Physical Activity and Adequate Nutrition in Adolescence Linked to Improved Bone Mineral Density in Premenopausal Women

by | May 21, 2024 | 2023, Bone Health, Fitness and Exercise, Minerals, Recent Articles, Vitamin D - Bone Health, Women's Health - Bone Health

Written by Taylor Woosley, Science Writer. Findings of this cross-sectional analysis of 866 premenopausal women shows that adequate vitamin D levels, physical activity, and proper nutrition positively influenced bone mineral density values.   

Adolescence is a critical period for establishing bone health and the age at which peak bone mass (PBM) is achieved varies for the hip, spine, and other sites, but 90-95% occurs by age 18 in females1. Although 40-80% of the variation in bone mineral density (BMD) and bone microarchitecture is genetically determined, a myriad of diseases and lifestyle factors may influence physiological bone accrual resulting in a lower bone mass in adulthood2. The risk of bone fractures due to low BMD in premenopausal women is rare, however, the prevalence is higher in postmenopausal women, as the low estrogen levels after menopause lead to increased bone resorption and low BMD3.

There is a growing recognition of the role of physical activity and diet in modulating BMD, bone mineral content, and remodeling, which can impact bone health later in life4. Some minerals and vitamins, such as calcium and vitamin D, are considered necessary for bone metabolism5. Vitamin D plays an important role in the development of bones, strengthens the bones, and prevents fractures6.

Sultan et al. conducted a cross-sectional study to examine the clinical and biomedical factors that determine Z-scores in healthy Saudi premenopausal women (aged 20-40 years) divided into two groups: pre- and post-peak mineral density. Participants completed a self-reported questionnaire to provide information regarding sociodemographic data, along with a Menstrual history questionnaire and a BMD questionnaire. Additionally, The Arab Teen Lifestyle Study (ATLS) questionnaire was utilized to collect lifestyle data. Physical activity was assessed using the Compendium of Physical Activity for Youth and nutrition intake was analyzed using the Short non-quantitative Food Frequency Questionnaire.

BMD measurements were collected using the quantitative ultrasound (QUS) technique on one heel for all subjects and T-scores and Z-scores were recorded using the manufacturer reference range after inputting the participant’s age into the machine software. Blood samples were obtained, and serum vitamin D was measured using a chemiluminescent microparticle immunoassay. Furthermore, serum parathyroid hormone was measured via a chemiluminescent immunoassay technique. Chi-square and non-parametric Mann-Whitney U tests were utilized for comparison between diverse groups. Multiple linear regression was used to assess the independent predictors of Z-scores before and after the age of PBM.

866 female participants were divided into two age groups: ≤30 (n = 281, 31.7%) and >30 years (n = 605, 68.3%). Significant findings of the cross-sectional study are as follows:

  • 8% of subjects had a previous diagnosis of vitamin D deficiency. The >30 years group had a significantly lower parity (p < 0.001), lower family history of osteoporosis (p < 0.05), significantly more menstrual irregularities (p < 0.001), and lower BMI (p < 0.001) compared to the older age group.
  • Age-matched Z-scores was reported in 97.3% of subjects, with no significant differences between the two groups (p = 0.997). 2.7% of participants had non-age-matched Z-scores and those subjects were characterized by significantly lower levels of vitamin D (14.88 vs. 20.21 ng/mL), (p = 0.026) and total METs (33.16 vs. 46) (p = 0.019) compared to those with age-matched Z-scores.
  • 2% of subjects reported partaking in physical activity, with a total median METs of 45.2. Those in the younger age group showed significantly higher METs than the older group for all physical activities, besides household activities (p < 0.001).

Results of the study suggest that early determinants of Z-scores were nutritional status and physical activity and then BMI, parity, and vitamin D deficiency after the age of PBM. Further research should continue to explore bone health in premenopausal women. Study limitations include the inability to generalize results due to the cross-sectional design of the study and potential measurement error from the self-reported questionnaires.

Source: Sultan, Intessar, Inass Taha, Shereen El Tarhouny, Rehab A. Mohammed, Azza M. Abdu Allah, Omar Al Nozha, Maha Desouky et al. “Determinants of Z-Score of Bone Mineral Density among Premenopausal Saudi Females in Different Age Groups: A Cross Sectional Study.” Nutrients 15, no. 19 (2023): 4280.

© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/
4.0/).

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Posted May 21, 2024.

Taylor Woosley studied biology at Purdue University before becoming a 2016 graduate of Columbia College Chicago with a major in Writing. She currently resides in Glen Ellyn, IL.

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