Intern
ati
o
n
a
l
Jo
urn
a
l
o
f
P
u
b
lic Hea
l
th Science (IJ
P
HS)
V
o
l.3
,
No
.4
, Dece
m
b
er
2
014
,
p
p
.
2
7
6
~
280
I
S
SN
: 225
2-8
8
0
6
2
76
Jo
urn
a
l
h
o
me
pa
ge
: h
ttp
://iaesjo
u
r
na
l.com/
o
n
lin
e/ind
e
x.ph
p
/
IJPHS
Body Mass Index as Predictor
of Bone Mineral Density in
Postmenopausal Women in India
Biplob Chow
dhur
y
1
, Br
ajanath K
und
u
2
1
Department of
Ph
y
s
ical
Education, Mugberia Ganga
dhar Mah
a
vid
y
alay
a, Vid
y
as
agar Univ
ersity
,
India
2
Department of
Ph
y
s
ic
al Education,
Visva-Bh
ara
ti Univ
ersit
y
,
In
dia
Article Info
A
B
STRAC
T
Article histo
r
y:
Received Sept 30, 2014
Rev
i
sed
O
c
t 25
, 20
14
Accepted Nov 25, 2014
Risk factors for the prediction
of os
teoporosis are an importan
t
and cost
effective metho
d
since osteopor
osis is
a silent disease. Th
e pur
pose of the
study
wa
s to eva
l
uate
the
a
ssoc
i
a
tions between weight, bod
y mass index
(BMI), the Osteoporosis Self-
A
ssessme
nt Tool (OST),
and bone
mineral
density
(BMD) in postmenopau
s
al women
in I
ndia. In
this
cro
ss sectional
stud
y
,
90 postmenopausal women aged
45–85
y
ears who had given consen
t
participated
and
the stud
y
was
conduc
ted between April, 2012
and M
a
y
,
2013. BMD was measured b
y
u
l
trasound bone
d
e
nsitometr
y
at calcaneal site.
Line
ar regressio
n
m
u
ltivaria
te m
odels were used to exam
ine th
e a
ssociations
with weight,
BMI,
OST,
and BMD.
Bo
d
y
weig
ht, BMI, and OST had almos
t
sim
ilar overal
l
perform
ance in th
eir abi
lit
y to c
l
a
ssif
y
wom
e
n with BMD T-
sc
ore
≤−
2.5. Regression results showed that
the line
a
r com
b
inati
on of three
independ
ent v
a
riables BMI, OST and
bod
y
weig
ht. BMI pred
icted 65.7% of
the vari
ance in
BM
D,
R
2
= .657,
R
2
adjusted = .609, (F=21.295,
p<.000). Th
e
strongest pred
ictor of
low B
M
D wa
s BMI. BMI showed significant
association with BMD with a
correla
tion of .846. Low weight and BMI
predic
t os
teop
oros
is
and ar
e as
s
o
cia
t
ed
with incr
eas
ed
ris
k
s
in
postmenopausal
women. The negativ
e
impact of
low bod
y
w
e
ig
ht on bone
health should b
e
more widely
recognized
.
Keyword:
Bo
d
y
m
a
ss in
dex
B
ody
wei
g
ht
B
one
m
i
neral
den
s
i
t
y
O
s
teopo
ro
sis
Post
m
e
nopa
us
al
wom
e
n
Copyright ©
201
4 Institut
e
o
f
Ad
vanced
Engin
eer
ing and S
c
i
e
nce.
All rights re
se
rve
d
.
Co
rresp
ond
i
ng
Autho
r
:
B
i
pl
ob
C
h
ow
d
h
u
r
y
,
Depa
rt
m
e
nt
of
Phy
s
i
cal
Ed
uca
t
i
on,
M
u
g
b
eri
a
Ga
n
g
ad
ha
r
M
a
ha
vi
dy
al
aya, Vidya
s
agar Unive
r
sity,
Pur
b
a
M
e
di
ni
p
u
r
,
West
B
e
n
g
a
l
,
I
ndi
a.
Em
a
il: b
c
v
b
p
e
@g
m
a
il.co
m
1.
INTRODUCTION
Osteoporosis is characterize
d
by low bone
mass and
micro-a
r
chitectural deteri
o
r
at
i
o
n o
f
bo
ne t
i
ssue
with an inc
r
e
a
sed ris
k
of
fracture and
m
o
rtality
[1]. Fracture
s
are
m
o
st
co
mmonly associate
d
with
ost
e
o
p
o
r
o
si
s l
i
k
e t
h
ose
of t
h
e
hi
p, t
h
e v
e
rt
e
b
rae
,
an
d t
h
e
wri
s
t
,
a
nd t
h
es
e are res
p
onsi
b
l
e
f
o
r m
o
rbi
d
i
t
y
and
excess m
o
rtality. Risk factors
have
be
e
n
e
x
tensively cha
r
act
eri
zed in
women ove
r
the a
g
e o
f
50
ye
a
r
s
and
a
r
e
u
s
ed
in
p
r
actice, o
f
ten
in
co
mb
in
ation
,
to
p
r
ed
ict fr
actures [2]-[5].
L
o
w weight
an
d low BMI are also related
t
o
a
n
i
n
c
r
ease
d
fract
ure
ri
s
k
. L
o
w
bo
dy
m
a
ss i
nde
x
(
B
M
I) i
s
a
we
l
l
-
doc
um
ent
e
d ri
s
k
fact
or
f
o
r
fut
u
re
fractures. Th
e
ai
m
o
f
th
is stu
d
y
was to
qu
an
tify th
is p
h
a
rmacological effect and to
e
x
plore the ass
o
ciation of
BMI with
fractu
r
e risk
in
rel
a
tio
n
to
ag
e, weigh
t
and
bon
e m
i
n
e
ral d
e
n
s
ity. In
a large
m
e
ta-an
a
lysi
s o
f
12
pr
os
pect
i
v
e
po
pul
at
i
o
n-
base
d
coh
o
r
t
s
d
o
c
u
m
e
nt
ed t
h
at
t
h
e a
g
e-a
d
just
e
d
ri
sk
of a
hi
p f
r
act
ure
was i
n
crea
sed
2
-
fol
d
i
n
ol
der
i
ndi
vi
d
u
al
s
wi
t
h
a
B
M
I
of
20
k
g
/
m
2
co
m
p
ared
with a
BMI of
25
kg/m
2
[6]. T
h
e e
x
istence of
a
p
o
s
itiv
e asso
ci
atio
n
between
b
o
d
y
size and
b
o
n
e
m
a
ss is
well estab
lish
e
d
.
[7
],[8
] Moreo
v
e
r, l
o
w
bo
dy
m
a
ss
i
nde
x (B
M
I
) has bee
n
sh
o
w
n t
o
be a pr
edi
c
t
o
r
of i
n
c
r
eased b
o
n
e l
o
ss at
t
h
e fore
arm
.
[6]
Ho
we
ver
,
t
h
e
asso
ciatio
n
at
o
t
h
e
r
sk
eletal r
e
g
i
on
s b
e
t
w
een
BMI
,
bon
e mass, an
d
bone lo
ss r
e
m
a
in
s
to
b
e
d
e
ter
m
in
ed
. Th
e
pot
e
n
t
i
a
l
im
pact
of
t
h
i
n
ness
o
n
t
h
e
de
vel
opm
ent
o
f
pos
tm
enopa
usal
o
s
t
e
op
or
osi
s
i
s
part
i
c
ul
a
r
l
y
rel
e
van
t
because of the
high inci
denc
e of m
a
lnutrition i
n
the
de
velopi
ng c
o
unt
ries and beca
use
sli
m
ness is prom
oted
Evaluation Warning : The document was created with Spire.PDF for Python.
I
J
PH
S I
S
SN
:
225
2-8
8
0
6
Bo
dy M
a
ss
I
n
d
ex ca
n
be
a
Go
od
Pre
d
i
c
t
o
r
of
Bo
ne Mi
ner
a
l
Densi
t
y
i
n
.
...
(
B
i
p
l
o
p C
h
ow
d
hur
y)
27
7
as the ideal i
n
industriali
zed
co
un
tries. The
p
u
rp
o
s
e of th
is stu
d
y
wa
s t
o
i
nve
stigate the
associations be
tween
bo
dy
wei
g
ht
,
B
M
I, O
S
T, B
M
D an
d s
u
bse
que
nt
f
r
act
u
r
e
ri
sks i
n
post
m
eno
p
a
u
sal
w
o
m
e
n a
g
ed
4
5
t
o
85
y
ears
to
g
u
i
d
e
clin
ician
s
in
th
e ev
al
u
a
tio
n
o
f
fract
u
r
e risk
in
th
is p
o
p
u
l
ation
.
We conclude that low BMI confers a
ri
sk
of s
u
bst
a
n
t
i
a
l
im
port
a
nce
fo
r al
l
fract
ur
es t
h
at
i
s
l
a
rge
l
y
i
ndepe
n
d
ent
of a
g
e a
n
d se
x,
but
de
pen
d
e
n
t
o
n
BMD. The significance
of BMI as a ri
sk factor va
ries according to the
level of BMI. Its validation on
a
n
in
tern
ation
a
l
basis p
e
rm
i
t
s th
e u
s
e of th
is risk
facto
r
in
case-find
ing
strategies.
2.
MATE
RIAL
S AND METHODS
App
r
ov
al fo
r t
h
is cro
ss sectio
n
a
l st
u
d
y
was g
r
an
ted
fro
m
t
h
e Un
iv
ersity In
stitu
tio
n
a
l Rev
i
ew B
o
ard
o
f
Visv
a-Bh
arati Un
iv
ersity. Particip
an
ts a to
tal o
f
90
co
mm
u
n
ity-d
wellin
g
o
s
teopo
ro
tic fem
a
les b
e
tween
th
e
ages of 45 and 85 years m
e
t the
in
clu
s
io
n criteria an
d
were en
ro
lled
in
th
is stu
d
y
.
After co
m
p
leti
o
n
o
f
in
fo
rm
ed
co
n
s
en
t, all p
a
rticip
an
ts co
m
p
let
e
d
a series
of one
-tim
e
m
eas
urem
ents
including ant
h
ropometric,
medications, li
fe style factors
and bone m
i
neral de
nsity.
BMD Asse
ssm
ent
The calcaneal heel site was used for all BMD assessm
ent
s
. Indi
vi
d
u
al
par
t
i
c
i
p
ant age, ra
ce, height,
and
wei
g
ht
we
re ent
e
re
d i
n
t
o
t
h
e de
nsi
t
o
m
e
ter, a
nd B
M
D
m
easurem
ent
was c
o
m
p
l
e
t
e
d i
n
ap
pr
o
x
i
m
atel
y
5 s.
Al
l
pa
rt
i
c
i
p
ant
s
we
re
gi
ve
n a
co
py
of t
h
ei
r
B
M
D re
p
o
rt
,
a
b
r
i
e
f i
n
t
e
rp
ret
a
t
i
on
of
t
h
ei
r
score
s
, i
n
f
o
rm
at
i
on
rega
rdi
ng
ost
e
op
o
r
osi
s
,
heal
t
h
y
fo
od
s t
h
at
p
r
o
v
i
d
e si
g
n
i
f
i
c
ant
am
ount
s
of
vi
t
a
m
i
n D and
cal
ci
u
m
, and cont
act
i
n
f
o
rm
at
i
on re
gar
d
i
n
g m
e
di
cal
fol
l
o
w-
u
p
at
t
h
ei
r
ow
n
di
scr
e
t
i
on.
Oste
op
oro
s
i
s
Sel
f
-
A
ssessme
n
t
T
ool
Because BMD m
easurem
e
n
ts are
not
widely ava
ilable in certain comm
unities,
several ri
sk
assessm
ent
t
o
o
l
s ha
ve
been
d
e
vel
o
ped
t
o
t
a
r
g
et
w
o
m
e
n at
hi
g
h
er
ri
s
k
of
ost
e
o
p
o
r
o
si
s
f
o
r
B
M
D t
e
st
i
n
g
[9]
.
The Ost
e
op
o
r
osi
s
Sel
f
-
A
sse
ssm
ent
Tool
(OST
) uses sel
f
-
r
ep
ort
e
d dat
a
and i
s
deri
ve
d by
sco
r
e = 0.
2 ×
(wei
ght
i
n
kg
−
ag
e), tru
n
cated
to
an
in
t
e
g
e
r
with
a lo
wer score, iden
tifyin
g
wo
m
e
n
at h
i
gh
er
risk
o
f
o
s
teopo
ro
sis at
th
e fem
o
ral n
e
ck
[10
]
. OST
has b
e
en
repo
rted
to
h
a
v
e
a sensitiv
ity o
f
89
.2% and
a sp
ecificit
y
o
f
4
5
.0% (u
sing
a cu
t
-
of
f
po
in
t of
≤
1)
fo
r i
d
ent
i
f
y
i
n
g
ost
e
op
o
r
osi
s
i
n
p
o
s
tm
enopa
usal
wom
e
n age
d
4
5
t
o
6
4
years [11].
Statistica
l Ana
l
y
s
is
:
Statistics were
calcu
lated
with SPSS (v
ersion 18
.0
f
o
r
W
i
ndo
w
s
;
I
B
M SPSS In
c).
A
n
alph
a lev
e
l
of
p
< .0
5 was
u
s
ed
t
o
d
e
term
in
e sign
ifican
ce. Descrip
tiv
e
st
atistics were
used t
o
a
n
alyze
characte
r
istics of the
part
i
c
i
p
a
n
t
s
.
A
reg
r
essi
o
n
a
n
al
y
s
i
s
was use
d
t
o
e
x
pl
ore t
h
e rel
a
t
i
ons
hi
ps
bet
w
ee
n B
M
D an
d
ri
sk
fac
t
ors
fo
r
o
s
teopo
ro
sis
(A
g
e
, BMI
,
OST, an
d FRAX)
.
3.
RESULTS
A
N
D
DI
SC
US
S
I
ON
We i
d
ent
i
f
i
e
d 90
post
m
enop
ausal
wom
e
n aged
45 t
o
8
5
y
ears w
ho f
u
l
f
i
l
l
e
d t
h
e st
udy
cri
t
e
ri
a. Th
e
m
ean age a
n
d
wei
g
ht
o
f
t
h
e
st
udy
were
5
9
.
54
(S
D
11
.3
8) y
e
a
r
s a
nd
58
.8
4
(S
D 1
1
.
0
9
)
kg
res
p
ect
i
v
el
y
.
Particip
an
t
’
s
baselin
e ch
aract
eristics were g
i
v
e
n in
Tab
l
e
1
.
Tabl
e 1. Part
i
c
i
p
ant
’
s Dem
ogr
aphi
c
C
h
ara
c
t
e
ri
st
i
c
s
Variables
M ±
SD
SE
Age in ye
ars
59.
54±1
1
.
3
8
1.
32
Height in
m
e
te
r
1.
51±0.
05
0.
00
W
e
ight in Kg.
58.
84±1
1
.
0
9
1.
28
BMI in
Kg/
m
2
25.
54±4.
5
8
0.
53
BMD T-score
-
3
.
01±1.
08
0.
12
OST
-
0
.
13±3.
64
0.
42
FRAX
24.
51±2
0
.
5
2
2.
38
M
=
M
ean,
SD
= St
an
dar
d
De
vi
at
i
on,
SE=
S
t
anda
rd
Er
ro
r,
B
M
I= B
o
dy
M
a
ss I
nde
x,
B
M
D= B
o
ne M
i
neral
density, OST=
Osteoporosis S
e
lf-Assessm
ent To
ol, FRAX= Fracture
Risk Assessm
ent
Tool.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
SN
:
2
252
-88
06
IJPHS
Vol. 3, No. 4, D
ecem
ber 2014
:
276 – 280
27
8
Fi
gu
re
1.
A
g
e-
wi
se
vari
at
i
o
ns
i
n
B
one
Mineral Density at calcaneal site
Figure
1 s
h
ows the
bone m
i
neral
de
nsity according to the
vari
ous
ag
e c
a
tegories
of
postm
e
nopa
usa
l
wom
e
n w
h
o
a
r
e ost
e
o
p
o
r
ot
i
c
. It
can
be cl
e
a
rl
y
obs
er
ved
t
h
at
wi
t
h
i
n
c
r
e
a
sed a
g
e t
h
e
b
one m
i
neral
d
e
nsi
t
y
decrease
d
i
n
li
near fas
h
ion i
n
the elde
rly women.
Stepwise
Multiple Reg
r
ession Predicti
o
n
of BMD
Resu
lts o
f
step
-wise m
u
lt
ip
le reg
r
ession
an
alysis fo
r an
th
rop
o
m
etric v
a
riab
les (ag
e
,
b
o
d
y
h
e
igh
t
,
wei
g
ht
, B
M
I,
OST a
n
d FR
A
X
sc
ore
)
,
best
pre
d
i
c
t
b
o
n
e m
i
neral
densi
t
y
(
B
M
D
) i
n
el
de
r
l
y
wom
e
n are
sho
w
n
in
Tab
l
e 2.
Tab
l
e
2
.
M
u
ltip
le reg
r
ession
an
alysis to
p
r
ed
ict BMD
M
odel
Variables Entered
Variables Re
m
ove
d
R
R Squar
e
Adjusted
R Squar
e
1
BM
I -
.
846
.
657
.
609
2
W
e
ight -
.
769
.
542
.
530
3
OST -
.
684
.
516
.
476
Abbre
v
iations
:
BMI= Body
mass in
dex,
O
S
T
=
Os
teo
p
or
osi
s
Sel
f
-
A
sses
s
ment T
o
ol
Fro
m
all th
e variab
les, en
tered
in
t
o
th
e eq
uatio
n
u
s
ing
stepwise m
u
ltip
le reg
r
ession
an
al
ysis, BMD
as d
e
p
e
n
d
e
n
t
,
fo
llowing
results were ob
tain
ed.
Ou
t
of
6
va
ri
abl
e
s e
n
t
e
red
i
n
t
o
e
quat
i
on
,
3
vari
a
b
l
e
s best
p
r
ed
icted
t
h
e
BMD. Th
e fi
rst an
d
fo
rem
o
st v
a
riab
le to
p
r
ed
ict Bo
n
e
Min
e
ral
Density (BMD)
was B
M
I with
t
h
e co
rrel
a
t
i
o
n
coe
ffi
ci
ent
of
R
=
.
8
4
6
wi
t
h
t
h
e c
ont
ri
b
u
t
i
o
n
o
f
6
5
.
7
%
(
F
=2
1.
29
5,
p<
.
0
0
0
)
. T
h
e
r
eaft
e
r
ot
her
vari
a
b
l
e
s
W
e
i
ght
5
4
.
2
%
(F
=31
.
2
6
,
p<
.0
0
0
)
,
O
S
T
5
1
.
6
% (F=
5
2.
29
6,
p<.
0
00
)
wer
e
p
r
edi
c
t
e
d
t
h
e B
o
ne
Min
e
ral Den
s
it
y (BMD),
respectiv
ely. Oth
e
r v
a
riab
les
d
i
d
n
o
t
pred
ict the Bon
e
Min
e
ral Den
s
ity (BMD) in
el
derl
y
m
e
n and w
o
m
e
n. Si
nc
e t
h
e F-val
u
e f
o
r t
h
i
s
re
g
r
essi
on m
odel
i
s
hi
ghl
y
si
g
n
i
f
i
can
t
and t
h
ere
f
ore
i
t
m
a
y
b
e
in
terpreted
t
h
at all th
e th
ree v
a
riab
les selected
in
th
e
mo
d
e
l are qu
ite v
a
lid
in
esti
m
a
tin
g
th
e bo
n
e
min
e
ral
d
e
nsity o
f
el
d
e
r
l
y po
pu
latio
n.
Discussions
W
o
m
e
n
at h
i
gh
r
i
sk
s of
osteo
por
o
tic fr
actur
es can
b
e
ex
amin
ed
in
clin
ical
practices with speci
fic
t
r
eatm
e
nt
i
n
t
e
rvent
i
o
ns
.
Wo
m
e
n wi
t
h
ri
sk
fact
or
s suc
h
as l
o
w b
ody
wei
ght
an
d B
M
I m
a
y
al
so be at
hi
ghe
r
ri
sk
of
fract
ure
s
. The
res
u
l
t
s
f
r
om
our st
udy
sup
p
o
rt
t
h
e
p
r
e
v
i
o
usl
y
d
o
cum
e
nt
ed ass
o
ci
at
i
ons
bet
w
een
w
e
i
ght
,
B
M
I, and B
M
D. B
o
dy
wei
g
h
t
has been i
d
e
n
t
i
f
i
e
d i
n
pre
v
i
o
us re
po
rt
s as a pre
d
i
c
t
o
r
of pe
ak b
one m
a
ss in pre
-
m
e
nopa
usal
w
o
m
e
n and a
p
r
edi
c
t
o
r
o
f
B
M
D i
n
ol
de
r
wo
m
e
n [1
2]
. It
ha
s sh
ow
n t
h
at
o
s
t
e
op
or
osi
s
,
as
defi
ned
by
a T-sc
ore
of
≤
−
2.5 at the fe
m
o
ral nec
k
or a T-score
≤
−
2.5 at any site is associated
with weight, BM
I, and
OST in
th
e en
tire stu
d
y
. A B
M
I o
f
25
kg
/m
2
h
a
s b
een
id
en
tified
as th
e referen
ce po
in
t
b
e
low wh
ich
th
e risk
of
hi
p a
nd a
n
y
ost
e
o
p
o
r
ot
i
c
fract
ure st
a
r
t
s
t
o
i
n
crea
se [
6
]
.
Sim
i
l
a
r concl
u
si
o
n
s we
re re
ached i
n
t
h
e St
udy
o
f
Osteopo
ro
tic Fractu
r
es
u
s
ing
a BMI
o
f
26
.2 kg
/m
2
. [5
] OST of >1
h
a
s trad
itio
n
a
lly b
e
en
u
s
ed
to d
e
termin
e
l
o
w
ri
sk
desi
gn
at
i
on i
n
p
o
st
-m
eno
p
a
u
sal
w
o
m
e
n [1
3]
.
A
p
o
ten
tial drawback
is th
at BM
I can b
e
influ
e
n
ced b
y
‐
4
‐
3.5
‐
3
‐
2.5
‐
2
‐
1.5
‐
1
‐
0.5
0
45
‐
55
56
‐
65
66
‐
75
76
‐
85
BMD
T
‐
score
Age
in
years
BMD
BMD
Evaluation Warning : The document was created with Spire.PDF for Python.
I
J
PH
S I
S
SN
:
225
2-8
8
0
6
Bo
dy M
a
ss
I
n
d
ex ca
n
be
a
Go
od
Pre
d
i
c
t
o
r
of
Bo
ne Mi
ner
a
l
Densi
t
y
i
n
.
...
(
B
i
p
l
o
p C
h
ow
d
hur
y)
27
9
th
e h
e
igh
t
lo
ss asso
ciated
wit
h
v
e
rteb
ral d
e
fo
rm
ities. Th
er
efore, in
ind
i
v
i
du
als with
im
p
o
r
tan
t
h
e
igh
t
lo
ss, th
e
ri
sk c
o
n
f
er
red
t
h
ro
u
gh B
M
I
on f
r
act
u
r
e r
i
sk co
ul
d
be un
de
rest
im
at
ed. These
fi
n
d
i
n
gs ha
ve i
m
port
a
n
t
conseque
nces for
case finding
strate
gi
es
ba
sed
on
cl
i
n
i
cal
ri
sk
fact
ors.
Lean
ness s
h
ou
l
d
be
re
gar
d
e
d
as a
sig
n
i
fican
t
risk facto
r
.
Second
ly, th
e u
s
e of lo
w BMI as a risk
factor will id
en
tify p
o
p
u
l
ation
s
with a lo
w
BMD and he
nce a high risk
of
fracture.
T
h
e fi
ndi
ng t
h
at
l
eanne
ss i
s
m
u
ch m
o
re im
port
a
nt
as a ri
sk
fa
ct
or f
o
r
fracture—t
h
an obesity is a
protectiv
e factor—m
eans
that advice concerni
n
g
bo
dy
wei
ght
a
n
d ost
e
o
p
o
r
o
si
s
n
eed
no
t b
e
i
n
co
nsisten
t
with th
e weigh
t
con
t
ro
l ad
vocate
d
for t
h
e pre
v
ention
of cardi
ova
scular
dise
ase or
diabetes. T
h
e
findings a
r
e in
close agreem
e
n
t with a rec
e
nt r
e
po
r
t
fr
o
m
t
h
e Stud
y of
Osteo
p
o
r
o
tic Fr
actu
r
e
s
that com
p
ared seve
ral fracture ris
k
asse
ss
ment tools
(inclu
d
i
ng
OST)
to
id
en
tify low h
i
p and
l
u
m
b
ar sp
in
e
B
M
D i
n
7,
77
9
US
w
o
m
e
n aged
6
7
y
ears
and
ol
der.
A
n
im
port
a
nt
fi
n
d
i
ng
of
t
h
i
s
st
u
d
y
i
s
t
h
e as
so
ci
at
i
on
bet
w
ee
n l
o
we
r
wei
ght
o
r
B
M
I and a
n
i
n
crea
sed ri
sk
of
o
s
teo
poro
s
is-related
fract
u
r
es in
th
is p
opu
latio
n. W
ith
each standa
rd de
viation
dec
r
ease in
we
ight or in BM
I, the age
-
a
d
jus
t
ed
ris
k
for fractures i
n
creas
ed
by
approxim
a
tely 19%. Res
u
lts were
com
p
arab
le with
OST. It is
d
i
fficult to
sho
w
an
in
d
e
p
e
nd
en
t effect
of
wei
g
ht
o
r
B
M
I o
n
t
h
e
ri
sk
of
ost
e
op
o
r
ot
i
c
fract
ures
aft
e
r i
n
t
e
grat
i
o
n
of B
M
D i
n
t
o
t
h
e m
odel
s
. Si
m
i
l
a
r
co
n
c
l
u
sion
s fou
n
d
in
a
m
e
ta-an
a
lysis in
which
th
e ag
e-
a
d
justed ris
k
fo
r
any
fract
ure increased
with lowe
r
BMI; after adju
sting
fo
r BM
D, BMI
was
no
t fo
und
to
b
e
p
r
ed
ictiv
e of fractu
r
e risk
ex
cep
t
fo
r
h
i
p
fractu
r
e [6
].
Th
is sug
g
e
sts th
at BMD m
a
y b
e
an
im
p
o
r
tant in
term
ed
iate i
n
th
e ov
erall strateg
y
.
4.
CO
NCL
USI
O
N
In
m
u
ltiv
ariate an
alysis, BMI and
wei
g
h
t
were fou
n
d
to
b
e
asso
ciated
with
fracture
risk
in
d
e
p
e
nd
en
t
of
pre
v
al
ent
f
r
act
ure.
In t
h
i
s
gr
o
up
of fem
a
l
e
s, B
M
D was
pri
m
ari
l
y
i
n
fl
u
e
nced
by
age,
wei
g
ht
an
d B
M
I.
W
e
concl
ude
t
h
at
l
o
w
B
M
I c
o
nfe
r
s a
ri
sk
o
f
fra
ct
ure
of
s
ubst
a
nt
i
a
l
im
port
a
nc
e t
h
at
i
s
l
a
r
g
el
y
i
nde
pen
d
e
n
t
of
sex
.
The significa
n
ce of BMI as a
risk fact
or
varies according to the level of
BM
I and t
o
a lesser exte
nt on age. It
can be
concluded that the m
easurem
ent
of
s
i
m
p
l
e
cl
i
n
i
cal
vari
a
b
l
e
s suc
h
as age,
hei
g
ht
,
and
wei
g
ht
(
o
r
B
M
I)
in areas whe
r
e
BMD testing
is not rea
d
ily accessible
or
li
mited facilitate
s the i
d
entifica
tion
of m
i
ddle-age
d
and
el
derl
y
w
o
m
e
n
at
ri
sk of ost
e
o
p
o
r
o
si
s
a
nd rel
a
t
e
d frac
t
ures. The ne
g
a
t
i
v
e
im
pact
of
l
o
w b
ody
wei
ght
o
n
bo
ne heal
t
h
sh
oul
d be
m
o
re wi
del
y
i
n
vest
i
g
at
ed.
Declar
ati
o
n of
Conflicting I
n
teres
ts
Th
e au
t
h
or(s)
d
eclared
no
po
ten
tial co
nflicts o
f
in
terest with
resp
ect to
th
e research, au
th
orsh
ip
,
an
d
/
o
r
pub
licatio
n
of th
is article.
Fundin
g
The a
u
thor(s
) received
no
fina
ncial support for th
e researc
h
and/
or
aut
h
ors
h
ip of
this
a
r
ticle.
ACKNOWLE
DGE
M
ENTS
A
u
t
h
or
s acknow
ledg
e th
e i
mmen
s
e h
e
lp
r
e
ceiv
e
d
fr
o
m
t
h
e scho
lar
s
wh
o
s
e ar
ticles ar
e cited
an
d
i
n
cl
ude
d i
n
ref
e
rences
o
f
t
h
i
s
m
a
nuscri
p
t
.
T
h
e a
u
t
h
ors
are
also
g
r
atefu
l
to au
thors / ed
itors /
p
u
b
lish
e
rs
o
f
all
th
o
s
e articles,
jo
urn
a
ls and
boo
k
s
fro
m
wh
ere th
e literatu
re
for th
is article
h
a
s
b
e
en
rev
i
ewed and
d
i
scu
s
sed
.
REFERE
NC
ES
[1]
Sambrook P., C
ooper C., “Osteo
porosis”,
Lancet,
vol/issue: 36(7)
, pp. 2010–2018,
2006.
[2]
Cum
m
i
ngs
SR., Nevitt MC.
,
Bro
w
ner W
S
., Stone K., Fox
KM.,
Ensrud KE., “
R
i
s
k factors for hi
p fractur
e in whi
t
e
women. Stud
y
o
f
Osteoporotic
F
r
actur
es Research Group”,
N
Eng
l
J Med
, vo
l/issue: 33(2)
, pp
. 767
–73, 1995
.
[3]
Van Staa TP., Leufkens
HG., Abenhaim L., Zh
an
g B., Coope
r
C., “Use of oral cor
ticosteroids and
risk of fractur
es”,
J Bon
e
M
i
ner
Re
s
, vol/issue: 15(4
)
, pp
. 993–1000
, 2000.
[4]
Kanis JA., Borgstrom F., De
Laet C., Johans
son H
., Johnell O., Jonsson B
., “Asse
ssment
of fracture r
i
sk”,
Osteoporos Int
, vol/issue: 16(3), pp.581–89,
2005
.
[5]
Kanis JA., Oden
A., Johnell O.,
Johan
sson H., De Laet C
., Brow
n J., “The use
of
clin
ical risk f
a
ctors enhances th
e
performance of
BMD in the prediction of hip
a
nd osteoporotic fractures
in men and women”,
Osteoporos Int
,
vol/issue: 18(6), pp.
1033–1046
, 2007.
[6]
De Laet C., Kan
i
s JA., Oden A., Johanson H., Johnell O.
, Delmas P., “Body
mas
s
index as a predictor of fractur
e
risk: a
m
e
ta-
a
na
l
y
sis
,” Osteopor
os Int
, vol/issue: 16(2), pp. 1330
–1338, 2005
.
[7]
Reid IR
., “Relationships among
bod
y
mass, its
co
mponents and b
one”,
Bon
e
, vol/issue: 3(1), pp. 5
47–555, 2002
.
[8]
Felson DT., Zhang Y., Hann
an
MT
., Anderson J
J
., “Effects of w
e
ight
and
bod
y
mass index on b
one
mi
ne
ral
de
nsity
in men
and women:
th
e Framingham stud
y
”
,
J Bone Min
e
r Res
, vol/issue: 8(5),
p
p
.
567–573
,
199
3.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
SN
:
2
252
-88
06
IJPHS
Vol. 3, No. 4, D
ecem
ber 2014
:
276 – 280
28
0
[9]
Cadarette
SM.,
Jaglal
SB.,
Murray
TM.
,
Mc
Isaa
c
WJ.
,
Jose
ph
L.
,
Br
own JP.,
“Evaluation of
decision ru
les f
o
r
referring women
for bone densitometr
y
b
y
du
al-
e
nerg
y
x-ray
ab
sorptiometr
y
”
,
JA
MA
, vo
l/issue:
28(6), pp. 57–6
3,
2001.
[10]
Koh LK., Sedrin
e WB., Tor
r
alb
a
TP.,
Kung A.,
Fujiwara S., Ch
an SP., “A simp
le
too
l
to id
entif
y
Asian women
at
increased r
i
sk of
osteoporosis”,
Osteoporos Int
, vol/issue: 12(3), pp.
699–705
,
20
01.
[11]
Gourlay
ML
.,
Miller WC., Ri
ch
y
F.,
Garr
et
t JM., Hanson LC., Reginster JY
., “Perform
ance of osteoporosis risk
assessment tools in postmenopau
s
al women ag
ed
45–64
y
ears”,
O
s
teoporos Int,
vo
l/issue: 16
(2), pp
. 921–927
, 2005
.
[12]
Hawker GA., Jamal SA., Ridou
t R., Ch
ase C., “A clinical pred
iction
rule
to
identif
y
pr
emenopausal women with
low bone mass”,
Osteoporos Int
, vol/issue: 13(4), pp.
400–406
,
20
02.
[13]
Rud B., Hilden J., H
y
ldstrup L.,
Hrobjartsson A., “Perfo
rmance of the Osteoporosis Sel
f-Assessment Tool in rulin
g
out low bon
e mineral density
in
postmenopa
usal
women: a s
y
s
t
ematic r
e
view
”,
Osteoporos Int,
vol/issue:
18(1)
, pp.
1177–1187, 200
7.
BIOGRAP
HI
ES OF
AUTH
ORS
Dr. Biplob Chowdhur
y
is an
Assisstant
Professor. He wo
rks at Department
Phy
s
ica
l
Education, Mu
gberia Gang
ad
har Mahavid
y
a
l
a
y
, Vid
y
as
aga
r
Univers
i
t
y
.
His
area of
s
p
ecia
liz
ation
ar
e Ex
erc
i
s
e
P
h
y
s
i
o
log
y
and P
ubl
i
c
Hea
lth
Res
e
a
r
c
h
Dr. Brajan
ath
Kundu is a Pr
ofe
ssor. He works at Department
of Ph
y
s
ical Education,
Vis
v
a Bharat
i
Univers
i
t
y
. His
areas
of S
p
ec
iali
za
tion ar
e E
x
ercis
e
P
h
y
s
iol
o
g
y
and Kin
anthropometr
y
.
Evaluation Warning : The document was created with Spire.PDF for Python.