Determinants of Bone Density in 30- to 65-Year-Old Women: A Co-Twin Study

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Abstract
Reported effects of body composition and lifestyle on bone mineral density in pre‐elderly adult women have been inconsistent. In a co‐twin study, we measured bone mineral density, lean and fat mass, and lifestyle factors. Analyzing within pair differences, we found negative associations between bone mineral density and tobacco use (2.3–3.3% per 10 pack‐years) and positive associations with sporting activity and lean and fat mass. Introduction: Reported effects of body composition and lifestyle of bone mineral density in pre‐elderly adult women have been inconsistent. Methods: In a co‐twin study of 146 female twin pairs aged 30 to 65 years, DXA was used to measure bone mineral density at the lumbar spine, total hip, and forearm, total body bone mineral content, and lean and fat mass. Height and weight were measured. Menopausal status, dietary calcium intake, physical activity, current tobacco use, and alcohol consumption were determined by questionnaire. Within‐pair differences in bone measures were regressed through the origin against within‐pair differences in putative determinants. Results: Lean mass and fat mass were associated with greater bone mass at all sites. A discordance of 10 pack‐years smoking was related to a 2.3–3.3% (SE, 0.8–1.0) decrease in bone density at all sites except the forearm, with the effects more evident in postmenopausal women. In all women, a 0.8% (SE, 0.3) difference in hip bone mineral density was associated with each hour per week difference in sporting activity, with effects more evident in premenopausal women. Daily dietary calcium intake was related to total body bone mineral content and forearm bone mineral density (1.4 ± 0.7% increase for every 1000 mg). Lifetime alcohol consumption and walking were not consistently related to bone mass. Conclusion: Several lifestyle and dietary factors, in particular tobacco use, were related to bone mineral density. Effect sizes varied by site. Characterization of determinants of bone mineral density in midlife and thereafter may lead to interventions that could minimize postmenopausal bone loss and reduce osteoporotic fracture risk.