Problems with Bone Health and the Influencing Factors of Bone Mineral Density in Women across the Life Cycle

Nami Chun; Hyunju Chae

doi:10.4069/kjwhn.2015.21.1.43

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Chun and Chae: Problems with Bone Health and the Influencing Factors of Bone Mineral Density in Women across the Life Cycle

Original Article

Korean J Women Health Nurs 2015;21(1):43-54.

Published online: 17 March 2015

DOI: https://doi.org/10.4069/kjwhn.2015.21.1.43

Problems with Bone Health and the Influencing Factors of Bone Mineral Density in Women across the Life Cycle

Nami Chun¹, Hyunju Chae^2,

¹College of Nursing, Sungshin Women's University, Seoul, Korea

²Department of Nursing, Joongbu University, Geumsan, Korea

Corresponding author: Chae, Hyunju Department of Nursing, Joongbu University, 201 Daehak-ro, Chubu-myeon, Geumsan 312-702, Korea. Tel: +82-41-750-6912, Fax: +82-41-750-6416, E-mail: hjchae@joongbu.ac.kr

Received 3 March 201517 March 2015 Accepted 17 March 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This study was conducted to identify the problem of bone health and potential influencing factors of bone mineral density (BMD) for women across the life cycle of menopause.

Methods

Complex sampling design data analysis was performed on the fifth Korea National Health and Nutrition Examination Survey 2010 in order to identify the problems with bone health, BMD and its influencing factors in 3,499 women who answered the menopausal status. Women's life cycle was categorized by premenopausal, postmenopausal, and elderly.

Results

35.1% of premenopausal women, 73.3% of postmenopausal women, and 96.0% of elderly women had problems with bone health that were related to low BMD. Influencing factors of BMD were residential area, alcohol drinking, and body mass index (BMI) for premenopausal women; age, residential area, education, marital status, income, and BMI for postmenopausal women; and age, education, and BMI for elderly women.

Conclusion

Problems with bone health required to be considered as a major health problem in all women regardless their life cycle. Interventions to maximize BMD need to be developed by considering its influencingfactors across the women's life cycle.

Keywords: Life cycle, Bone health, Bone mineral density

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Table 1.

General and Health related Characteristics (N=3,499)

Characteristics	Categories	Total (n=3,499)	Premenopausal women (n=1,706)	Postmenopausal women (n=964)	Elderly women (n=829)
Characteristics	Categories	n(%)^‡	n(%)^‡	n(%)^‡	n(%)^‡
Age (year)	19~29	409 (17.6)	409 (30.4)	0 (0.0)	0 (0.0)
	30~39	669 (19.5)	659 (33.3)	10 (1.0)	0 (0.0)
	40~49	628 (21.7)	535 (31.6)	93 (13.5)	0 (0.0)
	50~59	687 (18.0)	103 (4.7)	584 (61.5)	0 (0.0)
	60~69	277 (11.3)	0 (0.0)	277 (24.1)	290 (30.9)
	70~79	422 (9.0)	0 (0.0)	0 (0.0)	422 (52.2)
	≥80	117 (2.9)	0 (0.0)	0 (0.0)	117 (16.9)
Residential area	Metropolitan area	1,485 (44.0)	796 (47.5)	385 (41.7)	304 (35.2)
	Other area	2,014 (56.0)	910 (52.5)	579 (58.3)	525 (64.8)
Education^†	≤Elementary school	1.121 (28.0)	58 (4.2)	419 (43.0)	644 (88.5)
	Middle school	341 (9.8)	75 (4.9)	208 (23.8)	58 (5.8)
	High school	1,071 (34.8)	775 (47.7)	248 (24.7)	48 (4.9)
	≥University	875 (27.5)	785 (43.3)	79 (8.5)	11 (0.9)
Marital status	Unmarried	411 (16.7)	400 (28.3)	11 (1.1)	0 (0.0)
	Married	2,419 (66.3)	1,232 (66.6)	800 (83.0)	387 (40.8)
	Others	669 (17.1)	74 (5.1)	153 (15.9)	442 (59.2)
Occupation	No	1,789 (47.9)	763 (42.8)	461 (43.6)	565 (71.6)
	Yes	1,710 (52.1)	943 (57.2)	503 (56.4)	264 (28.4)
Income^†	1st quartile	859 (27.6)	410 (28.4)	247 (26.7)	200 (26.1)
	2nd quartile	852 (25.0)	408 (24.6)	245 (26.2)	199 (24.7)
	3rd quartile	875 (24.8)	430 (24.6)	237 (25.7)	208 (24.3)
	4th quartile	857 (22.6)	431 (22.4)	222 (21.3)	204 (24.9)
Alcohol	No	520 (17.3)	220 (13.4)	152 (18.4)	148 (37.1)
drinking^†	≤1 time	1,227 (46.1)	727 (46.3)	329 (48.0)	171 (41.6)
(per month)	2~4 times	613 (24.6)	414 (27.6)	145 (21.9)	54 (13.1)
	≥5 times	291 (12.0)	182 (12.7)	73 (11.7)	36 (8.2)
Smoking^†	No	3,031 (86.4)	1,450 (83.6)	886 (90.3)	695 (90.5)
	Yes	380 (13.6)	243 (16.4)	71 (9.7)	66 (9.5)
Physical	No	1,790 (51.8)	899 (52.0)	482 (48.6)	409 (55.8)
activity^†	Yes	1,612 (48.2)	792 (48.0)	471 (51.4)	349 (44.2)
BMI^†	Underweight (＜18.5)	194 (6.4)	144 (9.2)	16 (1.7)	34 (3.6)
	Normal (18.5~22.9)	1,548 (46.0)	934 (54.4)	351 (35.8)	263 (32.9)
	Overweight (23~24.9)	735 (20.7)	289 (16.2)	255 (27.6)	191 (25.7)
	Obesity (≥25)	978 (26.9)	337 (20.2)	341 (34.9)	300 (37.8)
Depressive	No	2,836 (82.9)	1,461 (85.3)	766 (79.0)	609 (80.6)
symptom^†	Yes	574 (17.1)	232 (14.7)	191 (21.0)	151 (19.1)
Stress^†	Low	2,391 (68.6)	1,153 (67.0)	698 (70.9)	540 (70.6)
	High	1,020 (31.4)	540 (33.0)	260 (29.1)	220 (29.4)
Hormone	No	3,075 (92.4)	1,658 (98.0)	735 (79.3)	682 (92.5)
therapy^†	Yes	329 (7.6)	35 (2.0)	219 (20.7)	75 (7.5)

^† Valid percent;

^‡ Weighted percent; BMI=Body Mass Index.

Table 2.

Bone Health and Bone Mineral Density (T-score) across the Life Cycle (N=3,499)

Variables	Premenopausal women (n=1,706)	Postmenopausal women (n=964)	Elderly women (n=829)
Variables	%^†	%^†	%^†
Osteopenia	33.5	57.3	38.8
Osteoporosis	1.6	16.0	57.2
Normal	64.9	26.7	4.0

^† Weighted percent.

Table 3.

Bone Mineral Density (T-score) across the Life Cycle (N=3,499)

Variables	Premenopausal women (n=1,706)		Postmenopausal women (n=964)		Elderly wommen (n=829)
Variables	Mean^†	SE	Mean^†	SE	Mean^†	SE
Total femur	0.30	.03	-0.22	.04	-1.40	.05
Femoral neck	-0.37	.04	-1.16	.03	-2.32	.04
Lumbar spine	-0.23	.03	-1.27	.05	-2.26	.06

^† Estimated mean; SE=standard error.

Table 4.

Bone Mineral Density (T-score) according to Women's Characteristics (N=3,499)

Characteristics	Categories	Premenopausal women (n=1,706)			Postmenopausal women (n=964)			Elderly women (n=829)
Characteristics	Categories	Mean^†	SE	t or F (p)	Mean^†	SE	t or F (p)	Mean^†	SE	t or F (p)
Age (year)	19~29	-0.24	.07	2.11
	30~39	-0.41	.05	(.101)	-0.63	.25	22.12
	40~49	-0.44	.06		-0.71	.09	(＜.001)
	50~59	-0.40	.10		-1.12	.05
	60~69				-1.52	.06		-1.84	.06	52.12
	70~79							-2.38	.05	(＜.001)
	≥80							-3.02	.11
Residential	Metropolitan area	-0.47	.05	7.80	-1.29	.05	11.35	-2.34	.06	0.11
area	Other area	-0.28	.05	(.006)	-1.06	.04	(.001)	-2.31	.06	(.745)
Education	≤Elementary school	-0.28	.13	2.22	-1.34	.05	9.33	-2.34	.04	7.88
	Middle school	-0.51	.15	(.087)	-1.06	.08	(＜.001)	-1.88	.13	(＜.001)
	High school	-0.30	.05		-0.98	.06		-1.87	.11
	≥University	-0.44	.05		-0.89	.14		-1.99	.30
Marital	Unmarried	-0.26	.07	2.66	-1.62	.43	7.18	-2.17	.06	9.73
status	Married	-0.42	.04	(.073)	-1.10	.04	(.001)	-2.42	.06	(.002)
	Others	-0.26	.12		-1.43	.08
Occupation	No	-0.42	.05	1.79	-1.24	.05	4.65	-2.33	.05	0.14
	Yes	-0.34	.04	(.182)	-1.09	.05	(.033)	-2.30	.07	(.705)
Income	1st quartile	-0.29	.07	0.93	-1.28	.06	5.55	-2.21	.07	1.60
	2nd quartile	-0.39	.06	(.429)	-1.05	.06	(.001)	-2.33	.08	(.192)
	3rd quartile	-0.40	.06		-1.28	.06		-2.37	.08
	4th quartile	-0.42	.05		-0.99	.08		-2.42	.08
Alcohol	No	-0.54	.07	5.28	-1.10	.10	1.10	-2.50	.09	3.10
drinking	≤1 time	-0.39	.05	(.002)	-1.13	.06	(.351)	-2.15	.09	(.028)
(per month)	2~4 times	-0.29	.07		-1.06	.09		-2.32	.13
	≥5 times	-0.19	.07		-0.88	.13		-2.11	.17
Smoking	No	-0.24	.07	3.96	-1.25	.12	0.81	-2.59	.16	4.28
	Yes	-0.40	.04	(.048)	-1.14	.04	(.370)	-2.26	.04	(.040)
Physical	No	-0.40	.05	1.88	-1.23	.05	3.91	-2.39	.06	7.00
activity	Yes	-0.33	.05	(.172)	-1.08	.05	(.050)	-2.17	.06	(.009)
BMI	Underweight (＜18.5)	-0.87	.09	37.10	-1.48	.24	7.96	-3.34	.17	24.06
	Normal (18.5~22.9)	-0.53	.04	(＜.001)	-1.35	.06	(＜.001)	-2.59	.06	(＜.001)
	Overweight (23~24.9)	-0.16	.08		-1.18	.06		-2.25	.07
	Obesity (≥25)	0.10	.06		-0.92	.06		-2.04	.07
Depressive	No	-0.29	.08	1.23	-1.17	.08	0.17	-2.36	.08	0.80
symptom	Yes	-0.38	.04	(.269)	-1.14	.03	(.682)	-2.27	.05	(.372)
Stress	Low	-0.32	.05	1.63	-1.16	.07	0.89	-2.26	.08	0.32
	High	-0.40	.04	(.203)	-1.14	.04	(.766)	-2.30	.04	(.573)
Hormone	No	-0.41	.21	0.04	-1.07	.10	1.02	-1.83	.11	18.67
therapy	Yes	-0.37	.04	(.843)	-1.17	.04	(.314)	-2.33	.04	(＜.001)

^† Estimated mean; SE=standard error; BMI=Body Mass Index.

Table 5.

Influencing Factors of Bone Mineral Density (N=3,499)

Factors	Variables	Categories	_β	SE	t	p
Premenopausal	Residential area	Metropolitan area	-.16	.06	-2.79	.006
women		Other area	Reference
(n=1,706)	Alcohol	No	-.24	.08	-2.90	.004
	drinking	≤1 time	-.12	.07	-1.63	.105
	(per month)	2~4 times	-.02	.08	-0.25	.806
		≥5 times	Reference
	BMI	Underweight (＜18.5)	-.99	.12	-8.11	＜.001
		Normal (18.5~22.9)	-.66	.07	-9.99	＜.001
		Overweight (23~24.9)	-.26	.10	-2.67	.008
		Obesity (≥25)	Reference
			R²=.125, F=19.82, p＜.001
Postmenopausal	Age (year)	30~39	.75	.26	2.93	.004
women		40~49	.58	.11	5.50	＜.001
(n=964)		50~59	.32	.08	4.05	＜.001
		60~69	Reference
	Residential area	Metropolitan area	-.20	.06	-3.21	.002
		Other area	Reference
	Education	≤Elementary school	-.33	.15	-2.20	.029
		Middle school	-.20	.16	-1.27	.206
		High school	-.04	.14	-0.26	.793
		≥University	Reference
	Marital status	Unmarried	-.43	.29	-1.47	.143
		Married	.21	.09	2.30	.023
		Others	Reference
	Income	1st quartile	-.19	.10	-1.96	.052
		2nd quartile	-.06	.09	-0.61	.543
		3rd quartile	-.24	.11	-2.22	.028
		4th quartile	Reference
	BMI	Underweight (＜18.5)	-.71	.25	-2.82	.005
		Normal (18.5~22.9)	-.50	.08	-6.48	＜.001
		Overweight (23~24.9)	-.28	.08	-3.60	＜.001
		Obesity (≥25)	Reference
			R²=.180, F=11.48, p＜.001
Elderly women	Age (year)	60~69	1.25	.18	6.79	＜.001
(n=829)		70~79	.70	.15	4.68	＜.001
		≥80	Reference
	Education	≤Elementary school	-.69	.23	-3.00	.003
		Middle school	-.56	.24	-2.32	.021
		High school	-.29	.27	-1.09	.275
		≥University	Reference
	BMI	Underweight (＜18.5)	-.75	.32	-2.35	.020
		Normal (18.5~22.9)	-.35	.10	-3.49	.001
		Overweight (23~24.9)	-.23	.12	-1.93	.056
		Obesity (≥25)	Reference
			R²=.325, F=12.34, p＜.001

BMI=Body Mass Index.

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