T.L. Karonova (1, 2), AT Andreeva (1), EV Mokhova (1), M.V. Budanova (1), E.N. Grineva (1, 2)

1) FSBI Northwestern Federal Medical Research Center of the Ministry of RMPH, St.Petersburg; 2) SBEI HPE SPbSMU n.a. Acad. I.P. Pavlov of RMPH, St. Petersburg
The results of studies assessing bone mineral density in obese people are rather inconsistent. The present study was aimed to the identification of indicators of mineralization of the skeleton in women with different body mass to clarify the contribution of vitamin D deficiency in the formation of osteopenic syndrome. The study involved 204 women aged 30 to 52 years (mean age 46.20 ± 0.54 years). Reduced bone mineral density (BMD) at the lumbar spine or proximal femur was found in 38 women (18.6%). It has been established that the 25 (OH) D levels (R2 = 0.25, P = 0.011) and parathyroid hormone levels (R2 = 0.15, P = 0.037) provided the greatest effect on the BMD of the lumbar spine (in women under the age of 40 years); the bone mineral density of proximal femur depended on the body mass index (R2 = 0.21, P = 0.016), waist circumference (R2 = 0.30, P = 0.005), amount of adipose tissue (R2 = 0.28 , P = 0.006) and serum leptin levels (R2 = 0.26, P = 0.043), regardless of the women age. Thus, the study showed that the amount of body fat, vitamin D deficiency and high leptin levels play an important role in bone remodeling in young women.


  1. Lips P. Vitamin D deficiency and secondary hyperparathyreoidism in the elderly: consequences for bone loss and fractures and therapeutic implications. Endocrine reviews. 2001;22(4):477–501.
  2. Bouillon R., Carmeliet G., Verlinden L., van Etten E., Verstuyf A., Luderer H.F., Lieben L., Mathieu C., Demay M. Vitamin D and Human Health: Lessons from Vitamin D Receptor Null Mice. Endocr. Rev. 2008;29(6):726–76.
  3. Lips P., Bouilon R., Van Schoor N.M., Vanderschueren D., Verschueren S., Kuchuk N., Milisen K., Boonen S .Reducing fracture risk with calcium and vitamin D. Clin. Endocrinol. 2010;73(3):277–85.
  4. Need A. G. Bone resorption markers in vitamin D insufficiency. Clin. Chim. Acta. 2006;368(1):48–52.
  5. Horwood N.J., Elliott J., Martin T.J., Gillespie M.T. Osteotropic agents regulate the expression of osteoclast differentiation factor and osteoprotegerine in osteoblastic stromal expression of osteoclast differentiation factor and osteoprotegerin in osteoblastic stromal cells. Endocrinology. 1998;139(11):4743–46.
  6. Cauley J.A., Lacroix A.Z., Wu L., Horwitz M., Danielson M.E., Bauer D.C., Lee J.S., Jackson R.D., Robbins J.A., Wu C., Stanczyk F.Z., LeBoff M.S., Wactawski-Wende J., Sarto G., Ockene J., Cummings S.R. Serum 25-hydroxyvitamin D concentration and risk for hip fractures. Ann. Intern. Med. 2008;149(4):242–50.
  7. Bischoff-Ferrari H.A., Kiel D.P., Dawson–Hughes B., Orav J.E., Li R., Spiegelman D., Dietrich T., Willett W.C. Dietary calcium and serum 25-hydroxyvitamin D status in relation to BMD among U.S. adults. J. Bone Miner. Res. 2009;24(5):935–42.
  8. Bischoff-Ferrari H.A., Dawson-Hughes B., Willett W.C., Staehelin H.B., Bazemore M.G., Zee R.Y., Wong J.B. Effect of vitamin D on falls: a meta-analysis. J. Am. Med. Assoc. 2004;291(16):1999–2006.
  9. Cameron I.D., Murray G.R., Gillespie L.D., Robertson M.C., Hill K.D., Cumming R.G., Kerse N. Interventions for preventing falls in older people in nursing care facilities and hospitals. Cochrane Database Syst. Rev. 2010;1:CD005465.
  10. Chapuy M.C., Preziosi P., Maamer M., Arnaud S., Galan P., Hercberg S., Meunier P.J. Prevalence of vitamin D insufficiency in an adult normal population. Osteoporos. Int. 1997;7(5):439–43.
  11. Heaney R.P. Functional indices of vitamin D status and ramifications of vitamin D deficiency. Am. J. Clin. Nutr. 2004;80(6):1706–709.
  12. Kremer R., Campbell P.P., Reinhardt T., Gilsanz V. Vitamin D status and its relationship to body fat, final height and peak bone mass in young women. J. Clin. Endocrinol. Metab. 2009;94(1):67–73.
  13. Guney E., Kisakol G., Ozgen G., Yilmaz C., Yilmaz R., Kabalak T. Effect of weight loss on bone metabolism: comparison of vertical banded gastroplasty and medical intervention. Obes. Surg. 2003;13:383–88.
  14. Douchi T., Yamamoto S., Oki T., Maruta K., Kuwahata R., Yamasaki H., Nagata Y. Difference in the effect of adiposity on bone density between pre- and postmenopausal women. Maturitas. 2000;34:261–66.
  15. Radak T.L. Caloric restriction and calcium’s effect on bone metabolism and body composition in overweight and obese premenopausal women. Nutr. Rev. 2004;62:468–81.
  16. Zhao L.J., Liu Y.J., Liu P.Y., Hamilton J., Recker R.R., Deng H.W. Relationship of obesity with osteoporosis. J. Clin. Endocrinol. Metab. 2007;92:1640–46.
  17. Institute for Clinical Systems Improvement (ICSI) Health Care Guideline: Diagnosis and treatment of osteoporosis. 3rd edition. July 2004.
  18. Каронова Т.Л. Показатели минеральной плотности костной ткани и уровень 25-гидроксивитамина D сыворотки крови у женщин репродуктивного возраста. Остеопороз и остеопатии. 2011;3:11–15.
  19. Остеопороз. Диагностика, профилактика и лечение (Серия «Клинические рекомендации») / Под ред. О.М. Лесняк, Л.И. Беневоленской. 2-е изд., перераб. и доп. М., 2010. 272 с.
  20. Electronic resource
  21. Electronic resource
  22. Holick M.F. Evaluation, Treatment, and Prevention of Vitamin D deficiency: an Endocrine society clinical practice guideline. J. Clin. Metab. 2011;9:1911–30.
  23. Клинические рекомендации Российской Ассоцииации эндокринологов. Дефицит витамина D у взрослых: диагностика, лечение и профилактика. 2015. 75 с.
  24. Kanis J.A., Melton L.J. III, Christiansen C., Johnston C.C., Khaltaev N. The diagnosis of osteoporosis. J. Bone Miner. Res. 1994;9:1137–41.
  25. Hsu Y.H., Venners S.A., Terwedow H.A. Relation of body composition, fat mass, and serum lipids to osteoporotic fractures and bone mineral density in Chinese men and women. Am. J. Clin. Nutr. 2006;83:146–54.
  26. Vanderschueren D., Vandenput L., Boonen S., Lindberg M.K., Bouillon R., Ohlsson C. Androgens and bone. Endocr. Rev. 2004;25(3):389–425.
  27. Khan A. Premenopausal women and low bone density. Can. Fam. Physician. 2006;52(6):743–47.
  28. Abraham A., Cohen A., Shane E. Premenopausal bone health: osteoporosis in premenopausal women. Clin. Obstet. Gynecol. 2013;56(4):722–29.
  29. Rosen C.J., Bouxsein M.L. Mechanisms of disease: is osteoporosis the obesity of bone? Nat. Clin. Pract. Rheumatol. 2006;2:35–43.
  30. Lecka-Czernik B., Moerman E.J., Grant D.F., Lehmann J.M., Manolagas S.C., Jilka R.L. Divergent effects of selective peroxisome proliferator–activated receptor-gamma 2 ligands on adipocyte versus osteoblast differentiation. Endocrinology. 2002;143:2376–84.
  31. Steppan C.M., Crawford D.T., Chidsey-Frink K.L. Ke H., Swick A.G. Leptin is a potent stimulator of bone growth in ob/ob mice. Regul. Pept. 2000;92:73–8.
  32. Cornish J., Callon K.E., Bava U., Lin C., Naot D., Hill B.L., Grey A.B., Broom N., Myers D.E., Nicholson G.C., Reid I.R. Leptin directly regulates bone cell function in vitro and reduces bone fragility in vivo. J. Endocrinol. 2002;175:405–15.
  33. Legiran S., Brandi M.L. Bone mass regulation of leptin and postmenopausal osteoporosis with obesity. Clin. Cases Miner. Bone Metab. 2012;9(3):145–49.
  34. Luo X.H., Guo L.J., Yuan L.Q., Xie H., Zhou H.D., Wu X.P., Liao E.Y. Adiponectin stimulates human osteoblasts proliferation and differentiation via the MAPK signaling pathway. Exp. Cell Res. 2005;309:99–109.
  35. Luo X.H., Guo L.J., Xie H., Yuan L.Q., Wu X.P., Zhou H.D., Liao E.Y. Adiponectin stimulates RANKL and inhibits OPG expression in human osteoblasts through the MAPK signaling pathway. J. Bone Miner. Res. 2006:21:1648–56.
  36. Laing E.A, Voorhees C., Hall D., et al. Prospective analysis of plasma 25-hydroxyvitamin D and bone mass in white and black prepubertal females. J. Bone Miner. Res. 2006;21:205.

About the Autors

T.L. Karonova - Doctor of Medical Sciences, Head of the SRL of Clinical Endocrinology of the Institute of Endocrinology FSBI NWFMRC of RMPH, Associate Professor at the Department of Faculty Therapy with a course of Endocrinology and Clinic SBEI HPE SPbSMU n.a. Acad. I.P. Pavlov of RMPH, St. Petersburg; e-mail:;
A.T. Andreeva - resident physician at the Institute of Endocrinology FSBI NWFMRC of RMPH, St. Petersburg
E.V. Mokhova - postgraduate student at the Institute of Endocrinology FSBI NWFMRC of RMPH, St. Petersburg
M.V. Budanova - Head of the Radiology Department, Junior Researcher at the Institute of Endocrinology FSBI NWFMRC of RMPH, St. Petersburg
E.N. Grineva - Doctor of Medical Sciences, Director of the Institute of Endocrinology FSBI NWFMRC of RMPH, Prof. at the Department of Faculty Therapy with a course of Endocrinology and Clinic SBEI HPE SPbSMU n.a. Acad. I.P. Pavlov of RMPH, St. Petersburg

Similar Articles

Бионика Медиа