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Secular Trends in Peak Bone Mineral Density: The National Health and Nutrition Examination Survey 1999–2018

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Abstract

Peak bone mineral density (BMD) is one of the most important factors influencing the development of osteoporosis. It was predicted that a 10% increase in peak BMD will delay the onset of osteoporosis by 13 years. However, changes in peak BMD over time are unknown. This study aimed to investigate secular trends in peak BMD among young adults in the United States. Based on the National Health and Nutrition Examination Survey from 1999–2018, 3,975 males aged 19–28 years and 2370 females aged 31–40 years were our target population for estimating peak lumbar spine BMD. BMD was measured by dual-energy X-ray absorptiometry. Generalized linear models adjusted for multiple covariates were used to examine the secular trends in peak BMD in males and females, respectively. Secular trends for peak lumbar spine BMD from 1999–2000 to 2017–2018 were not statistically significant in males or females (all Plinear and Pquadratic > 0.05). Similar results were observed in race/ethnicity subgroups (all Plinear and Pquadratic > 0.05). However, in stratified analyses by obesity category, peak lumbar spine BMD in obese males and females increased from 1999–2000 to 2009–2010 and then decreased until 2017–2018, while peak lumbar spine BMD in non-obese females decreased from 1999–2000 to 2005–2006 and then increased until 2017–2018 (all Pquadratic < 0.05). Peak lumbar spine BMD was greater in obese males and females than in non-obese males and females up to 2009–2010, but not from 2011–2012 onwards. Overall, there were no significant secular trends in peak lumbar spine BMD. However, secular trends differed between obese and non-obese groups.

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Acknowledgements

The authors acknowledge the data from the National Health and Nutrition Examination Survey (NHANES). All data are available at the NHANES website (https://wwwn.cdc.gov/nchs/nhanes/default.aspx).

Funding

This work is supported by a research grant from the Changchun Scientific and Technological Development Program (Grant Number: 21ZGM28). LML is supported by a Tier 1 Canada Research Chair (CRC-2017–00186). This work is also supported by a research grant from the Norman Bethune Program (Grant Number: 2023B11).

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Authors and Affiliations

  1. Department of Orthopedics, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning, China

    Xiaohua Zhang, Linghua Yang & Shuman Yang

  2. Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, 232-1163 Xinmin Street, Changchun, 130021, Jilin, China

    Xiaohua Zhang, Linghua Yang, Juan Zhang & Shuman Yang

  3. Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada

    Lisa M. Lix

  4. Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada

    William D. Leslie

  5. Department of Clinical Laboratory, The Second Hospital of Jilin University, Changchun, Jilin, China

    Bo Kan

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Contributions

Conception and design (XZ and SY); data curation, formal analysis, and validation (XZ, LY and JZ); interpretation of data (all authors); drafting the article (XZ); supervision (SY, BK, LL and WL); funding acquisition (SY and BK); critically revising the article for important intellectual content (all authors); final approval of the version to be published (all authors); and agreement to be accountable for all aspects of the work (all authors).

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Correspondence to Shuman Yang.

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Conflict of interest

Xiaohua Zhang, Linghua Yang, Juan Zhang, Lisa M. Lix, William D. Leslie, Bo Kan, Shuman Yang are declare that they have no conflicts of interest.

Ethics Approval

The data from NHANES has been approved by the National Center for Health Statistics Research Ethics Review Board; they are Protocol #98-12, Protocol #2005-06, Continuation of Protocol #2005-06, Continuation of Protocol #2005-06, Protocol #2011-17, Continuation of Protocol #2011-17, Continuation of Protocol #2011-17, Continuation of Protocol #2011-17 (Effective through October 26, 2017), and Protocol #2018-01 (Effective beginning October 26, 2017).

Consent to Participate

Written informed consent was obtained from all participants (i.e., individual participants, legal guardians, and the parents); this can be obtained from the NHANES website (https://www.cdc.gov/nchs/nhanes/biospecimens/participants.htm).

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Zhang, X., Yang, L., Zhang, J. et al. Secular Trends in Peak Bone Mineral Density: The National Health and Nutrition Examination Survey 1999–2018. Calcif Tissue Int 114, 480–489 (2024). https://doi.org/10.1007/s00223-024-01198-0

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