Document Type : Original Article


1 Department of Nutrition, Isfahan Cardiovascular Research Center

2 School of Medicine

3 Department of Epidemiology and Biostatistics, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran


Introduction: Osteoporosis is a multifactorial disease and one of the most important modifiable
factors in the development and maintenance of bone mass are nutrition nutritional status and its
relationship with Bone Mass Density (BMD) in postmenopausal women admitted in osteodensitometry
Center, Isfahan, Iran. Materials and Methods: Seventy‑two postmenopausal osteoporotic women
were studied. BMD of the lumbar spine and total hip were measured using dual‑energy X‑ray
absorptiometry. Demographic and dietary intakes were collected by interview and using a validated
food frequency questionnaires. T‑scores, Pearson correlation and one way analysis of variance
tests were conducted to analyze the data. Results: Mean of age and duration of menopause was
nearly 57.5 ± 7.2 and 10.6 ± 7.1 years, respectively. The mean t‑scores for BMD of spine and hip
were 0.877 ± 0.179 and 0.997 ± 0.21, respectively. The mean of calcium (Ca), phosphorous (P),
fluoride (F), Vitamin D, K and Zn were less than DRI and Na more than it (all P value less than
0.0001). BMD of hip was significantly correlated with dietary Ca, animal protein, Zn (P < 0.05), but
BMD of spine did not show any significant correlation with nutrients (P > 0.05). Conclusion: Most
of the postmenopausal osteoporotic women in this study had a considerable deficiency in terms of
micronutrients such as Ca, vitamin D and P, which can be deleterious for bone health.


1. Larijani B, Resch H, Bonjour JP, Aghai Meybodi HR, Mohajery
Tehrani MR. Osteoporosis in Iran, overview and management. Iran J
Public Health 2007;Supplementary Issue on Osteoporosis:1‑13.2. Johnell O, Kanis JA. An estimate of the worldwide prevalence
and disability associated with osteoporotic fractures. Osteoporos
Int 2006;17:1726‑33.
3. WHO scientific group on the assessment of osteoporosis at
primary health care level. Geneva: World Health Organization;
2007. Available from:
pdf. [Last accessed on 2008 May 03].
4. Abolhassani F, Mohammadi M, Soltani A. Burden of Osteoporosis
in Iran. Iran J Public Health 2004;Supplement issue on
osteoporosis :18‑28.
5. Keramat A, Patwardhan B, Larijani B, Chopra A, Mithal A,
Chakravarty D, et al. The assessment of osteoporosis risk factors in
Iranian women compared with Indian women. BMC Musculoskelet
Disord 2008;9:28.
6. International Osteoporosis Foundation. The facts about osteoporosis
and its impact. International Osteoporosis Foundation Web
site. Available from:
fact_sheet.html. [Last accessed on 2005 Jul 26].
7. Handa R, Kalla AA. Osteoporosis in developing countries. Best Pract
Res Clin Rheumatol 2008;22:693‑708.
8. Ghosh UK, Roy S, Sharma D, Gaur SC, Ganguli G. Relationship
of Osteoporosis with socioeconomic status, physical activity and
puerperal calcium supplementation. J Obstetr Gynaecol India
9. Socioeconomic Status Weighs Heavily on Health of Married
Couples. Available from:
general_health‑Epidemiology‑20010212‑2.asp [Last accessed on
2012 Mar 22].
10. Park JN, You MH, Ahn HC, Hwang KU. Bone mineral density and
its relations in Korean adult women. The 130th Annual Meeting of
APHA‑Philadelphia 2002.
11. Varenna M, Binelli L, Zucchi F, Ghiringhlli D, Gallazzi M, Sinigaglia L.
Prevalence of osteoporosis by education level in a cohort of
postmenopausal women. Osteoporos Int 1999;9:236‑41.
12. Inanici‑Ersoz F, Gokce‑Kutsal Y, Oncel S, Eryavuz M, Peker O, Ok S.
A multicenter case control study of risk factors for low tibia speed
of sound among residents of urban areas in Turkey. Rheumatol Int
13. Farahmand BY, Persson PG, Michaelsson K, Baron JA, Parker MG,
Ljunghall S; Swedish hip fracture group. Socioeconomic status,
marital status and hip fracture risk: A papulation‑ based case‑control
study. Osteoporosis Int 2000;11:803‑8.
14. Bonjour JP. Dietary Protein: An Essential Nutrient For Bone Health.
J Am Coll Nutr 2005;24(Suppl 6):526S‑6S.
15. Saadi HF, Reed RL, Carter AO, Qazaq H, Al‑Suhaili AR. Bone density
estimates and risk factors for osteoporosis in young women. East
Mediterr Health J 2001;4:730‑7.
16. Finkestein JS, Lee TS, Sowers M, Ettinger B, Neer RM, Kelsey JL,
et al. Ethnic variation in bone density in premenopausal women:
Effects of anthropometric and lifestyle factor. J Clin Endocrinol
Metab 2002;87:3057‑67.
17. Tamaki J. Evidence‑based, best‑practice guildelines for primary
prevention of osteoporotic fractures. Clin Calcium 2005;15:1312‑8.
18. Miggiano GA, Gagliardi I. Diet, nutrition and bone health. Clin Ter
19. Mccabe LD, Martin BR, Maccab GP. Dairy affect bone density in the
elderly. Am J Clin Nutr 2004;80:1066‑74.
20. Kontogianni MD, Melistas L, Yannakoulia M, Malagaris I,
Panagiotakos DB, Yiannakouris N. Association between dietary
patterns and indices of bone mass in a sample of Mediterranean
women. Nutrition 2009;25:165‑71.
21. Corwin RL, Hartman TJ, Maczuga SA, Graubard BI. Dietary saturated
fat intake is inversely associated with bone density in humans:
Analysis of NHANES III. J Nutr 2006;136:159‑65.
22. Macdonald HM, New SA, Golden MH. Nutrition associations with
bone loss during menopausal transition: Evidence of a beneficial
effect of calcium, alcohol and fruits and vegetable nutrient and of
a determinal effect of fatty acids. Am J Clin Nutr 2004;79:155‑65.
23. Ranjbar Omrani GH, Seyed Masoom Masoompour SM, Hamidi A,
Mardanifard HA, Taghavi SM, Talezadeh P, et al. Bone mineral
density in the normal Iranian population: A comparison with
American reference data. Arch Osteoporos 2006;1:29‑35.
24. Nutrition and Food Technology Research Institute. National Food
Consumption Survey. Tehran: Nutrition and Food Technology
Research Institute; 1995.
25. Larijani B, Hossein‑Nezhad A, Mojtahedi A, Pajouhi M, Bastanhagh M,
Soltani A, et al. Normative data of bone Mineral Density in
healthy population of Tehran, Iran: A Cross sectional study. BMC
Musculoskelet Disord 2005;6:38.
26. Akbarian M, Davachi F, Salimzadeh A, Shahram F, Gharibdoost F,
Nadji A, et al. Bone mass density in the normal population of Iran:
APLAR. J Rheumatol 2007;8:177‑83.
27. Guidelines for preclinical evaluation and clinical trials in
osteoporosis. Geneva: World Health Organization; 1998. p. 59.
28. Haghighian A, Tahbaz F, Hosseinnezhad A, Shafaei A, Sedaght M,
Kimiagar M, et al. Effect of soy protein on bone metabolism biomarkers
in postmenopausal women with osteopenia. Nut J 2005;29:30.
29. Hejazi J, Mohtadinia J, Kolahi S, Ebrahimi‑Mamaghani M. Nutritional
status among postmenopausal osteoporotic women in North West
of Iran. Asia Pac J Clin Nutr 2009;18:48‑53.
30. Kooshki A, Golafrooz M. Nutrient Intakes Affecting Bone Formation
Compared with Dietary Reference Intake (DRI) in Sabzevar Elderly
Subjects. Pak J Nut 2009;8:218‑21.
31. Chapman‑Novakofski K. Nutrition and Bone Health, 531‑545 in
Krause’s Food and the Nutrition Care Process. 13th ed. Elsevier:
Saunders, WA; 2012.
32. Bonjour JP. Dietary protein: An essential nutrient for bone health.
J Am Coll Nutr 2005;24:526S‑36S.
33. Bekheirnia MR, Abdollah Shamshirsaz A, Kamgar M, Bouzari N,
Erfanzadeh G, Larijani B, et al. Serum zinc and its relation to bone
mineral density in beta thalassemic adolescents. Biol Trace Elem
Res 2004;97:215‑24.
34. Munger RG, Cerhan JR, Chiu BC. Prospective study of dietary protein
intake and risk of hip fracture in postmenopausal women. Am J Clin
Nutr 1999;69:147‑52.
35. Connie MW. The Role of Nutrition on optimizing peak bone mass.
Asia Pac J Clin Nutr 2009;17:135‑7.
36. MengX, ZhuK, DevineA, KerrDA, BinnsCW, PrinceRL. A5‑ year cohort
study of the effects of high protein intake on lean mass and BMC in
elderly postmenopausal women. J Bone Miner Res 2009;24:1827‑34.
37. Foo LH, Zhang Q, Zhu K, Ma G, Greenfield H, Fraser DR. Influence
of body composition, muscle strength, diet and physical activity on
total body and forearm bone mass in Chinese adolescent girls. Br
J Nutr 2007;98:1281‑7.
38. Gnudi S, Sitta E, Fiumi N. Relationship between body composition
and bone mineral density in women with and without osteoporosis:
Relative contribution of lean and fat mass. J Bone Miner Metab
39. Sanada K, Miyachi M, Tabata I, Miyatani M, Tanimoto M, Oh TW,
et al. Muscle mass and bone mineral indices: Does the normalized
bone mineral content differ with age? Eur J Clin Nutr 2009;63:465‑72.
40. van Langendonck L, Claessens AL, Lysens R, Koninckx PR,
Beunen G. Association between bone, body composition, and
strength in premenarcheal girls and postmenopausal women. Ann
Hum Biol 2004;31:228‑44.
41. Liu JM, Zhao HY, Ning G, Zhao YJ, Zhang LZ, Sun LH, et al.
Relationship between body composition and bone mineral density
in healthy young and premenopausal Chinese women. Osteoporos
Int 2004;15:238‑42.
42. Campbell WW, Crim MC, Dallal GE, Young VR, Evans WJ. Increased
protein requirements in elderly people: New data and retrospective
reassessments. Am J Clin Nutr 1994;60:501‑9.
43. Ilich J, Brownbill R, Tamborini L. Bone and nutrition in elderly
women: Protein, energy, and calcium as main determinants of bone
mineral density. Eur J Clin Nutr 2003;57:554‑65.
44. New S, Bolton‑Smith C, Grubb D, Reid D. Nutritional influences on
bone mineral density: A cross‑sectional study in premenopausal
women. Am J Clin Nutr 1997;65:1831‑9.45. Maurer J, Harris M, Stanford V, Lohman T, Cussler E, Going S,
et al. Dietary iron positively influences bone mineral density in
postmenopausal women on hormone replacement therapy. J Nutr
46. Vanessa A, Margaret H, Timothy G, Scott B, Cynthia A, Judith L, et al.
Comparison between dietary assessment methods for determining
associations between nutrient intake and bone mineral density in
postmenopausal women. J Am Diet Assoc 2009;109:899‑904.
47. Devine A, Criddle RA, Dick IM, Kerr DA, Prince RL. A longitudinal
study of the effect of sodium and calcium intakes on regional
bone density in postmenopausal women. Am J Clin Nutr