Korean J Fam Pract. 2018; 8(4): 593-600  https://doi.org/10.21215/kjfp.2018.8.4.593
Association of Lumbar Spine Bone Mineral Density According to Obesity and Metabolic Health Status in Korean 60 Years of Age or Older
Min-Ji Kim1, Eun-Ju Sung1,*, Cheol-Hwan Kim1, Ho-Cheol Shin1, Seon-Yeong Lee2
1Department of Family Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine; 2Department of Family Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
Eun-Ju Sung Tel: +82-2-2001-2277, Fax: +82-2-2001-1404 E-mail: eunjusung68@gmail.com ORCID: http://orcid.org/0000-0002-6045-3154
Received: July 6, 2017; Revised: August 22, 2017; Accepted: August 30, 2017; Published online: August 20, 2018.
© The Korean Academy of Family Medicine. All rights reserved.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background: Obesity has been considered a protective factor for osteoporosis. Being obese not only means being overweight, but also having metabolic derangements. Several studies have shown that metabolic abnormalities may have negative effects on bone mineral density (BMD), but the evidence is inconclusive. We compared BMD according to a metabolically healthy obesity phenotype to analyze the influence of metabolic abnormalities and obesity on BMD.
Methods: We conducted a cross-sectional study of Korean adults who underwent a health screening program between 2010 and 2013. A total of 1,298 subjects (550 women and 748 men) were included. Lumbar spine (LS) BMD was assessed using dual-energy X-ray absorptiometry. Obesity was defined as body mass index (BMI) of 25 kg/m2 or higher. Participants were classified as being metabolically healthy if fewer than two of the following were present: hypertension, hyperglycemia, hypertriglyceridemia, and low high-density lipoproteinemia. Analyses were conducted in four groups that were divided according to obesity and metabolic health: metabolically healthy non-obese (MHNO), metabolically unhealthy non-obese (MUHNO), metabolically healthy obese (MHO), and metabolically unhealthy obese (MUHO).
Results: The mean values of LS BMD were higher in obese groups (MHO and MUHO) than in non-obese groups (MHNO and MUHNO). However, there were no significant differences between MHNO and MUHNO and between MHO and MUHO, which were different in metabolic health status. After adjusting for BMI and other covariates, there were no differences in LS BMD between the four groups.
Conclusion: Overweight may be an important factor in BMD, whereas metabolic health did not appear to be associated with BMD.
Keywords: Obesity; Metabolically Benign; Metabolic Syndrome; Bone Density
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