Lean mass appears to be more strongly associated with bone health than fat mass in urban black South African women

To examine the association between body composition (fat mass, lean mass and body mass index, BMI) and bone health (bone mineral density, BMD and fracture risk) in urban black South African women. A cross sectional study examining associations between body composition, dietary intake (food frequency questionnaire), habitual physical activity (Activity energy expenditure (AEE) measured using an accelerometer with combined heart rate monitor and physical activity questionnaire) and bone health (BMD using dual-energy X ray absorptiometry, DXA and fracture risk). Urban community dwellers from Ikageng in the North-West Province of South Africa. One hundred and eighty nine (189) healthy postmenopausal women aged a parts per thousand yen43 years. Fat mass and lean mass were significantly associated with BMD and fracture risk when adjusted for potential confounders. However, lean mass and not fat mass remained significantly associated with femoral neck BMD (beta = 0.49, p < 0.001), spine BMD (beta = 0.48, p < 0.0001) and hip BMD (beta = 0.59, p < 0.0001). Lean mass was also negatively associated with fracture risk (beta = -0.19 p =0.04) when both lean and fat mass were in the same model. Lean mass and fat mass were positively associated with femoral neck, spine and hip BMDs and negatively associated with fracture risk in urban black South African women. Our finding suggests that increasing lean mass rather than fat mass is beneficial to bone health. Our study emphasises the importance of positive lifestyle changes, intake of calcium from dairy and adequate weight to maintain and improve bone health of postmenopausal women.