Vol.2, No.7, 713-721 (2010)h
doi:10.4236/health.2010.27109
Copyright © 2010 SciRes. Openly accessible at http://www.scirp.org/jo urna l/HEALTH/
Healt
The effect of past and present lifestyle, nutrition habits,
and gender on bone mineral density
Masakatsu Nakada1*, Shinichi Demura2
1National Defense Academy Hashirimizu, Yokosuka, Japan;
*Corresponding Author:
2Graduate school of Natural Science & Technology, Kanazawa University Kakuma, Kanazawa, Japan
Received 2 March 2010; revised 14 March 2010; accepted 16 March 2010.
ABSTRACT
This study aimed to examine the gender and
age differences of the quantitative osteo-sono
assessment index (OSI) and the effects of the
p ast and present lifesty le and nutrition habit s on
OSI in adult males and females from 20 to 70
years of age. The subjects were 155 males (20-
79 years) and 399 females (20-78 years). The
bone mass was estimated by the right-calcaneal
OSI using an ultrasonic transmission method
with an AOS-100 device (ALOKA). The fre-
quency of tests for OSI in women tended to in-
crease rapidly in the 50-70 age group requiring
close examination or guidance. In 50-70 year-
old females, the proportion of dairy products
and vitamin D intake in the past (junior high
school and high school days) was significantly
lower in the group requiring close examination
or guidance (OSI < 2.428) than in the normal
group (OSI ≧ 2.428). That is, there was insuf-
ficient calcium intake (through dairy products)
and vitamin D intake, which is instrumental in
calcium absorption, (through fish, chicken eggs,
and fungi) during puberty, when bone mass in-
creases with skeletal growth. In conclusion, the
number in the group requiring close examina-
tion or guidance was high for 50-70 year-old
males and females. The OSI decreases rapidly
in females after their 50s and the number in the
group requiring close examination or guidance
increased rapidly.
Keywords: Lifestyle Habit; Nutrition Habit;
Ultrasound; Osteo-Sono Assessment Index; Gender
1. INTRODUCTION
Osteoporosis in elderly people markedly results in a de-
crease in activities of daily living (ADL) and quality of
life (QOL) [1-4]. Aging is an important factor which
affects bone mass and bone mineral density (BMD) [5].
BMD reaches its peak level from puberty to the time a
person reaches their 20s and is maintained until their 40s,
and then begins to decrease [2]. Nakata et al. [6] re-
ported that because it is difficult to prevent osteoporosis
in middle age with low peak bone mass, it is important
to acquire basic eating and exercise habits during young
adult age. Preventing a decrease of the peak bone mass
through proper nutrition, exercise, sun bathing, etc. is
very effective for preventing osteoporosis in old age [5].
It has been reported that eating habits in addition to ex-
ercise habits greatly affect bone formation [3,7]. Kim et
al. [8] found that the loss of bone mineral content and
bone mass with age differs by gender. Hence, the effect
of lifestyle on BMD and bone mass after acquiring the
peak bone mass should be studied according to gender
and by using people of a wide age range.
Calcium ingestion during puberty markedly increases
bone mass and may be an important factor in determin-
ing peak bone mass [2]. Bone mass in females decreases
by about 3 percent a year with age after menopause [9].
Hence, increasing peak bone mass as much as possible
during puberty is very important, and also the examina-
tion of relationships between BMD after adolescence
and past (puberty) lifestyle habits will be essential.
Nakada et al. [10] confirmed that the effect of past
and present lifestyle habits and nutrition on calcaneal
quantitative osteo-sono index (OSI) in pre- and post-
menopausal females. This study aimed to examine the
OSI differences among different gender and age groups,
and the effect of past and present lifestyle and nutrition
habits on OSI in people from 20 to 70 years of age.
2. METHODS
2.1. Subjects
The subjects were 155 males (20-79 years of age) and

M. Nakada et al. / HEALTH 2 (2010) 713-721
Copyright © 2010 SciRes. Openly accessible at http://www.scirp.org/journa l/HEALTH/
714
399 females (20-78 years of age). Written informed con-
sent was obtained from all subjects after a full explana-
tion of the experimental purpose and protocol.
2.2. Measurement of Bone Mineral Density
and Setting of Osteo-Sono Assessment
Index Group
The BMD was estimated by the right-calcaneus using an
ultrasonic transmission method with an AOS-100 device
(ALOKA). The calcaneal osteo-sono assesment was used
osteo-sono assesment index (OSI: TI × SOS2）by cal-
culating the speed of sound (SOS) of an ultrasonic
transmission in the calcaneus and transmission index (TI)
referring to the report of Ishiguro et al. [11].
The Japan Osteoporosis Foundation [2] classified fe-
males into a close examination group (OSI < 80% of an
average OSI = 2.158), a guidance required group (2.158
≦ OSI < 90% of an average OSI = 2.428) and a normal
group (OSI ≧2.428) based on an average OSI (OSI =
2.698) of females between 20 and 44 years old by osteo
sono assessment criteria. In this study, we combined the
former 2 groups considering a sample size of each age
level and compared the close examination and guidance
required groups (OSI < 2.428 ) and the normal group
(OSI ≧ 2.428 ). The appropriate criteria of OSI in males
has not been reported. Hence, males were classified into
a close examination and guidance required group (OSI <
90% ) and a normal group (OSI ≧ 90% ) based on an
average OSI of people between 20 and 44 years old in
reference to the females’ assessment criteria in Japan
Osteoporosis Foundation [2].
2.3. Lifestyle Habits and Nutrition
Questionnaire
Lifestyle habits and nutrition were evaluated by ques-
tionnaires. The survey was carried out just before the
measurement of OSI. Naka et al. [5] selected menopause,
habitual milk intake, intensity of physical exercise, and
awareness of eating habits and physical activity as life-
style items. Tomita selected breakfast habits, milk and
dairy products, fish and shellfish, meat products etc. in
present and childhood (about 6-15 yr) as eating habit
items. Elgán et al. [12] selected 10 items (dietary habits
(i.e. sugar, fat, fiber, and fruit/vegetables), physical ac-
tivity, smoking habits, alcohol consumption, time spent
outdoors etc.) as lifestyle items. The Japan Osteoporosis
Foundation [2] selected alcohol, tobacco, coffee, milk,
dairy products, fish, meat, soy products, green and yel-
low vegetables, and natto as meal and articles of taste
items for the interview sheet as examples of osteopo-
rosis prevention. Referring to the above, this study se-
lected the following 9 items to investigate the present
eating habits: 1) sleeping time, 2) frequency of alcohol
consumption, 3) smoking habits, 4) skipping meals, 5)
intake of dairy products (milk, cheese, yogurt, etc.), 6)
intake of calcium supplements, 7) intake of vitamin D
(fish, chicken egg, fungi), 8) intake of instant food (in-
stant noodles, instant coffee, etc.), and 9) frequency of
sun bathing. And, as the past (junior high school and
high school days) states, 1) sleeping time, 2) skipping
meals, 3) intake of dairy products, 4) intake of vitamin D,
and 5) intake of instant food among the above 5 items
were surveyed.
2.4. Data Analysis
Two–way (gender × age) ANOVA was used to examine
the age and gender differences of OSI. When a signifi-
cant difference was found, multiple comparisons were
performed by Bonferroni’s method. In both males and
females, cross tabulations by 20-40 year-olds and 50-70
year-olds were made up. A χ2 test was used to examine
the proportion of OSI groups. In each OSI group, cross
tabulations by the past and the present lifestyle and nu-
trition ingestion habits were made up and then a test of
independence was performed. When a significant dif-
ference was found, residual analysis was used. A prob-
ability level of 0.05 was indicative of statistical signifi-
cance.
3. RESULTS
Figure 1 shows the result of a two-way ANOVA (age ×
gender). A significant interaction effect was found. The
results of multiple comparisons showed gender differ-
ences, males having a higher OSI, except for 30 year-
olds. In males, the OSI of 20 year-olds was significantly
higher than that of 30-70 year-olds. In females, the OSI
of 20-40 year-olds was significantly higher than that of
50-70 year-olds.
Ta bl e 1 shows the result of χ2 test (age × gender) in
each OSI group. The frequency of the group requiring
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
20‐year 30‐year 40‐year 50‐year 60‐year70‐year
Male
Female
Gender F=85.750P=0.000 Partia lη
2
=0.137
AgeF=23.865P=0.000 Partialη
2
=0.180
Interactioneff ectF=4.846P=0.000 Par tia l
η
2
=0.043
20,40‐70year ：Male＞Female
Male：20year ＞30‐70year
Female：20‐40year＞50‐70year
OSI
Figure 1. Result of two-way ANOVA (age x gender) in OSI.

M. Nakada et al. / HEALTH 2 (2010) 713-721
Copyright © 2010 SciRes. Openly accessible at http://www.scirp.org/journa l/HEALTH/
715
715
Table 1. Result of χ2 test (age × gender) in each OSI group.
gender OSI group 20-40 year-olds 50-70 year-olds χ2 ρ φ
normal 59 (72%) 33 (45%) 11.451 0.000 0.285
Male
A close examination-guidance required 23 (28%) 40 (55%)
normal 155 (81%) 99 (48%) 46.21 0.000 0.349
Female
A close examination-guidance required 37 (19%) 108 (52%)
close examination or guidance showed a significant dif-
ference in males and females. The Average OSI of 20-44
year-old males was 3.034 and 90% of that corresponds
to 2.731. We used this value as the judgment criteria for
the group requiring close examination or guidance,
similar to the female group. The number of male sub-
jects corresponding to less than OSI = 2.731 in males out
of the 20-40 year-olds and 50-70 year-olds were 23 and
40, respectively.
and past lifestyle and nutrition habits. In the 20-40 year-
old females, a test of independence showed significant
differences in sleeping time. However, the results of re-
sidual analysis showed no significant differences in any
category. A test of independence showed significant dif-
ferences in the intake of dairy products and vitamin D in
the past in the 50-70 year-old females. The results of
residual analysis showed significant differences in the
intake of dairy products in the past; the normal group
showed a higher proportion of subjects with a greater
weekly intake (dairy products: z = 2.95 > 2.64, Vitamin
D: z = 2.75 > 2.64, p < 0.05).
Figure 2 shows the percentage of females in the group
requiring close examination or guidance. The percentage
tended to increase rapidly after 50 years of age (30-40
year-olds: about 1.5-1.7 times of 20 year-olds, 50 year-
olds: about 3.4 times of 20 year-olds, 60 year-olds: about
4.3 times of 20 year-olds, and 70 year-olds: about 5.9
times of 20 year-olds).
4. DISCUSSION
The Japan Osteoporosis Foundation [2] reported that
average OSI of 20 and 44 years old females (6096 peo-
ple) was OSI = 2.698 ± 0.298. From the present result
(OSI = 2.742 ± 0.350), it is considered that the OSI of
females in this study was the standard. The gender dif-
ferences of the OSI were found in all age groups, males
being higher, except for 30 year-olds. In males, the age
differences were found between the 20 year-old group
and age groups after 30, and the OSI tended to remain
the same level or to decrease slightly after their 30 s.
However, in females, the OSI tended to be maintained in
the 20-40 year-olds and to decrease sharply after their 50
s. Kim et al. [8] reported that bone mineral content in
males decreased 0.3 kg per each decade from their 20 s
to 40 s, kept almost the same level from their 40 s to
their 60 s, and decreased 0.3 kg from their 60 s to their
70 s. In females, the bone mineral content changed little
from their 20 s to their 40 s and decreased markedly
from their 60 s to 70 s. It is thought that OSI is higher in
males than in females and its decrease tendency with age
differs largely by gender because of the sharp decrease
observed in females beginning in their 50 s. And, the
proportion in the group requiring close examination or
guidance based on the judgment criteria by the Japan
Osteoporosis Foundation [2] was higher in 50-70 year-
olds than in 20-40 year-old males and females, but
tended to increase sharply after 50 s (Figure 2) in fe-
ales. This is thought to relate to the marked decrease of
Tab le 2 (20-40 years-old males) and Tab le 3 (50-70
year-old males) show the cross tabulations of the fre-
quency of OSI groups and the frequency of the present
and past lifestyle and nutrition habits. A test of inde-
pendence showed significant differences in the fre-
quency in the intake of vitamin D in the 50-70 year-old
males. However, the results of residual analysis showed
no significant differences in any category. In the 20-40
year-old males, there were no significant differences in
all present lifestyle and nutrition ingestion habit items.
Ta bl e 4 (20-40 year-old females) and Ta bl e 5 (50-70
year-old females) show the cross tabulations of the fre-
quency of OSI groups and the frequency of the present
Figure 2. Frequency of OSI in the close examination-guidance
required group in female. m

M. Nakada et al. / HEALTH 2 (2010) 713-721
Copyright © 2010 SciRes. Openly accessible at http://www.scirp.org/journa l/HEALTH/
716
Table 2. Present and past lifestyle and nutrition habits and the OSI of 20-40-year-olds males.
Sleeping time Less than 6
hours
More than 6
hours-less than
7 hours
More than 7
hours-less than 8
hours
More than 8
hours χ2 ρ φ
Normal 12 33 12 1 2.817 0.421 0.19
Present CEGR 4 14 3 2
Normal 9 20 18 6 0.981 0.806 0.11
Past CEGR 2 9 9 2
Alcohol intake No 1-3 times a month1-3 times a weeknearly every
day
Normal 13 15 16 15 3.277 0.351 0.20
Present CEGR 5 10 3 5
Smoking No Have a habit Quit
Normal 28 14 17 0.109 0.947 0.04
Present CEGR 10 6 7
Skip a meal No Breakfast Lunch Supper
Normal 45 13 0 1 6.452 0.092 0.28
Present CEGR 21 1 1 0
Normal 45 12 0.568 0.451 0.09
Past CEGR 19 3
Intake of dairy products No 1-3 times a week4-7 times a week
Normal 10 25 24 0.476 0.788 0.08
Present CEGR 5 8 10
Normal 7 23 27 0.371 0.831 0.07
Past CEGR 4 9 10
Intake of Ca supplement No Rarely Continuous
Normal 40 14 5 3.691 0.158 0.21
Present CEGR 20 3 0
Intake of vitamin D No 1-3 times a week4-7 times a week
Normal 7 37 15 1.130 0.568 0.12
Present CEGR 1 15 7
Normal 3 34 17 0.311 0.856 0.06
Past CEGR 1 16 6
Intake of instant food No 1-3 times a monthMore than once a
week
Normal 9 20 30 2.425 0.297 0.17
Present CEGR 2 12 9
Normal 3 30 24 0.39 0.823 0.07
Past CEGR 2 11 10
Sunbathing No 1-3 times a
week
More than 4 times a
week
Normal 14 24 20 1.734 0.42 0.15
Present CEGR 5 13 5
Note: CEGR:close examination or guidance required group

M. Nakada et al. / HEALTH 2 (2010) 713-721
Copyright © 2010 SciRes. Openly accessible at http://www.scirp.org/journa l/HEALTH/
717
717
Table 3. Present and past lifestyle and nutrition habits and the OSI of 50-70-year-olds males.
Sleeping time Less than 6
hours
More than 6
hours-less than 7
hours
More than 7
hours-less than 8
hours
More than 8
hours χ2 ρ φ
Normal 6 14 11 1 3.316 0.345 0.21
Present
CEGR 9 13 13 6
Normal 1 11 17 1 2.89 0.409 0.21
Past
CEGR 2 14 13 4
Alcohol intake No 1-3 times a month1-3 times a weeknearly every day
Normal 9 1 5 17 1.095 0.778 0.12
Present
CEGR 15 2 4 20
Smoking No Have a habit Quit
Normal 11 6 13 1.179 0.555 0.13
Present
CEGR 11 7 23
Skip a meal No Breakfast Lunch Supper
Normal 25 3 1 0 2.272 0.321 0.18
Present
CEGR 39 2 0 0
Normal 21 4 1 0 1.801 0.406 0.17
Past
CEGR 33 4 0 0
Intake of dairy products No 1-3 times a month4-7 times a week
Normal 5 13 14 0.579 0.749 0.09
Present
CEGR 9 14 18
Normal 11 12 7 4.078 0.13 0.25
Past
CEGR 21 13 3
Intake of Ca supplement No Rarely Continuous
Normal 27 3 2 0.595 0.743 0.09
Present
CEGR 34 4 1
Intake of vitamin D No 1-3 times a week4-7 times a week
Normal 1 23 8 0.415 0.813 0.08
Present
CEGR 2 31 8
Normal 0 (–1.80) 20 (–1.20) 8 (2.56) 8.897 0.012* 0.37
Past
CEGR 4 (1.80) 31 (1.20) 2 (–2.56)
Intake of instant food No 1-3 times a monthMore than once
a week
Normal 6 18 8 2.797 0.247 0.20
Present
CEGR 13 15 12
Normal 14 10 5 0.139 0.933 0.05
Past
CEGR 16 14 6
Sunbathing No 1-3 times a weekMore than 4 times
a week
Normal 6 12 12 1.400 0.497 0.14
Present
CEGR 4 18 18
Note: CEGR: close examination or guidance required group, *P < 0.05, Number shown in parentheses is the Z score of the residual analysis.

M. Nakada et al. / HEALTH 2 (2010) 713-721
Copyright © 2010 SciRes. Openly accessible at http://www.scirp.org/journa l/HEALTH/
718
Table 4. Present and past lifestyle and nutrition habits and the OSI of 20-40-year-olds females.
Sleeping time Less than 6
hours
More than 6
hours-less than 7
hours
More than 7
hours-less than 8
hours
More than 8
hours χ2 ρ φ
Normal 49 (0.54) 70 (–2.15) 35 (2.38) 1 (–1.11) 8.359 0.039* 0.21
Present
CEGR 10 (–0.54) 24 (2.15) 2 (–2.38) 1 (1.11)
Normal 21 50 39 9 7.405 0.060 0.22
Past
CEGR 1 11 11 6
Alcohol intake No 1-3 times a month1-3 times a weeknearly every day
Normal 47 63 21 23 3.537 0.316 0.14
Present
CEGR 14 9 5 8
Smoking No Have a habit Quit
Normal 128 13 13 0.458 0.795 0.05
Present
CEGR 29 4 4
Skip a meal No Breakfast Lunch Supper
Normal 125 17 3 4 2.393 0.495 0.11
Present
CEGR 29 6 0 0
Normal 110 30 0 0 0.113 0.737 0.03
Past
CEGR 26 6 0 0
Intake of dairy products No 1-3 times a month4-7 times a week
Normal 15 62 78 0.699 0.705 0.06
Present
CEGR 2 16 19
Normal 16 58 72 2.592 0.274 0.12
Past
CEGR 2 18 13
Intake of Ca supplement No Rarely Continuous
Normal 113 29 12 1.483 0.476 0.09
Present
CEGR 30 6 1
Intake of vitamin D No 1-3 times a week4-7 times a week
Normal 8 88 58 2.501 0.286 0.11
Present
CEGR 3 25 9
Normal 4 86 49 4.167 0.125 0.16
Past
CEGR 3 18 7
Intake of instant food No 1-3 times a monthMore than once a
week
Normal 28 56 69 5.915 0.052 0.18
Present
CEGR 2 11 24
Normal 22 76 45 0.060 0.970 0.02
Past
CEGR 4 16 9
Sunbathing No 1-3 times a weekMore than 4 times a
week
Normal 43 62 47 2.545 0.280 0.12
Present
CEGR 14 10 13
Note: CEGR: close examination or guidance required group, *P < 0.05, Number shown in parentheses is the Z score of the residual analysis.

M. Nakada et al. / HEALTH 2 (2010) 713-721
Copyright © 2010 SciRes. Openly accessible at http://www.scirp.org/journa l/HEALTH/
719
719
Table 5. Present and past lifestyle and nutrition habits and the OSI of 50-70-year-olds females.
Sleeping time Less than 6
hours
More than 6
hours-less than 7
hours
More than 7
hours-less than 8
hours
More than 8
hours χ2 ρ φ
Normal 19 49 26 2 2.401 0.493 0.11
Present
CEGR 26 50 26 6
Normal 5 25 36 11 0.506 0.917 0.06
Past
CEGR 4 26 32 13
Alcohol intake No 1-3 times a month1-3 times a weeknearly every day
Normal 57 13 11 18 1.191 0.755 0.08
Present
CEGR 62 19 10 16
Smoking No Have a habit Quit
Normal 81 9 7 0.822 0.633 0.06
Present
CEGR 93 8 5
Skip a meal No Breakfast Lunch Supper
Normal 87 5 0 1 3.444 0.328 0.13
Present
CEGR 95 3 3 1
Normal 66 12 0 0 2.224 0.329 0.12
Past
CEGR 72 10 2 0
Intake of dairy products No 1-3 times a month4-7 times a week
Normal 3 30 65 3.592 0.116 0.13
Present
CEGR 7 41 57
Normal 14(–0.18) 44(–0.93) 27(2.95*) 9.751 0.008* 0.24
Past
CEGR 24(0.18) 50(0.93) 11(–2.95*)
Intake of Ca supplement No Rarely Continuous
Normal 73 11 15 0.803 0.669 0.06
Present
CEGR 73 16 15
Intake of vitamin D No 1-3 times a week4-7 times a week
Normal 8 51 39 0.108 0.947 0.02
Present
CEGR 10 54 43
Normal 5(–1.38) 42(–1.82) 36(2.75*) 8.189 0.017* 0.22
Past
CEGR 10(1.38) 53(1.82) 19(–2.75*)
Intake of instant food No 1-3 times a monthMore than once a
week
Normal 35 30 31 0.727 0.695 0.06
Present
CEGR 34 32 40
Normal 30 39 14 0.372 0.830 0.05
Past
CEGR 33 35 13
Sunbathing No 1-3 times a weekMore than 4 times a
week
Normal 12 35 47 0.955 0.620 0.07
Present
CEGR 17 38 44
N
ote: CEGR: close examination or guidance required group, *P < 0.05, Number shown in parentheses is the Z score of the residual analysis.

M. Nakada et al. / HEALTH 2 (2010) 713-721
Copyright © 2010 SciRes. Openly accessible at http://www.scirp.org/journa l/HEALTH/
720
bone mass with a rapid decline of estrogen levels in
postmenopausal females [13]. The OSI is generally higher
in males than females. Average OSI of 20-44 years peo-
ple also in this study showed a significant gender differ-
ence (males: OSI = 3.034 ± 0.396, females: OSI = 2.742
± 0.350, t = 5.283, P = 0.000). The proper criteria has
not been reported for males, so this study conveniently
utilized the adult female criteria creation method devel-
oped by the Japan Osteoporosis Foundation [2]. It is
considered that males’ OSI level is higher and thus the
criteria for the group requiring close examination or
guidance differs between genders. Hence, from now, the
OSI standard for males will need to be hastily created
based on a large amount of data.
The group requiring close examination or guidance in
50-70 year-old females had a lower proportion of sub-
jects with weekly intake (4-7 times a week) of dairy
products and vitamin D (fish, chicken egg, fungi) in the
past than the normal group. Tomita et al. [7] reported
that, in the study of junior college dietetics students, the
intake of milk, dairy products, and vegetables on a rou-
tine basis is useful to increase bone mass. Nakata et al.
[6] reported that calcaneal OSI in women’s junior col-
lege students was higher in the high milk intake group.
The three year longitudinal study by Dawson-Hughes et
al. [14] found that the proper intake of vitamin D in ad-
dition to calcium intake reduces the decline of BMD. It
was reported also that inadequate metabolism of vitamin
D decreases calcium absorption in both osteoporotics
and elderly subjects [15]. From the present results, it is
considered that the 50-70 year-old females belonging to
the group requiring close examination or guidance were
deficient in calcium intake through dairy products and
intake of vitamin D which is very important for the ab-
sorption of calcium during puberty to increase bone
mass with skeletal growth. In addition, the above sug-
gests that it is important to have adequate calcium and
vitamin D intake in puberty in addition to old age.
Meanwhile, males showed an insignificant relation-
ship between OSI and items involving the present and
past lifestyle and nutrition habits. Because they do not
have a large physiological change as females when they
experience menopause in middle age, the effect of the
intake of calcium and vitamin D during puberty on
maintenance of BMD and bone formation may be lower
than in females. Many bone fractures that occur in eld-
erly people are of the femoral neck and this fracture
causes bedriddenness and disturbances of gait. Therefore
preventing the cause, osteoporosis, is very important
[2,5].
From now, it will be necessary to compare bone min-
eral density between young adults and the elderly longi-
tudinally, and to examine the combined effect of the past
and present lifestyle and exercise habits on BMD.
In summary, the OSI is higher in males than females
and it is higher in 20 year-olds than 30-70 year-olds in
males and is higher in 20-40 year-olds than 50-70 year-
olds in females. The proportion of the group requiring
close examination or guidance is high in 50-70 year-olds,
particularly in females with a rapid increase after their
50s. The 50-70 year-old females in the group requiring
close examination or guidance were deficient in calcium
intake through dairy products in addition to the intake of
vitamin D, which is important for the absorption of cal-
cium during puberty when bone mass increases with
skeletal growth. The intake of calcium and vitamin D
during puberty may be very important to prevent the
decrease of bone mineral density in old age.
REFERENCES
[1] Gushiken, M. and Akisaka, M. (2004) A survey of cal-
caneus bone mineral density related to physique in young
females and comparison of the findings to those of eld-
erly females in Okinawa. The Journal of Education and
Health Science, 49(4), 239-247.
[2] Japan Osteoporosis Foundation (2000) This handbook for
preventing osteoporosis is based on the Health and
Medical Service Act for the Aged. Japan Medical Jour-
nal, 2nd Edition, Tokyo, 1-135.
[3] Kim, H., Tanaka, K., Nakanishi, T. and Amagai, H. (1999)
Effects of age and body composition on rate of bone
mineral density loss in Japanese adult women. Japanese
Journal of Physical Fitness and Sports Medicine, 48(1),
81-90.
[4] Yokouchi, J., Ando, D., Ono, Y., Ozaki, Y., Asakawa, K.,
Kitagawa, J., Nakahara, Y. and Koyama, K. (2003) The
relationship between calcaneal quantitative ultrasound
parameters and anthropometric measures in university
women. Japanese Journal of Physical Fitness and Sports
Medicine, 52(5), 639-646.
[5] Naka, T., Nakajima, D., Oh, T.W., Han, I., Sakurai, T. and
Igawa, S. (2004) Effects of lifestyle on bone metabolism
in middle-aged and aged Japanese women. Japanese
Journal of Physiological Anthropology, 9(3), 85-92.
[6] Nakata, H., Okazaki, N., Yagita, K., Ohtsuki, S., Satoh, H.
and Mimura, K. (2003) The relationship between ultra-
sound calcaneal bone mass, physique, and daily habits in
women’s junior college students. The Journal of Educa-
tion and Health Science, 49(52), 155-162.
[7] Tomita, N. and Akisaka, M. (2007) A study on the rela-
tionship between bone mineral density and dietary habits
and regular exercise activity of junior college dietetics
students. The Journal of Education and Health Science,
52(4), 212-224.
[8] Kim, H., Tanaka, K., Amagai, H. and Suzuki, T. (1999)
Age-related changes of body composition by dual-energy
X-ray absorptiometry in Japanese men and women. Ja-
pan Journal of Physical Education, 44(6), 500-509.
[9] Dawson-Hughes, B. (1996) Calcium and vitamin D nu-
tritional needs of elderly women. The Journal of Nutri-

M. Nakada et al. / HEALTH 2 (2010) 713-721
Copyright © 2010 SciRes. Openly accessible at http://www.scirp.org/journa l/HEALTH/
721
721
tion, 126(Suppl 4), 1165s-1167s.
[10] Nakada, M. and Demura, S. (2010) Effect of past and
present lifestyle habits and nutrition on calcaneal quanti-
tative osteo-sono index in pre- and post-menopausal fe-
males. Health, 2(2), 124-130.
[11] Ishiguro, N., Miyatani, M., Kanehisa, H., Kuno, S. and
Fukunaga, T. (2003) Relationship between walking steps
during daily life and both the bone intensity of calcaneus
and muscle thickness of the lower leg in elderly men and
women. Japanese Journal of Physical Fitness and Sports
Medicine, 52, 127-132.
[12] Elgán, C. and Fridlund, B. (2006) Bone mineral density
in relation to body mass index among young women: A
prospective cohort study. International Journal of Nurs-
ing Studies, 43(6), 663-672.
[13] Kameda, T., Mano, H., Yuasa, T., Mori, Y., Miyazawa, K.,
Shiokawa, M., Nakamaru, Y., Hiroi, E., Hiura, K., Ka-
meda, A., Yang, N.N., Hakeda, Y. and Kumegawa, M.
(1997) Estrogen inhibits bone resorption by directly in-
ducing apoptosis of the bone-resorbing osteoclasts. The
Journal of Experimental Medicine, 186(4), 489-495.
[14] Dawson-Hughes, B., Harris, S.S., Krall, E.A. and Dallal,
G.E. (1997) Effect of calcium and vitamin D supplemen-
tation on bone density in men and women 65 years of age
or older. The New England Journal of Medicine, 337(10),
670-676.
[15] Gallagher, J.C., Riggs, B.L., Eisman, J., Hamstra, A.,
Arnaud, S.B. and DeLuca, H.F. (1979) Intestinal calcium
absorption and serum vitamin D metabolites in normal
subjects and osteoporotic patients: Effect of age and die-
tary calcium. The Journal of Clinical Investigation, 64(3),
729-736.