Forearm bone mineral density in postmenopausal Indian women: correlation with calcium nutrition

Swati Sharma, Bhavna Agarwal, Rohit Sharma, Simarpreet Singh


Background: Osteoporosis is characterized by low bone mass with micro architectural deterioration of bone tissue leading to enhanced bone fragility, thus increasing the susceptibility to fracture. This study was conducted with the objective of measuring forearm bone mineral density in postmenopausal Indian women and to establish a correlation with indices of calcium nutrition i.e. dietary calcium intake, calcium supplements, serum calcium, serum phosphorus, serum alkaline phosphatase and serum intact parathyroid hormone.

Methods: Fifty healthy, ambulatory postmenopausal women were selected and a prospective observational study was conducted to correlate the BMD with indices of calcium nutrition. Patient’s laboratory investigations (serum calcium, serum phosphorous, serum alkaline phosphatase and serum intact parathyroid hormone were done and BMD was assessed with dual-energy X-ray absorptiometry at non-dominant forearm; T-scores and Z-score were derived. Correlation analysis was done to investigate the relationship between indices of calcium nutrition and BMD.

Results: The proportion of osteoporosis in forearm was 22%in the deficient group, 60% in the insufficient group and 18% in the sufficient group. Among the study group 15 subjects were osteoporotic by T score mid forearm where as 7 were osteoporotic with T score ultra distal forearm and 11 subjects had osteoporosis with T score total forearm.

Conclusions: Out of all the indices of calcium nutrition, the correlation between the serum alkaline phosphatase and T score forearm was statistically significant.


Bone mineral density, Osteoporosis, Postmenopausal women, Serum calcium, Serum phosphorous, Serum alkaline phosphatase, Serum intact parathyroid hormone

Full Text:



Malhotra N, Mittal A. Osteoporosis in Indians. Indian J Med Res. 2008;127:265-8.

Anuradha VK, Rubina MM. Epidemiology and treatment of osteoposis in women: an indian perpective. Int J Women’s Health. 2015;7:841-850.

Gupta A. Osteoporosis in India – The nutritional hypothesis. Natl Med J India. 1996;9(6):265-274.

Harinarayan CV. Prevalence of vitamin D insufficiency in postmenopausal south Indian women. Osteoporos Int. 2005;16(4):397-402.

Arya V, Bhambri R, Godbole MM, Mithal A. Vitamin D status and its relationship with bone mineral density in healthy Asian Indians. Osteoporos Int. 2004;15(l):56-61.

Haeney RP, Recker RR. Effects of nitrogen, phosphorus and caffeine on calcium balance in women. J Lab Clin Med. 1982;99:46-55.

Speroff L, Glass RH, Kase NG. Menopause and the Perimenopausal transition, In Clinical Gynecologic Endocrinology and Infertility, Lippincott Williams and Wilkins 6th ed. 1999; 691-707.

Genant HK, Engelle K, Fuerest T, Glüer CC, Grampp S, Harris ST et al. Non invasive assessment of bone mineral and structure: state of art. J Bone Mineral Res. 1996;11(6):707-30.

Martin JC, Reid DM. Appendicular measurements in screening women for low axial bone mineral density. Br J Radiol. 1996;69:234-240.

Gnudi S, Malavolta N, Lisi L, Ripamonti C. Bone mineral density and bone loss measured at the radius to predict the risk of nonspinal osteoporotic fracture. J Bone Mineral Res. 2001;16(6):1130-5.

Usha G, Krishnaswamy B. Bone mineral density and fracture threshold in South Indian Elderly. J Assoc Physicians India. 2002;50:247-9.

Aggarwal N, Bathla S, Juneja S. Measurement of bone mineral density by dexa scan in post menopausal women. Obstet Gynecol Today. 2004;9(10):768-771.

Gandhi AB, Kumar A, Shukla R. Evaluation of BMD of women above 40 years of age. J Obstet Gynecol India. 2005;55(3):265-7.

ACOG Committee Opinion. Bone density screening for osteoporosis. Obstet Gynecol. 2002;99:523-5.

Savardekar LS, Rashmi SS, Umesh I, Danta B, Anand P, Bhavin J. Bone density in normal Indian women: Assessment by USG and DEXA. Obstet Gynecol Today. 2004;9:772-6.

Cavanaugh DJ, Cann CE. Brisk walking does not stop bone loss in postmenopausal women. Bone 1988;9:201-4.

Sandler RB, Slemenda CW, Laporte RE, Cauley JA, Schramm MM, Barresi ML et al. Post menopausal bone density and milk consumption in childhood and adolescence. Am J Clin Nutr. 1985;42:270-4.

Di Daniele N, Carbonelli MG, Candeloro N, Iacopino L, De Lorenzo A, Andreoli A. Effect of supplementation of calcium and vitamin D on bone mineral density and bone mineral content in peri-and post-menopause women: a double-blind, randomized, controlled trial. Pharmacologic Res. 2004 Dec 31;50(6):637-41.

Prince RL, Smith M, Dick IM, Price RI, Webb PG, Henderson NK et al. Prevention of postmenopausal osteoporosis. N Eng J Med. 1991;325:1189-95.

Villareal DT, Civitelli R, Chines A, Avioli LV. Subclinical vitamin D deficiency in postmenopausal women with low vertebral bone mass. J Clin Endocrinol Metab. 1991;72:628-34.

Krall EA, Hughes BD. Walking is related to bone density and rates of bone loss. Am J Med. 1994;96:20-26.

Sharma S, Khandelwal S. Effective risk assessment tools for osteoporosis in the Indian menopausal female. J Midlife Health. 2010;1(2):79-85.

Lurati, Laria. Relationship between Lumbar Bone Mineral Density (BMD) and Body Mass Index (BMI) in premenopausal population. a large chort study. Rheumatology. 2015;5:181.1000181.