폐경 전후 한국 성인 여성에서 골밀도와 체성분과의 관련성
Relationship Between Bone Mineral Density and Body Composition in Pre- and Post-menopausal Korean Women
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연구배경: 폐경 전후 여성에서 제지방량과 지방량이 요추와 대퇴경부의 골밀도에 미치는 영향을 조사하고자 한다. 방법: 2008년과 2009년에 시행된 국민건강영양조사에서20세 이상 여성 4,334명을 대상으로 분석하였다. 요추 및대퇴경부의 골밀도와 체성분은 이중에너지방사선 흡수계측법(dual-energy X-ray absorptiometry)으로 측정하였다. 단계적 다중회귀분석 이외에는 복합 표본분석 통계방법을이용하여 분석을 시행하였다. 결과: 혼란변수를 보정한 후에도 폐경 전후 여성 모두에서 제지방량과 체지방량은 요추 및 대퇴경부 골밀도와 통계적으로 유의한 양의 상관관계를 보였다(P<0.001). 폐경전 여성에서는 요추와 대퇴경부 골밀도의 가장 중요한 결정요인은 제지방이었으며(R2=0.156 for L-spine BMD,R2=0.168 for femur neck BMD), 체지방량의 영향은 적었다. 폐경 후 여성에서는 요추 골밀도에는 제지방보다는 체지방이, 대퇴경부 골밀도에 체지방보다 제지방이 주는 영향이 더 컸다(R2=0.016 vs. 0.077 for L-spine BMD, R2=0.077vs. 0.007 for femur neck BMD). 폐경 후 여성에서 혼란변수를 보정한 후에도 제지방량과 체지방량이 증가할수록요추 및 대퇴경부 골다공증의 유병률이 감소하였다(Ptrend <0.001). 결론: 폐경 전후 여성 모두에서 제지방량과 체지방량은요추 및 대퇴경부 골밀도와 유의한 양의 관련성을 보였으며, 골다공증의 위험을 감소시켰다. 폐경 전 여성의 요추및 대퇴경부 골밀도와 폐경 후 여성의 대퇴경부 골밀도에는 제지방의 영향이 가장 컸으며, 폐경 후 여성의 요추 골밀도에는 체지방의 영향력이 더 컸다.
Abstract
Background: To investigate the relationship between body composition and bone mineral density (BMD) in preand post-menopausal women in Korea. Methods: The data of 4,334 pre- and post-menopausal women older than 20 years from the Korea National Health and Nutrition Examination Survey conducted in 2008-2009 were assessed. BMD and body composition were measured by dual-energy X-ray absorptiometry. All analyses except stepwise multiple linear regression analysis were performed using the KNHANES sample weights to account for the complex survey design. Results: After adjusting for confounding variables, lean mass and fat mass were positively correlated with BMD at both L1-4 spine and femur neck in both pre- and post-menopausal women (P<0.001). For the pre-menopausal women, lean mass was the most important determinant of BMD at both sites (R2=0.156 for L1-4 spine BMD, R2=0.168 for femur neck BMD), and the impact of fat mass were minimal. For the post-menopausal women, fat mass had a greater influence on the BMD at L1-4 spine than lean mass (R2=0.016 vs. R2=0.077), but lean mass had a greater impact than fat mass on the BMD at the femur neck (R2=0.077 vs. R2=0.007). After adjusting for confounding variables, post-menopausal osteoporosis increased as both lean mass and fat mass decreased (Ptrend<0.001). Conclusions: In Korean pre- and post-menopausal women, both lean mass and fat mass had positive correlations with the BMD at both sites and decreased the risk of osteoporosis. Lean mass had a greater influence on premenopausal BMD at both sites and postmenopausal BMD at the femur neck, whereas fat mass had greater influence on post-menopausal BMD at L1-4 spine.
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