Bone mineral density reference values in Singaporean adults and comparisons for osteoporosis establishment – The Yishun Study

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Abstract

Background

While there have been studies in Singapore on the prevalence and economic burden of osteoporotic hip fracture, there is a severe lack of reference data on bone mineral density and prevalence of osteoporosis. The purpose of this study is to establish the reference values for BMD and compare prevalence of osteoporotic conditions using other available reference values so as to better understand the status of bone health in Singaporean adults.

Methods

We carried out a population-based cross-sectional study using dual-energy x-ray absorptiometry (Hologic Discovery Wi) to measure the bone mineral density of Singaporean adults aged ≥21 years. A total of 542 participants were recruited from the large north-eastern residential town of Yishun. We computed T- scores (denoted by T _SG) for each individual in the study. Similar diagnoses were also done based on T-scores provided by the densitometer (T _DXA), NHANES database (T _NHANES), and China (T _CHN), and the differences in prevalence compared. We then compared the concordance between T _SG and T _DXA in the classification of osteoporosis. Osteoporosis was defined according to criteria by the World Health Organization (WHO).

Results

Peak lumbar spine BMD was 1.093 ± 0.168 g/cm ² in women, and 1.041 ± 0.098 g/cm ² for men. Peak whole-body BMD was 1.193 ± 0.93 g/cm ² in women at, and 1.224 ± 0.112 g/cm ² for men. Prevalence of osteoporosis based on lumbar spine was 9.3% in postmenopausal women, and 0.7% in men after 50 years of age. The percentage difference in prevalence range from 60.5–163.6%, when using reference values from T _DXA, T _NHANES, and T _CHN. Comparing diagnosis using T _DXA and T _SG cut-off values, 28 versus 15 women were diagnosed as osteoporotic respectively. The kappa statistics was 0.81 for women and 0.85 for men.

Conclusion: Our study shows that T-scores provided by DXA manufacturer over-diagnosed osteoporosis in Singaporeans, and the prevalence of osteoporotic conditions is not accurately represented. This over-diagnosis may result in unnecessary treatment in some individuals.

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Most cited references 35

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Global trends in insufficient physical activity among adolescents: a pooled analysis of 298 population-based surveys with 1·6 million participants

Regina Guthold, Gretchen Stevens, Leanne Riley … (2020)

Summary Background Physical activity has many health benefits for young people. In 2018, WHO launched More Active People for a Healthier World, a new global action on physical activity, including new targets of a 15% relative reduction of global prevalence of insufficient physical activity by 2030 among adolescents and adults. We describe current prevalence and trends of insufficient physical activity among school-going adolescents aged 11–17 years by country, region, and globally. Methods We did a pooled analysis of cross-sectional survey data that were collected through random sampling with a sample size of at least 100 individuals, were representative of a national or defined subnational population, and reported prevalence of of insufficient physical activity by sex in adolescents. Prevalence had to be reported for at least three of the years of age within the 10–19-year age range. We estimated the prevalence of insufficient physical activity in school-going adolescents aged 11–17 years (combined and by sex) for individual countries, for four World Bank income groups, nine regions, and globally for the years 2001–16. To derive a standard definition of insufficient physical activity and to adjust for urban-only survey coverage, we used regression models. We estimated time trends using multilevel mixed-effects modelling. Findings We used data from 298 school-based surveys from 146 countries, territories, and areas including 1·6 million students aged 11–17 years. Globally, in 2016, 81·0% (95% uncertainty interval 77·8–87·7) of students aged 11–17 years were insufficiently physically active (77·6% [76·1–80·4] of boys and 84·7% [83·0–88·2] of girls). Although prevalence of insufficient physical activity significantly decreased between 2001 and 2016 for boys (from 80·1% [78·3–81·6] in 2001), there was no significant change for girls (from 85·1% [83·1–88·0] in 2001). There was no clear pattern according to country income group: insufficient activity prevalence in 2016 was 84·9% (82·6–88·2) in low-income countries, 79·3% (77·2–87·5) in lower–middle-income countries, 83·9% (79·5–89·2) in upper–middle-income countries, and 79·4% (74·0–86·2) in high-income countries. The region with the highest prevalence of insufficient activity in 2016 was high-income Asia Pacific for both boys (89·0%, 62·8–92·2) and girls (95·6%, 73·7–97·9). The regions with the lowest prevalence were high-income western countries for boys (72·1%, 71·1–73·6), and south Asia for girls (77·5%, 72·8–89·3). In 2016, 27 countries had a prevalence of insufficient activity of 90% or more for girls, whereas this was the case for two countries for boys. Interpretation The majority of adolescents do not meet current physical activity guidelines. Urgent scaling up of implementation of known effective policies and programmes is needed to increase activity in adolescents. Investment and leadership at all levels to intervene on the multiple causes and inequities that might perpetuate the low participation in physical activity and sex differences, as well as engagement of youth themselves, will be vital to strengthen the opportunities for physical activity in all communities. Such action will improve the health of this and future young generations and support achieving the 2030 Sustainable Development Goals. Funding WHO.

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Consensus development conference: diagnosis, prophylaxis, and treatment of osteoporosis.

(1993)

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Changes in bone mineral density with age in men and women: a longitudinal study.

C Hassager, C Christiansen, L Warming (2001)

We performed a prospective study to evaluate the normal changes in bone mineral density (BMD) in the forearm, hip, spine and total body, and to study the agreement between changes in BMD estimated from cross-sectional data and the actual longitudinal changes. Six hundred and twenty subjects (398 women, 222 men; age 20-89 years) without diseases or medication known to affect bone metabolism undertook baseline evaluations, and 525 (336 women, 189 men) completed the study. BMD was measured twice 2 years apart by dual-energy X-ray absorptiometry. From cross-sectional evaluations the only premenopausal bone loss (<0.003 g/cm2/year) was found in the hip. In women after menopause and in men an age-related bone loss (0.002-0.006 g/cm2/year) was found at all sites. The data from the longitudinal evaluation showed a small bone loss in women before menopause at the hip and lumbar spine (<0.4%/year (<0.004 g/cm2/year)); this bone loss nearly tripled in the early postmenopausal years (<10 years since menopause), and thereafter decreased to the premenopausal rate for the hip, and to zero for the lumbar spine. The most pronounced bone loss after menopause occurred in the forearm (1.2%/year (0.006 g/ cm2/year)), and it remained constant throughout life. In men there was a small longitudinal bone loss in the hip throughout life, and a small bone loss in the distal forearm after the age of 50 years. In all groups, except for the early postmenopausal women, we found a small increase in total body BMD with age. When comparing the changes in BMD estimated from cross-sectional data with the longitudinal changes, only the hip and forearm generally displayed agreement, whereas the changes in the total body and spine generally were incongruous. In conclusion, the hip and forearm appear to be the sites with the best agreement between the cross-sectional estimated and the longitudinal age-related changes in BMD.

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Author and article information

Contributors

Kexun Kenneth Chen:

ORCID: http://orcid.org/0000-0002-6280-0391

chen.kexunkenneth@gmail.com

Shiou-Liang Wee: weeshiouliang@gmail.com

Journal

Journal ID (nlm-ta): BMC Musculoskelet Disord

Journal ID (iso-abbrev): BMC Musculoskelet Disord

Title: BMC Musculoskeletal Disorders

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2474

Publication date (Electronic): 25 September 2020

Publication date PMC-release: 25 September 2020

Publication date Collection: 2020

Volume: 21

Electronic Location Identifier: 633

Affiliations

[1 ]Geriatric Education and Research Institute (GERI), 2 Yishun Central 2, Tower E Level 4 GERI Admin, Singapore, 768024 Singapore

[2 ]GRID grid.486188.b, ISNI 0000 0004 1790 4399, Health and Social Sciences Cluster, , Singapore Institute of Technology, ; Singapore, Singapore

[3 ]GRID grid.428397.3, ISNI 0000 0004 0385 0924, Programme of Health Services and System Research, , Duke-National University of Singapore Graduate Medical School, ; Singapore, Singapore

[4 ]GRID grid.415203.1, ISNI 0000 0004 0451 6370, Diagnostic Radiology, , Khoo Teck Puat Hospital, ; Singapore, Singapore

[5 ]GRID grid.415203.1, ISNI 0000 0004 0451 6370, Geriatric Medicine, , Khoo Teck Puat Hospital, ; Singapore, Singapore

[6 ]GRID grid.4280.e, ISNI 0000 0001 2180 6431, Department of Psychological Medicine, , National University of Singapore, ; Singapore, Singapore

Author information

Kexun Kenneth Chen http://orcid.org/0000-0002-6280-0391

Article

Publisher ID: 3646

DOI: 10.1186/s12891-020-03646-y

PMC ID: 7519574

PubMed ID: 32977780

SO-VID: 964dd825-c7ca-43ad-87b3-a5226b0074dd

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 18 June 2020

Date accepted : 14 September 2020

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ScienceOpen disciplines: Orthopedics

Keywords: bone mineral density,reference range,osteoporosis,prevalence,normative

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ScienceOpen disciplines: Orthopedics

Keywords: bone mineral density, reference range, osteoporosis, prevalence, normative

Bone mineral density reference values in Singaporean adults and comparisons for osteoporosis establishment – The Yishun Study

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Abstract

Background

Methods

Results

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Orthopedics

Most cited references 35

Global trends in insufficient physical activity among adolescents: a pooled analysis of 298 population-based surveys with 1·6 million participants

Consensus development conference: diagnosis, prophylaxis, and treatment of osteoporosis.

Changes in bone mineral density with age in men and women: a longitudinal study.

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