energy X-ray absorptiometry "DXA”.
 Computed tomography (CT).
 Magnetic resonance imaging (MRI).

Bioelectrical impedance analysis (BIA)

 BIA is a method based on the resistance to
the passage of electric current through
organic tissues, which have different water
and electrolytic content.
Dual energy x-ray
absorptiometry (DXA)
 (DXA) was originally designed to measure bone
mineral content, and is still most widely used for
this application, but this method may also be
used to estimate the composition of soft tissue
lean mass and fat mass of the total body and
segmental body regions.
 Introduction
 Osteoporosis and obesity are important global
health problems with an increasing prevalence.

 A positive association between body weight or

body mass index (BMI) and bone mineral density
(BMD) has been clearly demonstrated.

 Possible explanations for higher BMD in heavier

people include the weight-bearing effect of both
fat mass (FM) and lean mass (LM).

 lean mass is thought to influence bone through

muscle-mediated effects of physical exercise.

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The effect of fat distribution on BMD is far
from clear.
Adipose tissue might influence BMD through
the production of hormone and adipokines by
adipocyte or through an effect on the
secretion of bone-active hormones from the
pancreas.

 In postmenopausal women fat mass has

been shown most consistently to be positively
related to BMD, possibly mediated by higher
estrogen levels.
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 The aim of our study is to investigate the relation
between body composition parameters and bone
mineral density in overweight Egyptian women.

 Our study investigated the differential effects of fat

mass (FM) and lean mass (LM) on BMD in pre and post
menopusal overweight women.

 Correlations between total and regional BMD and

regional FM, LM and total body fat percentage were
studied in both groups.

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 Subjects and Methods
 This study designed as a cross-sectional investigation,
performed on 50 Egyptian women aged between 30 and 70
years with a mean age of 52.9 +/- 10.9 years old and body
mass index (BMI) over 25.
BMI = Weight/height2 (N=20-25, overweight=25-30, Obese > 30).

 Total and regional bone mineral density (BMD) and body

composition were measured by dual-energy X-ray
absorptiometry (DXA- Lunar).

 BMD was measured at the radius, hip, lumbar spine and

total body (BMD and BMC).

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Anthropometric measurements were taken for
all subjects including weight, height, waist, hip
and mid upper arm circumferences.

A. Sites of the circumference measurements. b Regions of trunk fat (T), leg fat (L),
‘‘android’’ fat, and ‘‘gynoid’’ fat assessed by DXA

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 Subjects were divided into two groups according
to the menstrual history, pre-menopausal and
post-menopausal.

 Comparison between pre- and post-menopausal

groups were done by the Student t-test.

 The multiple-regression analysis stepwise method

was used to determine the relative contribution of
body composition variables on total and regional
BMD.

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Results

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 Table 1
BMD and body composition characteristics by menopausal
status
 Table 2
Correlation between total and regional BMD and body
composition by multiple regression analysis using the
stepwise method in Pre-menopausal women

r2%
Values are standardized multiple regression coefficient. Values in parentheses are
partial correlation coefficient, − not selected by the stepwise method (P<0.05).

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 Table 3
Correlation between total and regional BMD and body
composition multiple regression analysis using the
stepwise method in Post-menopausal women

Fat ratio

r2%
Values are standardized multiple regression coefficient. Values in parentheses are
partial correlation coefficient, − not selected by the stepwise method (P<0.05).

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 Pre-menopausal women Post-menopausal women
Total BMD

Total BMD

(Age (year (Age (year

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 In postmenopausal, the study
showed that increased fat % and
lean % are positively correlated to
BMD of various sites.
Post-menopausal women Post-menopausal women

Femoral neck BMD

Total BMD

Lean Mass Lean Mass

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 Post-menopausal women
Spine L2-L4

Forearm radius 33%

Femoral neck BMD

%Trunk/total fat

Forearm BMD
%Trunk/total fat

%Trunk/total 21
fat
• In premenopausal, the study showed
that only increased lean % is
positively correlated to BMD.
• However the fat % wasn’t correlated
to BMD.

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Pre-menopausal women Pre-menopausal women

Total BMD
Total BMD

Lean Mass %Total Fat

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 Discussion
 Correlation between body composition and BMD is
controversial.

 Some studies have reported the positive correlation

between fat mass (FM) and BMD and others have
reported the correlation with fat-free mass.

 In addition, some studies reported that both FM and

fat free mass affect BMD in the same direction.

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 In addition to the weight-bearing effect on the
bone in overweight women, abundant fat
mass (FM) might have a protective effect
against age-related BMD decline and
postmenopausal BMD decline.

 However, the decline of BMD after

menopause would overcome the protective
effects of overweight on BMD.

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 Results showed higher regional and total BMD in
pre-menopausal women compared to post-menopausal
with slow age-related decline in BMD because our
subjects were overweight women.

 BMD of women showed decline after menopause,

multiple regression analysis revealed that total and
regional BMD were correlated with both lean mass (LM)
and regional fat mass (FM) strongly in post-menopausal
women.

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 The present study showed that both fat mass
and lean mass were significant predictors of
bone density in post-menopausal women, with
lean mass being more important predictor
than fat mass.

 BMD of pre-menopausal women was not

correlated with fat mass (FM) which indicates
that potential effects of FM on BMD is critically
dependent on menopusal status and age.

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 Lean mass was being more important predictor
than fat mass in pre-menopausal women.

 The study shows significant positive correlation

between regional BMD and corresponding regional
percentage fat.

 Therefore, both lean mass (LM) and fat mass (FM)

have important effects on BMD in Egyptian
overweight women , depending on age, the skeletal
site measured and menopausal status.

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Thank You