The effect of past and present lifestyle, nutrition habits, and gender on bone mineral density

doi:10.4236/health.2010.27109

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Vol.2, No.7, 713-721 (2010)h

doi:10.4236/health.2010.27109

Healt

The effect of past and present lifestyle, nutrition habits,

and gender on bone mineral density

Masakatsu Nakada1*, Shinichi Demura2

1National Defense Academy Hashirimizu, Yokosuka, Japan;

*Corresponding Author: [email protected]

2Graduate school of Natural Science & Technology, Kanazawa University Kakuma, Kanazawa, Japan

Received 2 March 2010; revised 14 March 2010; accepted 16 March 2010.

ABSTRACT

This study aimed to examine the gender and

age differences of the quantitative osteo-sono

assessment index (OSI) and the effects of the

p ast and present lifesty le and nutrition habit s on

OSI in adult males and females from 20 to 70

years of age. The subjects were 155 males (20-

79 years) and 399 females (20-78 years). The

bone mass was estimated by the right-calcaneal

OSI using an ultrasonic transmission method

with an AOS-100 device (ALOKA). The fre-

quency of tests for OSI in women tended to in-

crease rapidly in the 50-70 age group requiring

close examination or guidance. In 50-70 year-

old females, the proportion of dairy products

and vitamin D intake in the past (junior high

school and high school days) was significantly

lower in the group requiring close examination

or guidance (OSI < 2.428) than in the normal

group (OSI ≧ 2.428). That is, there was insuf-

ficient calcium intake (through dairy products)

and vitamin D intake, which is instrumental in

calcium absorption, (through fish, chicken eggs,

and fungi) during puberty, when bone mass in-

creases with skeletal growth. In conclusion, the

number in the group requiring close examina-

tion or guidance was high for 50-70 year-old

males and females. The OSI decreases rapidly

in females after their 50s and the number in the

group requiring close examination or guidance

increased rapidly.

Keywords: Lifestyle Habit; Nutrition Habit;

Ultrasound; Osteo-Sono Assessment Index; Gender

1. INTRODUCTION

Osteoporosis in elderly people markedly results in a de-

crease in activities of daily living (ADL) and quality of

life (QOL) [1-4]. Aging is an important factor which

affects bone mass and bone mineral density (BMD) [5].

BMD reaches its peak level from puberty to the time a

person reaches their 20s and is maintained until their 40s,

and then begins to decrease [2]. Nakata et al. [6] re-

ported that because it is difficult to prevent osteoporosis

in middle age with low peak bone mass, it is important

to acquire basic eating and exercise habits during young

adult age. Preventing a decrease of the peak bone mass

through proper nutrition, exercise, sun bathing, etc. is

very effective for preventing osteoporosis in old age [5].

It has been reported that eating habits in addition to ex-

ercise habits greatly affect bone formation [3,7]. Kim et

al. [8] found that the loss of bone mineral content and

bone mass with age differs by gender. Hence, the effect

of lifestyle on BMD and bone mass after acquiring the

peak bone mass should be studied according to gender

and by using people of a wide age range.

Calcium ingestion during puberty markedly increases

bone mass and may be an important factor in determin-

ing peak bone mass [2]. Bone mass in females decreases

by about 3 percent a year with age after menopause [9].

Hence, increasing peak bone mass as much as possible

during puberty is very important, and also the examina-

tion of relationships between BMD after adolescence

and past (puberty) lifestyle habits will be essential.

Nakada et al. [10] confirmed that the effect of past

and present lifestyle habits and nutrition on calcaneal

quantitative osteo-sono index (OSI) in pre- and post-

menopausal females. This study aimed to examine the

OSI differences among different gender and age groups,

and the effect of past and present lifestyle and nutrition

habits on OSI in people from 20 to 70 years of age.

2. METHODS

2.1. Subjects

The subjects were 155 males (20-79 years of age) and

M. Nakada et al. / HEALTH 2 (2010) 713-721

714

399 females (20-78 years of age). Written informed con-

sent was obtained from all subjects after a full explana-

tion of the experimental purpose and protocol.

2.2. Measurement of Bone Mineral Density

and Setting of Osteo-Sono Assessment

Index Group

The BMD was estimated by the right-calcaneus using an

ultrasonic transmission method with an AOS-100 device

(ALOKA). The calcaneal osteo-sono assesment was used

osteo-sono assesment index (OSI: TI × SOS2）by cal-

culating the speed of sound (SOS) of an ultrasonic

transmission in the calcaneus and transmission index (TI)

referring to the report of Ishiguro et al. [11].

The Japan Osteoporosis Foundation [2] classified fe-

males into a close examination group (OSI < 80% of an

average OSI = 2.158), a guidance required group (2.158

≦ OSI < 90% of an average OSI = 2.428) and a normal

group (OSI ≧2.428) based on an average OSI (OSI =

2.698) of females between 20 and 44 years old by osteo

sono assessment criteria. In this study, we combined the

former 2 groups considering a sample size of each age

level and compared the close examination and guidance

required groups (OSI < 2.428 ) and the normal group

(OSI ≧ 2.428 ). The appropriate criteria of OSI in males

has not been reported. Hence, males were classified into

a close examination and guidance required group (OSI <

90% ) and a normal group (OSI ≧ 90% ) based on an

average OSI of people between 20 and 44 years old in

reference to the females’ assessment criteria in Japan

Osteoporosis Foundation [2].

2.3. Lifestyle Habits and Nutrition

Questionnaire

Lifestyle habits and nutrition were evaluated by ques-

tionnaires. The survey was carried out just before the

measurement of OSI. Naka et al. [5] selected menopause,

habitual milk intake, intensity of physical exercise, and

awareness of eating habits and physical activity as life-

style items. Tomita selected breakfast habits, milk and

dairy products, fish and shellfish, meat products etc. in

present and childhood (about 6-15 yr) as eating habit

items. Elgán et al. [12] selected 10 items (dietary habits

(i.e. sugar, fat, fiber, and fruit/vegetables), physical ac-

tivity, smoking habits, alcohol consumption, time spent

outdoors etc.) as lifestyle items. The Japan Osteoporosis

Foundation [2] selected alcohol, tobacco, coffee, milk,

dairy products, fish, meat, soy products, green and yel-

low vegetables, and natto as meal and articles of taste

items for the interview sheet as examples of osteopo-

rosis prevention. Referring to the above, this study se-

lected the following 9 items to investigate the present

eating habits: 1) sleeping time, 2) frequency of alcohol

consumption, 3) smoking habits, 4) skipping meals, 5)

intake of dairy products (milk, cheese, yogurt, etc.), 6)

intake of calcium supplements, 7) intake of vitamin D

(fish, chicken egg, fungi), 8) intake of instant food (in-

stant noodles, instant coffee, etc.), and 9) frequency of

sun bathing. And, as the past (junior high school and

high school days) states, 1) sleeping time, 2) skipping

meals, 3) intake of dairy products, 4) intake of vitamin D,

and 5) intake of instant food among the above 5 items

were surveyed.

2.4. Data Analysis

Two–way (gender × age) ANOVA was used to examine

the age and gender differences of OSI. When a signifi-

cant difference was found, multiple comparisons were

performed by Bonferroni’s method. In both males and

females, cross tabulations by 20-40 year-olds and 50-70

year-olds were made up. A χ2 test was used to examine

the proportion of OSI groups. In each OSI group, cross

tabulations by the past and the present lifestyle and nu-

trition ingestion habits were made up and then a test of

independence was performed. When a significant dif-

ference was found, residual analysis was used. A prob-

ability level of 0.05 was indicative of statistical signifi-

cance.

3. RESULTS

Figure 1 shows the result of a two-way ANOVA (age ×

gender). A significant interaction effect was found. The

results of multiple comparisons showed gender differ-

ences, males having a higher OSI, except for 30 year-

olds. In males, the OSI of 20 year-olds was significantly

higher than that of 30-70 year-olds. In females, the OSI

of 20-40 year-olds was significantly higher than that of

50-70 year-olds.

Ta bl e 1 shows the result of χ2 test (age × gender) in

each OSI group. The frequency of the group requiring

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

20‐year 30‐year 40‐year 50‐year 60‐year70‐year

Male

Female

Gender　　　　F=85.750P=0.000　Partia lη

=0.137

AgeF=23.865P=0.000　　Partialη

=0.180

Interactioneff ectF=4.846P=0.000　Par tia l

=0.043

20,40‐70year ：Male＞Female

Male：20year ＞30‐70year

Female：20‐40year＞50‐70year

OSI

Figure 1. Result of two-way ANOVA (age x gender) in OSI.

M. Nakada et al. / HEALTH 2 (2010) 713-721

715

Table 1. Result of χ2 test (age × gender) in each OSI group.

gender OSI group 20-40 year-olds 50-70 year-olds χ2 ρ φ

normal 59 (72%) 33 (45%) 11.451 0.000 0.285

Male

A close examination-guidance required 23 (28%) 40 (55%)

normal 155 (81%) 99 (48%) 46.21 0.000 0.349

Female

A close examination-guidance required 37 (19%) 108 (52%)

close examination or guidance showed a significant dif-

ference in males and females. The Average OSI of 20-44

year-old males was 3.034 and 90% of that corresponds

to 2.731. We used this value as the judgment criteria for

the group requiring close examination or guidance,

similar to the female group. The number of male sub-

jects corresponding to less than OSI = 2.731 in males out

of the 20-40 year-olds and 50-70 year-olds were 23 and

40, respectively.

and past lifestyle and nutrition habits. In the 20-40 year-

old females, a test of independence showed significant

differences in sleeping time. However, the results of re-

sidual analysis showed no significant differences in any

category. A test of independence showed significant dif-

ferences in the intake of dairy products and vitamin D in

the past in the 50-70 year-old females. The results of

residual analysis showed significant differences in the

intake of dairy products in the past; the normal group

showed a higher proportion of subjects with a greater

weekly intake (dairy products: z = 2.95 > 2.64, Vitamin

D: z = 2.75 > 2.64, p < 0.05).

Figure 2 shows the percentage of females in the group

requiring close examination or guidance. The percentage

tended to increase rapidly after 50 years of age (30-40

year-olds: about 1.5-1.7 times of 20 year-olds, 50 year-

olds: about 3.4 times of 20 year-olds, 60 year-olds: about

4.3 times of 20 year-olds, and 70 year-olds: about 5.9

times of 20 year-olds).

4. DISCUSSION

The Japan Osteoporosis Foundation [2] reported that

average OSI of 20 and 44 years old females (6096 peo-

ple) was OSI = 2.698 ± 0.298. From the present result

(OSI = 2.742 ± 0.350), it is considered that the OSI of

females in this study was the standard. The gender dif-

ferences of the OSI were found in all age groups, males

being higher, except for 30 year-olds. In males, the age

differences were found between the 20 year-old group

and age groups after 30, and the OSI tended to remain

the same level or to decrease slightly after their 30 s.

However, in females, the OSI tended to be maintained in

the 20-40 year-olds and to decrease sharply after their 50

s. Kim et al. [8] reported that bone mineral content in

males decreased 0.3 kg per each decade from their 20 s

to 40 s, kept almost the same level from their 40 s to

their 60 s, and decreased 0.3 kg from their 60 s to their

70 s. In females, the bone mineral content changed little

from their 20 s to their 40 s and decreased markedly

from their 60 s to 70 s. It is thought that OSI is higher in

males than in females and its decrease tendency with age

differs largely by gender because of the sharp decrease

observed in females beginning in their 50 s. And, the

proportion in the group requiring close examination or

guidance based on the judgment criteria by the Japan

Osteoporosis Foundation [2] was higher in 50-70 year-

olds than in 20-40 year-old males and females, but

tended to increase sharply after 50 s (Figure 2) in fe-

ales. This is thought to relate to the marked decrease of

Tab le 2 (20-40 years-old males) and Tab le 3 (50-70

year-old males) show the cross tabulations of the fre-

quency of OSI groups and the frequency of the present

and past lifestyle and nutrition habits. A test of inde-

pendence showed significant differences in the fre-

quency in the intake of vitamin D in the 50-70 year-old

males. However, the results of residual analysis showed

no significant differences in any category. In the 20-40

year-old males, there were no significant differences in

all present lifestyle and nutrition ingestion habit items.

Ta bl e 4 (20-40 year-old females) and Ta bl e 5 (50-70

year-old females) show the cross tabulations of the fre-

quency of OSI groups and the frequency of the present

Figure 2. Frequency of OSI in the close examination-guidance

required group in female. m

M. Nakada et al. / HEALTH 2 (2010) 713-721

716

Table 2. Present and past lifestyle and nutrition habits and the OSI of 20-40-year-olds males.

Sleeping time Less than 6

hours

More than 6

hours-less than

7 hours

More than 7

hours-less than 8

hours

More than 8

hours χ2 ρ φ

Normal 12 33 12 1 2.817 0.421 0.19

Present CEGR 4 14 3 2

Normal 9 20 18 6 0.981 0.806 0.11

Past CEGR 2 9 9 2

Alcohol intake No 1-3 times a month1-3 times a weeknearly every

day

Normal 13 15 16 15 3.277 0.351 0.20

Present CEGR 5 10 3 5

Smoking No Have a habit Quit

Normal 28 14 17 0.109 0.947 0.04

Present CEGR 10 6 7

Skip a meal No Breakfast Lunch Supper

Normal 45 13 0 1 6.452 0.092 0.28

Present CEGR 21 1 1 0

Normal 45 12 0.568 0.451 0.09

Past CEGR 19 3

Intake of dairy products No 1-3 times a week4-7 times a week

Normal 10 25 24 0.476 0.788 0.08

Present CEGR 5 8 10

Normal 7 23 27 0.371 0.831 0.07

Past CEGR 4 9 10

Intake of Ca supplement No Rarely Continuous

Normal 40 14 5 3.691 0.158 0.21

Present CEGR 20 3 0

Intake of vitamin D No 1-3 times a week4-7 times a week

Normal 7 37 15 1.130 0.568 0.12

Present CEGR 1 15 7

Normal 3 34 17 0.311 0.856 0.06

Past CEGR 1 16 6

Intake of instant food No 1-3 times a monthMore than once a

week

Normal 9 20 30 2.425 0.297 0.17

Present CEGR 2 12 9

Normal 3 30 24 0.39 0.823 0.07

Past CEGR 2 11 10

Sunbathing No 1-3 times a

week

More than 4 times a

week

Normal 14 24 20 1.734 0.42 0.15

Present CEGR 5 13 5

Note: CEGR:close examination or guidance required group

M. Nakada et al. / HEALTH 2 (2010) 713-721

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Table 3. Present and past lifestyle and nutrition habits and the OSI of 50-70-year-olds males.

Sleeping time Less than 6

hours

More than 6

hours-less than 7

hours

More than 7

hours-less than 8

hours

More than 8

hours χ2 ρ φ

Normal 6 14 11 1 3.316 0.345 0.21

Present

CEGR 9 13 13 6

Normal 1 11 17 1 2.89 0.409 0.21

Past

CEGR 2 14 13 4

Alcohol intake No 1-3 times a month1-3 times a weeknearly every day

Normal 9 1 5 17 1.095 0.778 0.12

Present

CEGR 15 2 4 20

Smoking No Have a habit Quit

Normal 11 6 13 1.179 0.555 0.13

Present

CEGR 11 7 23

Skip a meal No Breakfast Lunch Supper

Normal 25 3 1 0 2.272 0.321 0.18

Present

CEGR 39 2 0 0

Normal 21 4 1 0 1.801 0.406 0.17

Past

CEGR 33 4 0 0

Intake of dairy products No 1-3 times a month4-7 times a week

Normal 5 13 14 0.579 0.749 0.09

Present

CEGR 9 14 18

Normal 11 12 7 4.078 0.13 0.25

Past

CEGR 21 13 3

Intake of Ca supplement No Rarely Continuous

Normal 27 3 2 0.595 0.743 0.09

Present

CEGR 34 4 1

Intake of vitamin D No 1-3 times a week4-7 times a week

Normal 1 23 8 0.415 0.813 0.08

Present

CEGR 2 31 8

Normal 0 (–1.80) 20 (–1.20) 8 (2.56) 8.897 0.012* 0.37

Past

CEGR 4 (1.80) 31 (1.20) 2 (–2.56)

Intake of instant food No 1-3 times a monthMore than once

a week

Normal 6 18 8 2.797 0.247 0.20

Present

CEGR 13 15 12

Normal 14 10 5 0.139 0.933 0.05

Past

CEGR 16 14 6

Sunbathing No 1-3 times a weekMore than 4 times

a week

Normal 6 12 12 1.400 0.497 0.14

Present

CEGR 4 18 18

Note: CEGR: close examination or guidance required group, *P < 0.05, Number shown in parentheses is the Z score of the residual analysis.

M. Nakada et al. / HEALTH 2 (2010) 713-721

718

Table 4. Present and past lifestyle and nutrition habits and the OSI of 20-40-year-olds females.

Sleeping time Less than 6

hours

More than 6

hours-less than 7

hours

More than 7

hours-less than 8

hours

More than 8

hours χ2 ρ φ

Normal 49 (0.54) 70 (–2.15) 35 (2.38) 1 (–1.11) 8.359 0.039* 0.21

Present

CEGR 10 (–0.54) 24 (2.15) 2 (–2.38) 1 (1.11)

Normal 21 50 39 9 7.405 0.060 0.22

Past

CEGR 1 11 11 6

Alcohol intake No 1-3 times a month1-3 times a weeknearly every day

Normal 47 63 21 23 3.537 0.316 0.14

Present

CEGR 14 9 5 8

Smoking No Have a habit Quit

Normal 128 13 13 0.458 0.795 0.05

Present

CEGR 29 4 4

Skip a meal No Breakfast Lunch Supper

Normal 125 17 3 4 2.393 0.495 0.11

Present

CEGR 29 6 0 0

Normal 110 30 0 0 0.113 0.737 0.03

Past

CEGR 26 6 0 0

Intake of dairy products No 1-3 times a month4-7 times a week

Normal 15 62 78 0.699 0.705 0.06

Present

CEGR 2 16 19

Normal 16 58 72 2.592 0.274 0.12

Past

CEGR 2 18 13

Intake of Ca supplement No Rarely Continuous

Normal 113 29 12 1.483 0.476 0.09

Present

CEGR 30 6 1

Intake of vitamin D No 1-3 times a week4-7 times a week

Normal 8 88 58 2.501 0.286 0.11

Present

CEGR 3 25 9

Normal 4 86 49 4.167 0.125 0.16

Past

CEGR 3 18 7

Intake of instant food No 1-3 times a monthMore than once a

week

Normal 28 56 69 5.915 0.052 0.18

Present

CEGR 2 11 24

Normal 22 76 45 0.060 0.970 0.02

Past

CEGR 4 16 9

Sunbathing No 1-3 times a weekMore than 4 times a

week

Normal 43 62 47 2.545 0.280 0.12

Present

CEGR 14 10 13

Note: CEGR: close examination or guidance required group, *P < 0.05, Number shown in parentheses is the Z score of the residual analysis.

M. Nakada et al. / HEALTH 2 (2010) 713-721

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Table 5. Present and past lifestyle and nutrition habits and the OSI of 50-70-year-olds females.

Sleeping time Less than 6

hours

More than 6

hours-less than 7

hours

More than 7

hours-less than 8

hours

More than 8

hours χ2 ρ φ

Normal 19 49 26 2 2.401 0.493 0.11

Present

CEGR 26 50 26 6

Normal 5 25 36 11 0.506 0.917 0.06

Past

CEGR 4 26 32 13

Alcohol intake No 1-3 times a month1-3 times a weeknearly every day

Normal 57 13 11 18 1.191 0.755 0.08

Present

CEGR 62 19 10 16

Smoking No Have a habit Quit

Normal 81 9 7 0.822 0.633 0.06

Present

CEGR 93 8 5

Skip a meal No Breakfast Lunch Supper

Normal 87 5 0 1 3.444 0.328 0.13

Present

CEGR 95 3 3 1

Normal 66 12 0 0 2.224 0.329 0.12

Past

CEGR 72 10 2 0

Intake of dairy products No 1-3 times a month4-7 times a week

Normal 3 30 65 3.592 0.116 0.13

Present

CEGR 7 41 57

Normal 14(–0.18) 44(–0.93) 27(2.95*) 9.751 0.008* 0.24

Past

CEGR 24(0.18) 50(0.93) 11(–2.95*)

Intake of Ca supplement No Rarely Continuous

Normal 73 11 15 0.803 0.669 0.06

Present

CEGR 73 16 15

Intake of vitamin D No 1-3 times a week4-7 times a week

Normal 8 51 39 0.108 0.947 0.02

Present

CEGR 10 54 43

Normal 5(–1.38) 42(–1.82) 36(2.75*) 8.189 0.017* 0.22

Past

CEGR 10(1.38) 53(1.82) 19(–2.75*)

Intake of instant food No 1-3 times a monthMore than once a

week

Normal 35 30 31 0.727 0.695 0.06

Present

CEGR 34 32 40

Normal 30 39 14 0.372 0.830 0.05

Past

CEGR 33 35 13

Sunbathing No 1-3 times a weekMore than 4 times a

week

Normal 12 35 47 0.955 0.620 0.07

Present

CEGR 17 38 44

ote: CEGR: close examination or guidance required group, *P < 0.05, Number shown in parentheses is the Z score of the residual analysis.

M. Nakada et al. / HEALTH 2 (2010) 713-721

720

bone mass with a rapid decline of estrogen levels in

postmenopausal females [13]. The OSI is generally higher

in males than females. Average OSI of 20-44 years peo-

ple also in this study showed a significant gender differ-

ence (males: OSI = 3.034 ± 0.396, females: OSI = 2.742

± 0.350, t = 5.283, P = 0.000). The proper criteria has

not been reported for males, so this study conveniently

utilized the adult female criteria creation method devel-

oped by the Japan Osteoporosis Foundation [2]. It is

considered that males’ OSI level is higher and thus the

criteria for the group requiring close examination or

guidance differs between genders. Hence, from now, the

OSI standard for males will need to be hastily created

based on a large amount of data.

The group requiring close examination or guidance in

50-70 year-old females had a lower proportion of sub-

jects with weekly intake (4-7 times a week) of dairy

products and vitamin D (fish, chicken egg, fungi) in the

past than the normal group. Tomita et al. [7] reported

that, in the study of junior college dietetics students, the

intake of milk, dairy products, and vegetables on a rou-

tine basis is useful to increase bone mass. Nakata et al.

[6] reported that calcaneal OSI in women’s junior col-

lege students was higher in the high milk intake group.

The three year longitudinal study by Dawson-Hughes et

al. [14] found that the proper intake of vitamin D in ad-

dition to calcium intake reduces the decline of BMD. It

was reported also that inadequate metabolism of vitamin

D decreases calcium absorption in both osteoporotics

and elderly subjects [15]. From the present results, it is

considered that the 50-70 year-old females belonging to

the group requiring close examination or guidance were

deficient in calcium intake through dairy products and

intake of vitamin D which is very important for the ab-

sorption of calcium during puberty to increase bone

mass with skeletal growth. In addition, the above sug-

gests that it is important to have adequate calcium and

vitamin D intake in puberty in addition to old age.

Meanwhile, males showed an insignificant relation-

ship between OSI and items involving the present and

past lifestyle and nutrition habits. Because they do not

have a large physiological change as females when they

experience menopause in middle age, the effect of the

intake of calcium and vitamin D during puberty on

maintenance of BMD and bone formation may be lower

than in females. Many bone fractures that occur in eld-

erly people are of the femoral neck and this fracture

causes bedriddenness and disturbances of gait. Therefore

preventing the cause, osteoporosis, is very important

[2,5].

From now, it will be necessary to compare bone min-

eral density between young adults and the elderly longi-

tudinally, and to examine the combined effect of the past

and present lifestyle and exercise habits on BMD.

In summary, the OSI is higher in males than females

and it is higher in 20 year-olds than 30-70 year-olds in

males and is higher in 20-40 year-olds than 50-70 year-

olds in females. The proportion of the group requiring

close examination or guidance is high in 50-70 year-olds,

particularly in females with a rapid increase after their

50s. The 50-70 year-old females in the group requiring

close examination or guidance were deficient in calcium

intake through dairy products in addition to the intake of

vitamin D, which is important for the absorption of cal-

cium during puberty when bone mass increases with

skeletal growth. The intake of calcium and vitamin D

during puberty may be very important to prevent the

decrease of bone mineral density in old age.

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