Journal List > Korean J Nutr > v.45(5) > 1043953

Korean J Nutr. 2012 Oct;45(5):470-478. Korean.
Published online October 31, 2012.
© 2012 The Korean Nutrition Society
Dietary factors affecting bone mineral density in Korean rural postmenopausal women
Jeong Sook Choe,1 Eun Mi Ahn,1 Sung Ok Kwon,2 Young Hee Park,1 and Jinyoung Lee1
1Agro-food Utilization Division, Rural Development of Administration, Suwon 441-853, Korea.
2Department of Food and Nutrition, Kyoung Hee University, Seoul 130-701, Korea.

To whom correspondence should be addressed. (Email: )
Received June 26, 2012; Revised July 26, 2012; Accepted October 08, 2012.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.


This study was conducted to investigate dietary factors, bone status, and bone loss in postmenopausal women in rural areas. A total of 189 women participated in the follow-up study after two years. Radius, Tibia, and Phalanx SOS (Speed of Sound) was measured on two occasions 2 years apart by ultra-sonic-metry, and % body fat was measured by bioelectrical impedance analysis at the baseline and after 2years. Dietary intake data were collected 4 times at different season by 24-hour recall method, and then calculated as average. Bone density of radius decreased by 4.2% during the two year period. When the subjects were divided into three groups, by bone decline level during two years, the lowest bone loss group had higher potassium and vegetable intake than other groups. Age and calcium intakes showed significant correlation with bone decline rate at tibia. In multiple regressions, the baseline SOS, vitamin A, vegetables and eggs intakes were found to be significant factors for tibia bone decline. In conclusion, dietary factors, such as higher vegetable intake, seem to affect the changes in bone mineral density in more favorable way. Therefore, efforts are needed to enhance the access to nutritional care for rural elderly postmenopausal women.

Keywords: Postmenopausal women; bone mineral density; radius; nutrient density; food intake


Fig. 1
Flowchart of the study. *: Quantitative Ultrasound
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Fig. 2
Bone loss (%) over 2 years by age-groups.
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Table 1
Body composition of subjects at baseline and after 2 years
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Table 2
Values of bone SOS (m/s) measured by ultrasound in each year
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Table 3
Mean bone loss (%) by tertile of bone loss (%)
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Table 4
Age, menopausal age, duration after menopause and number of birth by tertile of bone loss at radius
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Table 5
Body composition by tertile of bone loss at radius
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Table 6
Energy and nutrient density by tertile of bone loss (%) at radius and tibia
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Table 7
Food intake by tertile of bone loss (%) at radius and tibia
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Table 8
Partial correlations between bone loss (%) and related factors
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Table 9
Partial correlations between bone loss(%) at tibia and related factors by age-groups
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Table 10
Multiple regression analysis with baseline bone SOS, and nutrient density and food intake as independent variables and bone loss (%) at radius
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This work was supported by National Academy of Agricultural Science, Rural Development of Administration, Republic of Korea.

1. Statistics Korea. Report of society investigation. Daejeon: Statistics Korea; 2011.
2. Kim OS, Ryu HS. The study on blood lipid levels according to the food habits and food intake patterns in Korean elderly. Korean J Food Nutr 2009;22(3):421–429.
3. Uh SB, Kim HS, Baek K, Kang KH, Yuk JY, Kim BS. A study on risk factors of nutrition in a rural aged people. J Korea Sport Res 2005;16(6):237–250.
4. Ministry of Health and Welfare, Korea Centers for Disease Control and Prevention. Korean National Health and Nutrition Examination Survey. Cheongwon: Korea Centers for Disease Control and Prevention; 2010.
5. Jang S, Park C, Jang S, Yoon HK, Shin CS, Kim DY, Ha YC, Lee SS, Choi HJ, Lee YK, Kim BT, Choi JY. Medical service utilization with osteoporosis. Endocrinol Metab 2010;25(4):326–339.
6. Ministry of Health and Welfare, Korea Centers for Disease Control and Prevention. Korean National Health and Nutrition Examination Survey. Cheongwon: Korea Centers for Disease Control and Prevention; 2008.
7. Lee WJ, Kim NW. A statistical compare analysis of bone mineral density of lumbar spine and femur, risk factors for osteoporosis in the women of pre, postmenopausal. J Radiol Sci Technol 2005;28(3):227–234.
8. Aaseth J, Boivin G, Andersen O. Osteoporosis and trace elements--an overview. J Trace Elem Med Biol 2012;26(2-3):149–152.
9. Moon ES, Lee ES. The relationship between knowledge, health beliefs, and prevention behaviors of osteoporotic fracture in patients receiving osteoporosis treatment. Korean J Women Health Nurs 2010;16(2):147–156.
10. Lee JS, Yu CH. Some factors affecting bone mineral density of Korean rural women. Korean J Nutr 1999;32(8):935–945.
11. Lim S, Shin CS, Kim KS, Kim SY, Bang EJ, Shin EK, Choi HR, Chung MH, Cho SI. Determinants of limb-bone mineral density in healthy men and women aged over 50 in rural area. J Korean Soc Endocrinol 2003;18(2):193–205.
12. Sung CJ, Choi YH, Kim MH, Choi SH, Cho KO. A study of nutrient intake and serum levels of osteocalcin, Ca, P, and Mg and their correlation to bone mineral density in Korean postmenopausal women residing in rural areas. Korean J Community Nutr 2002;7(1):111–120.
13. Kim JG, Moon YW. Diagnosis of osteoporosis. J Korean Hip Soc 2011;23(2):108–115.
14. Shin YL. Assessment of bone mineral density. J Korean Soc Pediatr Endocrinol 2006;11(2):123–130.
15. Chung SJ, Kang SH, Song SM, Ryu SH, Yoon J. Nutritional quality of Korean adults' consumption of lunch prepared at home, commercial places, and institutions: analysis of the data from the 2001 National Health and Nutrition Survey. Korean J Nutr 2006;39(8):841–849.
16. Baek KH, Kang MI. Official positions of the international society for clinical densitometry. J Korean Soc Endocrinol 2005;20(1):1–7.
17. Park J, Choi M, Lee S, Choi Y, Park Y. The association between bone mineral density, bone turnover markers, and nutrient intake in pre- and postmenopausal women. Korean J Nutr 2011;44(1):29–40.
18. Ahlborg HG, Johnell O, Nilsson BE, Jeppsson S, Rannevik G, Karlsson MK. Bone loss in relation to menopause: a prospective study during 16 years. Bone 2001;28(3):327–331.
19. Baczyk G, Chuchracki M, Klejewski A. The relationship between selected biochemical parameters, clinical factors and bone mineral density in postmenopausal women with osteoporosis. Ginekol Pol 2012;83(3):194–201.
20. Lee MK, Yoon BK, Chung HY, Park HM. The serum vitamin D nutritional status and its relationship with skeletal status in Korean postmenopausal women. Korean J Obstet Gynecol 2011;54(5):241–246.
21. Saarelainen J, Kiviniemi V, Kröger H, Tuppurainen M, Niskanen L, Jurvelin J, Honkanen R. Body mass index and bone loss among postmenopausal women: the 10-year follow-up of the OSTPRE cohort. J Bone Miner Metab 2012;30(2):208–216.
22. Greendale GA, Sowers M, Han W, Huang MH, Finkelstein JS, Crandall CJ, Lee JS, Karlamangla AS. Bone mineral density loss in relation to the final menstrual period in a multi-ethic cohort: Results from the study of women's health across the nation (SWAN). J Bone Miner Res 2012;27(1):111–118.
23. Chung JE, Hwang SJ, Kim MJ, Song JY, Cho HH, Kwon DJ, Lew YO, Lim YT, Kim EJ, Kim JH, Kim JH, Kim MR. Relationship between body composition and bone mineral density in pre- and post-menopausal women. J Korean Soc Menopause 2010;16(1):29–38.
24. Cure-Cure C, Cure-Ramírez P, Terán E, López-Jaramillo P. Bone-mass peak in multiparity and reduced risk of bone-fractures in menopause. Int J Gynaecol Obstet 2002;76(3):285–291.
25. Hur SE, Chung HW. Age related difference in the bone mineral density of the distal forearm in Korean women. J Korean Soc Menopause 2003;9(3):226–231.
26. Jeong IG, Yoon JH, Kim JO, Kim YP, Lee MS, Yoon JS, Byun JJ. Relationship of isokinetic flexion and extension muscle strength, muscle mass to bone mineral density in body limbs. Korean J Sports Med 2003;21(2):176–183.
27. Bae YJ, Sung CJ. A comparison between postmenopausal osteoporotic women and normal women of their nutrient intakes and the evaluation of diet quality. Korean J Community Nutr 2005;10(2):205–215.
28. Farrell VA, Harris M, Lohman TG, Going SB, Thomson CA, Weber JL, Houtkooper LB. Comparison between dietary assessment methods for determining associations between nutrient intakes and bone mineral density in postmenopausal women. J Am Diet Assoc 2009;109(5):899–904.
29. Yeon JY, Sung CJ. A study on dietary mineral intakes, urinary mineral excretions, and bone mineral density in Korean postmenopausal women. Korean J Community Nutr 2011;16(5):569–579.
30. Kim KR, Kim KH, Lee EK, Lee SS. A study on the factors affecting bone mineral density in adult women-based on the mothers of elementary school students. Korean J Nutr 2000;33(3):241–249.
31. Park HM, Heo J, Park Y. Calcium from plant sources is beneficial to lowering the risk of osteoporosis in postmenopausal Korean women. Nutr Res 2011;31(1):27–32.
32. Kim MS, Koo JO. Analysis of factors affecting bone mineral density with different age among adult women in Seoul area. Korean J Community Nutr 2007;12(5):559–568.
33. Tucker KL, Chen H, Hannan MT, Cupples LA, Wilson PW, Felson D, Kiel DP. Bone mineral density and dietary patterns in older adults: the Framingham Osteoporosis Study. Am J Clin Nutr 2002;76(1):245–252.
34. Promislow JH, Goodman-Gruen D, Slymen DJ, Barrett-Connor E. Retinol intake and bone mineral density in the elderly: the Rancho Bernardo Study. J Bone Miner Res 2002;17(8):1349–1358.
35. Ribaya-Mercado JD, Blumberg JB. Vitamin A: is it a risk factor for osteoporosis and bone fracture? Nutr Rev 2007;65(10):425–438.
36. Talaulikar VS, Chambers T, Manyonda I. Exploiting the antioxidant potential of a common vitamin: could vitamin C prevent postmenopausal osteoporosis? J Obstet Gynaecol Res 2012;38(1):253–257.
37. Ruiz-Ramos M, Vargas LA, Fortoul Van der Goes TI, Cervantes-Sandoval A, Mendoza-Nunez VM. Supplementation of ascorbic acid and alpha-tocopherol is useful to preventing bone loss linked to oxidative stress in elderly. J Nutr Health Aging 2010;14(6):467–472.