Vol.3, No.1, 128-131 (2013) Open Journal of Preventive Medicine
Bone mineral density in Iranian patients: Effects of
age, sex, and body mass index
Mehrdad Aghaei1, Hamid Reza Bazr Afshan1*, Mostafa Qorbani2, Hossien Shadpour Dashti3,
Roya Safari4
1Bone joints & Connective Tissue Disease Research Center, Golestan University of Medical Sciences, Gorgan, Iran;
*Corresponding Author: Mahdieh.shojaa_mw@yahoo.com
2Department of Epidemiology & Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
3Department of Internal Medicine, Golestan University of Medical Sciences, Gorgan, Iran
4Department of Internal Medicine, Tehran University of Medical Sciences, Tehran, Iran
Received 22 June 2012; revised 28 July 2012; accepted 5 August 2012
Introduction: Osteoporosis is a multifactorial
skeletal disease that is characterized by reduced
bone mineral density (BMD). BMD values de-
pend on several factors such as age, sex and
age at menopause. The purpose of this study
was to determine the prevalence and changes in
bone mineral density in Iranian patients. Meth-
ods: Three hundred patients were selected through
random sampling technique in 2009. BMD was
assessed by Norland (Excell) technique at the
lumbar and femoral neck. Weight and height
were measured through standard methods. A
thorough history was taken from each patient.
The data was analyzed using SPSS software
version 13.0. P-values less than 0.05 were con-
sidered statistically significant. Results: From
among the 300 studied patients, 86.6% were fe-
male. their mean age was 52.7 years. Their av-
erage body mass index (BMI) was 28.14 kg/m2.
Mean T-Score at lumbar spine and femoral neck
was 1.07 ± 1.19 and 1.75 ± 1.33 respectively.
Mean BMD value at lumbar spine and femoral
neck was 0.92 ± 0.19 and 0.77 ± 0.16 respectively.
The prevalence of osteoporosis at lumbar spine
and femoral neck was 33.7% and 16.7, respec-
tively. There was a significant correlation be-
tween age, BMI and BMD values (P-Value < 0.01).
Correlation between gender and BMD value at
the lumbar spine and femoral neck was not sig-
nificant. Conclusion: This study shows that age-
ing and low BMI are risk factors associated with
bone loss. it is recommended to measure BMD
and implement prevention programs for high-
risk people.
Keywords: Bone Mineral Density; Body Mass Index;
Age; Gender
Osteoporosis is a multifactorial skeletal disease char-
acterized by reduced bone mineral density (BMD) along
with the deterioration of the microarchitectural structure
of bone tissue, and a consequent increase in bone fragil-
ity and fracture risk [1,2]. Osteoporosis is a common
disease among the elderly, particularly the post-meno-
pausal women [3-7]. BMD values depend on such factors
as age, sex and age at menopause [8-10]. It has been pre-
dicted that in 2050, 50% of all hip fractures in the world
will be occurring in Asia [11]. Osteoporosis is a disease
that affects many millions of people around the world. It
affects more than 75 million people in the United States,
Europe and Japan [12]. It is estimated that world’s an-
nual incidence of hip fracture will increase from 1.26
million cases in 1990 to 2.6 million by 2025 and to 4.5
million by 2050 [13]. Osteoporotic fractures affect the
quality of life and are associated with premature mortal-
ity [14].
The prevalence of osteoporosis among Iranian women
varies from 6 to 34.4 percent in different cities and
provinces [15-18]. In the present study, we evaluated the
prevalence and correlation of osteoporosis with demo-
graphic factors among patients referred to a densitometry
center in Gorgan, a city located in North Iran.
From among 3000 patients who were referred to the
Azar 5th teaching hospital affiliated to Gorgan Univer-
sity of Medical Sciences, 300 patients were selected
through random sampling technique in 2009. The indi-
viduals with underlying diseases affecting bone mass
such as rheumatoid arthritis, renal and liver failure and
any cansers were excluded. BMD was assessed by Nor-
land (Excell) technique at the lumbar and femoral neck.
Based on WHO classification, individuals with T-score
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M. Aghaei et al. / Open Journal of Preventive Medicine 3 (2013) 128-13 1 129
values higher than 1 were classified as normal, those
with T-score between 1 and 2.5 as osteopenic, and
those with T-score less than 2.5 as osteoporotic [12].
Weight and height were measured through standard
methods and BMI was calculated by dividing weight
(kilogram) by square height (square meter). A thorough
history was taken from each patient. The data was ana-
lyzed using SPSS software version 13.0. The descriptive
data were presented as frequency, mean and SD, whereas
regression, ×2 and T-test were used for further analysis
and the comparison of the data. P-values less than 0.05
were considered statistically significant.
From among the 300 studied patients, 260 (86.6%)
were female. Their mean age was 52.7 ± 14.42 years,
ranging from 21 to 85 years. Their body mass index
(BMI) ranged from 16.0 to 45.54 kg/m2, with an average
of 28.14 (SD = 5.42). Mean BMD value at the lumbar
spine and femoral neck was 0.92 ± 0.19 and 0.77 ± 0.16
respectively. According to the T Score values at lumbar
spine, 101 patients (33.7%) had osteoporosis and 115
(38.3%) had osteopenia. Furthermore, regarding the val-
ues reported at the femoral neck, 50 patients (16.7%) had
osteoporosis and 121 others (40.3%) had osteopenia.
Mean T-Score at lumbar spine and femoral neck was
1.07 ± 1.19 (3.78 to 2.25) and 1.75 ± 1.33 (5.07 to
1.75), respectively. There was a positive and significant
correlation between age and BMD values at both lumbar
spine (r = 0.32, P-Value < 0.01) and femoral neck (r =
0.42, P-Value < 0.01). There was a significant and posi-
tive correlation between BMI values and bone loss at
lumbar spine (r = 0.31, P-Value < 0.01); such a signifi-
cant correlation, however, was not reported at the femo-
ral neck region (r = 0.12, P-Value = 0.11). The preva-
lence of osteoporosis among women and men at the
lumbar spine was 14 and 2.7 percent respectively. 28.3
percent of women and 5.3 percent of men had osteoporo-
sis at the femoral neck but correlation between gender
and BMD value at the lumbar spine and femoral neck
was not significant (Table 1). The correlation between
age groups and BMD at both lumbar spine and femoral
neck was significant (P-Value < 0.01) (Table 2).
In our study, the prevalence of osteoporosis at lumbar
spine and femoral neck was 33.7 and 16.7 respectively.
Table 3 shows the prevalence of osteoporosis at the LS
and FN in different places of the world. The figure
ranges from 6.3 in Saudi Arabia to 40.1 percent Korea
that is consistent with this study. These discrepancies can
be explained based on the differences in race, life style
and dietary habits of the people of these countries. In
Table 1. Correlation between BMD and sex.
Site BMD status
Osteoporosis42 (14) 8 (2.7)
Osteopeni 105 (35) 16 (5.3)
normal 113 (37.7) 16 (5.3)
Osteoporosis85 (28.3) 16 (5.3)
Osteopeni 96 (32) 19 (6.3)
normal 79 (26.3) 5 (1.7)
Table 2. Prevalence of osteoporosis and BMD status according
to the age groups at both lumbar spine and femoral neck.
lumbar femur
number (%)
lumbar femur
number (%)
lumbar femur
number (%)
than 29
2 (10)
2 (10)
5 (25)
9 (45)
13 (65)
9 (45)
30 - 392 (7.5)
2 (7.1)
7 (25)
13 (46.4)
19 (67.9)
13 (46.4)
40 - 491 (1.7)
4 (7.6)
14 (23.3)
22 (36.7)
45 (75)
34 (56.7)
50 - 5915 (15.8)
31 (32.6)
41 (43.2)
44 (46.3)
39 (41.1)
20 (21.1)
60 - 6917 (28.3)
32 (53.3)
33 (55)
20 (33)
10 (16.7)
8 (13.3)
than 70
13 (35.1)
30 (81.1)
21 (56.8)
7 (18.9)
3 (8.1)
Table 3. Prevalence of osteoporosis in different places of the
place Prevalence of osteoporosis femoral neck
lumbar spine
Japan 11.6 38
Saudi Arabia 6.3 38.3
Canada 7.9 12.1
Thailand 13.6 19.8
Korea 12.4 40.1
Turkey 7.5 33
Iran 18.9 18.9
line with our study, many studies have introduced age as
an important factor for bone loss [17-24]. Jang et al.
showed that the prevalence of osteoporosis in post-
menopausal women increases with age from 30.6% in
those aged between 45 and 64 to 68.7 percent in those
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M. Aghaei et al. / Open Journal of Preventive Medicine 3 (2013) 128-13 1
aged over 75 [25]. In our study, there was a positive
strong correlation between BMI and bone mineral den-
sity in lumbar spine. In other words, each unit increase in
BMI values is associated with 0.314 unit increase in bone
density. Several studies in the UAE [26], India [27], Japan
[28], Netherlands [29], the US [30] and Morocco [31]
have considered a positive correlation between BMI and
bone mineral density. A Brazilian study reported that
body weight is important for gaining and losing body
mass, and causes an impact on BMD-age relationship
[32]. Our results showed that the prevalence of osteopo-
rosis among women was more than men but this correla-
tion was not significant. In some study, on the contrary
to our findings, revealed significantly higher prevalence
of osteoporosis in women than in men [33-36] This can
be due to the very low number of men compared with
women in our study. On the other hand, although hor-
monal changes in women, especially after menopause,
has an important role in osteoporosis, but men should not
ignore about BMD changes.
The present research indicated the negative effect of
age and positive effect of BMI on bone mass. Although,
the prevalence of osteoporosis was higher among women,
there was no statistically significant difference in this
regard. As a result, it is recommended to use risk factors
for requesting testing, mainly DXA and implement pre-
vention programs for high-risk people and more attention
needs to be paid to men osteoporosis. Future prospective
studies are therefore necessary to gather more accurate
information in this regard.
The study was funded by the Department of Research affairs of Go-
lestan University of Medical Sciences. The authors wish to gratefully
acknowledge the contribution of all the patients who participated in the
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