Int J Med Sci 2020; 17(16):2585-2593. doi:10.7150/ijms.49030

Research Paper

Positive association between metabolic syndrome and bone mineral density among Malaysians

Kok-Yong Chin1, Chin Yi Chan1, Shaanthana Subramaniam1, Norliza Muhammad1, Ahmad Fairus2, Pei Yuen Ng3, Nor Aini Jamil4, Noorazah Abd Aziz5, Soelaiman Ima-Nirwana1, Norazlina Mohamed1✉

1. Department of Pharmacology, Universiti Kebangsaan Malaysia Medical Centre, Cheras 56000, Malaysia.
2. Department of Anatomy, Universiti Kebangsaan Malaysia Medical Centre, Cheras 56000, Malaysia.
3. Drug and Herbal Research Centre, Faculty of Pharmacy, Universiti Kebangsaan Malaysia Kuala Lumpur Campus, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia.
4. Centre for Community Health Studies (ReaCH), Faculty of Health Science, Universiti Kebangsaan Malaysia Kuala Lumpur Campus, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia.
5. Department of Family Medicine, Universiti Kebangsaan Malaysia Medical Centre, Cheras 56000, Malaysia.

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Citation:
Chin KY, Chan CY, Subramaniam S, Muhammad N, Fairus A, Ng PY, Jamil NA, Aziz NA, Ima-Nirwana S, Mohamed N. Positive association between metabolic syndrome and bone mineral density among Malaysians. Int J Med Sci 2020; 17(16):2585-2593. doi:10.7150/ijms.49030. Available from http://www.medsci.org/v17p2585.htm

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Abstract

Objectives: Metabolic syndrome (MetS) is a cluster of metabolic abnormalities that elevates the individual risk of cardiovascular diseases. These abnormalities are also known to alter bone remodelling. Therefore, MetS may be associated with osteoporosis. This study aims to determine the association between MetS and its components and bone mineral density (BMD) assessed by dual-energy X-ray absorptiometry (DXA) among Malaysians.

Methods: 400 Malaysians aged ≥ 40 years (52.5% women) residing in Klang Valley, Malaysia, were recruited. Subjects' demographic and lifestyle details were collected using a questionnaire, and blood pressure and body anthropometry were measured. Subjects' lumbar spine and total hip BMD were measured by DXA. Their fasting blood was collected for blood glucose level and lipid profile analysis. Regression analysis was used to analyze the relationship between MetS or its components and BMD.

Results: Subjects with MetS had higher BMD compared to subjects without MetS in models unadjusted for BMI (spine p=0.008; hip p<0.001). This difference was attenuated with BMI adjustment (spine p=0.625; hip p=0.478). Waist circumference was associated positively with BMD in models unadjusted for BMI (spine p=0.012; hip p<0.001), but the association became negative with BMI adjustment (spine p=0.044; hip p=0.021). Systolic blood pressure was associated positively with total hip BMD (p=0.019) but BMI adjustment attenuated the relationship (p=0.080). Triglyceride level was associated with osteoporosis in a fully adjusted model (p=0.001). Overall, MetS was associated with osteoporosis (p=0.019) but lifestyle (p=0.188) and BMI adjustment attenuated the relationship (p=0.904).

Conclusion: MetS is positively associated with BMD, and this relationship is predominantly mediated by BMI. Although MetS is not a significant risk factor for osteoporosis, the inverse relationship between waist circumference, a marker of central obesity, and BMD highlights the need to prevent adiposity to improve metabolic and skeletal health.

Keywords: cholesterol, hypertension, insulin resistance, osteopenia, osteoporosis, triglycerides