Korean J Fam Med 2018; 39(2): 74-84  https://doi.org/10.4082/kjfm.2018.39.2.74
The Association between Fat Mass, Lean Mass and Bone Mineral Density in Premenopausal Women in Korea: A Cross-Sectional Study
Jeehyun Kim1, Hyuktae Kwon1,*, Bo-Kyoung Heo1,*, Hee-Kyung Joh2, Cheol Min Lee3, Seung-Sik Hwang4, Danbee Park1, Jae-Hong Park1
1Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
2Department of Family Medicine, Seoul National University Health Service Center, Seoul, Korea
3Department of Family Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
4Department of Social and Preventive Medicine, Inha University School of Medicine, Incheon, Korea
Hyuktae Kwon https://orcid.org/0000-0002-0312-3650
Tel: +82-2-2072-4039, Fax: +82-2-766-3276, E-mail: ezkel@snuh.org
Bo-Kyoung Heo https://orcid.org/0000-0002-5326-2085
Tel: +82-2-2072-4039, Fax: +82-2-766-3276, E-mail: ultraman123@naver.com
*These authors contributed equally to this work.
Received: September 2, 2016; Revised: September 30, 2016; Accepted: October 14, 2016; Published online: March 20, 2018.
© Korean Academy of Family Medicine. All rights reserved.

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Abstract
Background: We investigated the association between body composition, especially truncal or non-truncal fat mass (FM), and bone mineral density (BMD) in premenopausal women in Korea.
Methods: A cross-sectional study was performed using data from the Korea National Health and Nutrition Examination Survey IV and V (2008–2011). Total lean mass (LM), total FM (TFM), truncal FM, and non-truncal FM, and BMD of the total femur, femoral neck (FN), and lumbar spine were measured using dual-energy X-ray absorptiometry. The association between body composition and BMD was analyzed using multiple linear regression. The risk of low BMD according to quartiles of TFM, truncal FM, and non-truncal FM was calculated using logistic regression. Subgroup analysis according to body mass index was also performed.
Results: In 4,343 premenopausal women, total LM was positively associated with BMD regardless of weight adjustment. TFM, truncal FM, and non-truncal FM were inversely associated with BMD after adjusting for weight. Odds ratios (ORs) for low BMD and 95% confidence intervals (CIs) of the highest quartile of TFM, truncal FM, and non-truncal FM compared with the lowest quartile were calculated. The risk of low BMD of the FN was higher in the highest quartile of TFM (OR, 4.48; 95% CI, 1.11–18.01) and truncal FM (OR, 5.48; 95% CI, 1.75–17.20). Truncal FM and not-truncal FM had an inverse association with BMD in the non-obese and obese subgroups of women.
Conclusion: Total LM has a protective effect on BMD and FM can have a detrimental effect on BMD besides its skeletal loading effect.
Keywords: Bone Density; Fat Mass; Lean Mass; Premenopause; Osteoporosis


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