Objective: This study aimed to analyze the bone mineral density (BMD) in various body regions, investigate the effects of age and sex on BMD, and characterize BMD variations among different lumbar segments (L1–L4). Thereby uncovering patterns of regional bone loss, quantifying heterogeneity risks, and dynamically tracking individual trajectories.
Methods: BMD was measured using dual-energy x-ray absorptiometry (DXA). Patients were stratified to analyze the effects of age and sex on BMD at the following sites: lumbar spine (L1–L4); femur: Ward's triangle, greater trochanter, femoral shaft, femoral neck, upper femoral neck, and lower femoral neck; and head, ribs, and pelvis. Subgroup analyses were conducted based on age, BMD Z-scores, BMD T-scores, and body mass index (BMI) to compare lumbar segmental BMD (L1–L4) between the sexes. The study conducted from 2019 to 2024 included lumbar spine data from 20,199 patients; femur data from 23,218 patients; and head, ribs, and pelvis data from 1288 patients.
Results: In males, the BMD at the femoral Ward's triangle, femoral shaft, and femoral neck (including the upper and lower regions) began to decline from 45 to 49 years of age. The BMD of the femoral greater trochanter decreased at 50–54 years of age. The head BMD in males decreased at 55–59 years of age. The rib BMD showed no significant age-related changes, though the pelvic BMD decreased at 60–64 years. In females, the head, femoral greater trochanter, and femoral shaft BMD decreased at 45–49 years of age.In male patients aged 50–89 years and female patients aged 40–89 years, male and female patients in the Z > −2.0 group, male and female patients in the BMD T-score stratification groups, male patients with a BMI < 30 kg/m2, the BMDs of L1 and L2 were significantly lower than those of L3 and L4 among different age groups. The BMD of L1/L2 was significantly lower than that of L3/L4 in all female patients, regardless of BMI group.
Conclusion: The BMDs of several body regions are associated with age and sex, with variations in the rate of change, age at first change, and age-related trends depending on the anatomical site and sex. Heterogeneity exists among the lumbar segments, as the BMDs of L1 and L2 are generally significantly lower than those of L3 and L4; however, this trend varies in specific subgroups.
| [1] |
J. A. Kanis, “Assessment of Fracture Risk and Its Application to Screening for Postmenopausal Osteoporosis: Synopsis of a WHO Report. WHO Study Group,” Osteoporosis International: A Journal Established as Result of Cooperation Between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA 4, no. 6 (1994): 368–381.
|
| [2] |
C. B. Newgard and N. E. Sharpless, “Coming of Age: Molecular Drivers of Aging and Therapeutic Opportunities,” Journal of Clinical Investigation 123, no. 3 (2013): 946–950.
|
| [3] |
I. Padlina, E. Gonzalez-Rodriguez, D. Hans, et al., “The Lumbar Spine Age-Related Degenerative Disease Influences the BMD Not the TBS: The Osteolaus Cohort,” Osteoporosis International: A Journal Established as Result of Cooperation Between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA 28, no. 3 (2017): 909–915.
|
| [4] |
M. Di, Y. Weng, G. Wang, et al., “Cortical Endplate Bone Density Measured by Novel Phantomless Quantitative Computed Tomography May Predict Cage Subsidence More Conveniently and Accurately,” Orthopaedic Surgery 15, no. 12 (2023): 3126–3135.
|
| [5] |
X. Y. Wang, S. M. Yun, W. F. Liu, Y. K. Wang, S. Pan, and Y. J. Xu, “Opportunistic Assessment of Hip Fracture Risk Based on Chest CT,” Orthopaedic Surgery 16, no. 12 (2024): 2933–2941.
|
| [6] |
S. M. Cadarette, S. B. Jaglal, T. M. Murray, W. J. McIsaac, L. Joseph, and J. P. Brown, “Evaluation of Decision Rules for Referring Women for Bone Densitometry by Dual-Energy x-Ray Absorptiometry,” Journal of the American Medical Association 286, no. 1 (2001): 57–63.
|
| [7] |
“Osteoporosis Prevention, Diagnosis, and Therapy,” Journal of the American Medical Association 285, no. 6 (2001): 785–795.
|
| [8] |
S. Z. Xu, W. Zhou, X. D. Mao, J. Xu, L. P. Xu, and J. Y. Ren, “Reference Data and Predictive Diagnostic Models for Calcaneus Bone Mineral Density Measured With Single-Energy X-Ray Absorptiometry in 7428 Chinese,” Osteoporosis International: A Journal Established as Result of Cooperation Between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA 12, no. 9 (2001): 755–762.
|
| [9] |
X. P. Wu, E. Y. Liao, H. Zhang, P. F. Shan, X. Z. Cao, and S. P. Liu, “Establishment of BMD Reference Plots and Determination of Peak BMD at Multiple Skeletal Regions in Mainland Chinese Women and the Diagnosis of Osteoporosis,” Osteoporosis International: A Journal Established as Result of Cooperation Between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA 15, no. 1 (2004): 71–79.
|
| [10] |
Y. Sekioka, K. Kushida, K. Yamazaki, and T. Inoue, “Calcaneus Bone Mineral Density Using Single X-Ray Absorptiometry in Japanese Women,” Calcified Tissue International 65, no. 2 (1999): 106–111.
|
| [11] |
E. Y. Liao, X. P. Wu, X. H. Luo, et al., “Establishment and Evaluation of Bone Mineral Density Reference Databases Appropriate for Diagnosis and Evaluation of Osteoporosis in Chinese Women,” Journal of Bone and Mineral Metabolism 21, no. 3 (2003): 184–192.
|
| [12] |
L. A. Burt, D. A. Hanley, and S. K. Boyd, “Cross-Sectional Versus Longitudinal Change in a Prospective HR-pQCT Study,” Journal of Bone and Mineral Research: The Official Journal of the American Society for Bone and Mineral Research 32, no. 7 (2017): 1505–1513.
|
| [13] |
S. Y. Park, J. H. Kim, H. J. Choi, et al., “Longitudinal Changes in Bone Mineral Density and Trabecular Bone Score in Korean Adults: A Community-Based Prospective Study,” Archives of Osteoporosis 15, no. 1 (2020): 100.
|
| [14] |
N. M. Jandl, T. Rolvien, T. Schmidt, et al., “Impaired Bone Microarchitecture in Patients With Hereditary Hemochromatosis and Skeletal Complications,” Calcified Tissue International 106, no. 5 (2020): 465–475.
|
| [15] |
G. Schröder, K. Denkert, L. Hiepe, et al., “Histomorphometric Analysis of Osteocyte Density and Trabecular Structure of 92 Vertebral Bodies of Different Ages and Genders,” Annals of Anatomy = Anatomischer Anzeiger: Official Organ of the Anatomische Gesellschaft 246 (2023): 152022.
|
| [16] |
S. Blouin, B. M. Misof, M. Mähr, et al., “Osteocyte Lacunae in Transiliac Bone Biopsy Samples Across Life Span,” Acta Biomaterialia 157 (2023): 275–287.
|
| [17] |
P. J. Pickhardt, S. J. Lee, J. Liu, et al., “Population-Based Opportunistic Osteoporosis Screening: Validation of a Fully Automated CT Tool for Assessing Longitudinal BMD Changes,” British Journal of Radiology 92, no. 1094 (2019): 20180726.
|
| [18] |
N. Korpinen, P. Oura, and J. A. Junno, “Sex- and Site-Specific, Age-Related Changes in Bone Density—A Terry Collection Study,” Homo: Internationale Zeitschrift Fur Die Vergleichende Forschung Am Menschen 74, no. 1 (2023): 17–32.
|
| [19] |
H. Otsuka, H. Tabata, N. Ito, et al., “Age-Related Differences in Bone Structural Parameters Using 3D-DXA and TBS in Men and Women: The Bunkyo Health Study,” Bone 199 (2025): 117549.
|
| [20] |
M. L. Oppenheimer-Velez, H. Giambini, A. Rezaei, J. J. Camp, S. Khosla, and L. Lu, “The Trabecular Effect: A Population-Based Longitudinal Study on Age and Sex Differences in Bone Mineral Density and Vertebral Load Bearing Capacity,” Clinical Biomechanics (Bristol, Avon) 55 (2018): 73–78.
|
| [21] |
S. Rühling, J. Dittmann, T. Müller, et al., “Sex Differences and Age-Related Changes in Vertebral Body Volume and Volumetric Bone Mineral Density at the Thoracolumbar Spine Using Opportunistic QCT,” Frontiers in Endocrinology 15 (2024): 1352048.
|
| [22] |
N. Yoganandan, F. A. Pintar, B. D. Stemper, et al., “Trabecular Bone Density of Male Human Cervical and Lumbar Vertebrae,” Bone 39, no. 2 (2006): 336–344.
|
| [23] |
N. P. Yang, T. Lin, C. S. Wang, and P. Chou, “Community-Based Survey of Low Quantitative Ultrasound Values of Calcaneus in Taiwan,” Journal of Clinical Densitometry: The Official Journal of the International Society for Clinical Densitometry 6, no. 2 (2003): 131–141.
|
| [24] |
T. Hirota, M. Nara, M. Ohguri, E. Manago, and K. Hirota, “Effect of Diet and Lifestyle on Bone Mass in Asian Young Women,” American Journal of Clinical Nutrition 55, no. 6 (1992): 1168–1173.
|
| [25] |
J. Kaiser, B. Allaire, P. M. Fein, et al., “Correspondence Between Bone Mineral Density and Intervertebral Disc Degeneration Across Age and Sex,” Archives of Osteoporosis 13, no. 1 (2018): 123.
|
| [26] |
C. A. Baumann, P. Pazooki, K. P. McNamara, et al., “Characterization of Lumbar Lordosis: Influence of Age, Sex, Vertebral Body Wedging, and L4-S1,” Clinical Spine Surgery 38, no. 1 (2025): E30–E37.
|
| [27] |
J. Abbas, K. Hamoud, N. Peled, and I. Hershkovitz, “Lumbar Schmorl's Nodes and Their Correlation With Spine Configuration and Degeneration,” BioMed Research International 2018 (2018): 1574020.
|
| [28] |
X. Zheng, X. Jin, F. Ye, et al., “Ferroptosis: A Novel Regulated Cell Death Participating in Cellular Stress Response, Radiotherapy, and Immunotherapy,” Experimental Hematology & Oncology 12, no. 1 (2023): 65.
|
| [29] |
M. A. Boyanov, “Whole Body and Regional Bone Mineral Content and Density in Women Aged 20–75 Years,” Acta Endocrinologica (Bucharest, Romania: 2005) 12, no. 2 (2016): 191–196.
|
| [30] |
M. Hagman, E. W. Helge, T. Hornstrup, et al., “Bone Mineral Density in Lifelong Trained Male Football Players Compared With Young and Elderly Untrained Men,” Journal of Sport and Health Science 7, no. 2 (2018): 159–168.
|
| [31] |
T. Banica, C. Verroken, G. T'Sjoen, et al., “Modest Changes in Sex Hormones During Early and Middle Adulthood Affect Bone Mass and Size in Healthy Men: A Prospective Cohort Study,” Journal of Bone and Mineral Research 37, no. 5 (2022): 865–875.
|
| [32] |
V. Rochira, “Late-Onset Hypogonadism: Bone Health,” Andrology 8, no. 6 (2020): 1539–1550.
|
| [33] |
D. Sundh, D. Mellström, Ö. Ljunggren, et al., “Low Serum Vitamin D Is Associated With Higher Cortical Porosity in Elderly Men,” Journal of Internal Medicine 280, no. 5 (2016): 496–508.
|
| [34] |
D. Y. Fausto, J. B. B. Martins, A. C. Machado, P. S. Saraiva, A. Pelegrini, and A. C. A. Guimarães, “What Is the Evidence for the Effect of Physical Exercise on Bone Health in Menopausal Women? An Umbrella Systematic Review,” Climacteric: The Journal of the International Menopause Society 26, no. 6 (2023): 550–559.
|
| [35] |
B. Heidari, A. Muhammadi, Y. Javadian, A. Bijani, R. Hosseini, and M. Babaei, “Associated Factors of Bone Mineral Density and Osteoporosis in Elderly Males,” International Journal of Endocrinology and Metabolism 15, no. 1 (2017): e39662.
|
| [36] |
A. Kopiczko, K. Gryko, and M. Łopuszańska-Dawid, “Bone Mineral Density, Hand Grip Strength, Smoking Status and Physical Activity in Polish Young Men,” Homo 69, no. 4 (2018): 209–216.
|
| [37] |
J. C. Alvarenga, H. Fuller, S. G. Pasoto, and R. M. Pereira, “Age-Related Reference Curves of Volumetric Bone Density, Structure, and Biomechanical Parameters Adjusted for Weight and Height in a Population of Healthy Women: An HR-pQCT Study,” Osteoporosis International 28, no. 4 (2017): 1335–1346.
|
| [38] |
S. Ota, K. Chiba, N. Okazaki, A. Yonekura, M. Tomita, and M. Osaki, “Cortical Thickness Mapping at Segmented Regions in the Distal Radius Using HR-pQCT,” Journal of Bone and Mineral Metabolism 40, no. 6 (2022): 1021–1032.
|
| [39] |
N. B. Watts, N. Binkley, C. D. Owens, et al., “Bone Mineral Density Changes Associated With Pregnancy, Lactation, and Medical Treatments in Premenopausal Women and Effects Later in Life,” Journal of Women's Health 30, no. 10 (2021): 1416–1430.
|
| [40] |
A. Shieh, A. S. Karlamangla, M. H. Huang, W. Han, and G. A. Greendale, “Faster Lumbar Spine Bone Loss in Midlife Predicts Subsequent Fracture Independent of Starting Bone Mineral Density,” Journal of Clinical Endocrinology and Metabolism 106, no. 7 (2021): e2491–e2501.
|
| [41] |
S. G. Moshage, A. M. McCoy, J. D. Polk, and M. E. Kersh, “Temporal and Spatial Changes in Bone Accrual, Density, and Strain Energy Density in Growing Foals,” Journal of the Mechanical Behavior of Biomedical Materials 103 (2020): 103568.
|
| [42] |
M. Jaworski and K. Graff, “Peripheral Quantitative Computed Tomography of the Distal and Proximal Forearm in Children and Adolescents: Bone Densities, Cross-Sectional Sizes and Soft Tissues Reference Data,” Journal of Musculoskeletal & Neuronal Interactions 18, no. 2 (2018): 237–247.
|
| [43] |
A. M. J. Møller, J. M. Delaissé, J. B. Olesen, et al., “Aging and Menopause Reprogram Osteoclast Precursors for Aggressive Bone Resorption,” Bone Research 8 (2020): 27.
|
| [44] |
R. Sapir-Koren and G. Livshits, “Postmenopausal Osteoporosis in Rheumatoid Arthritis: The Estrogen Deficiency-Immune Mechanisms Link,” Bone 103 (2017): 102–115.
|
| [45] |
A. Kanto, Y. Kotani, K. Murakami, et al., “Risk Factors for Future Osteoporosis in Perimenopausal Japanese Women,” Menopause (New York, NY) 29, no. 10 (2022): 1176–1183.
|
| [46] |
T. H. Lin, J. Pajarinen, T. Sato, et al., “NF-κB Decoy Oligodeoxynucleotide Mitigates Wear Particle-Associated Bone Loss in the Murine Continuous Infusion Model,” Acta Biomaterialia 41 (2016): 273–281.
|
| [47] |
H. Hadizadeh, H. Hadizadeh, M. Ganjiani, M. Karimpour, and A. Hosseinpour, “Investigation of the Effect of the Angle Between Femoral and Prosthesis Mechanical Axes on Bone Remodeling of Femur in Total Knee Arthroplasty,” Proceedings of the Institution of Mechanical Engineers Part H, Journal of Engineering in Medicine 235, no. 9 (2021): 976–984.
|
| [48] |
J. H. Lee, J. Park, J. H. Kim, et al., “Integrative Analysis of Genetic and Clinical Risk Factors for Bone Loss in a Korean Population,” Bone 147 (2021): 115910.
|
| [49] |
R. Litke, F. Puisieux, J. Paccou, J. B. Beuscart, and I. Delabriere, “A Retrospective Study on the Etiological Exploration of Osteoporosis in Aging Men in a French Geriatric Setting,” Annales d'Endocrinologie 83, no. 2 (2022): 109–113.
|
| [50] |
C. Pakpahan, C. D. K. Wungu, A. Agustinus, and D. Darmadi, “Do Vitamin D Receptor Gene Polymorphisms Affect Bone Mass Density in Men?: A Meta-Analysis of Observational Studies,” Ageing Research Reviews 75 (2022): 101571.
|
| [51] |
Z. Kutleša, I. Ordulj, I. Perić, et al., “Opportunistic Measures of Bone Mineral Density at Multiple Skeletal Sites During Whole-Body CT in Polytrauma Patients,” Osteoporosis International: A Journal Established as Result of Cooperation Between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA 34, no. 4 (2023): 775–782.
|
| [52] |
G. Simion, N. Eckardt, B. W. Ullrich, C. Senft, and F. Schwarz, “Bone Density of the Cervical, Thoracic and Lumbar Spine Measured Using Hounsfield Units of Computed Tomography—Results of 4350 Vertebras,” BMC Musculoskeletal Disorders 25, no. 1 (2024): 200.
|
| [53] |
S. A. Holcombe, Y. Huang, and B. A. Derstine, “Population Trends in Human Rib Cross-Sectional Shapes,” Journal of Anatomy 244, no. 5 (2024): 792–802.
|
| [54] |
S. A. Holcombe and B. A. Derstine, “Rib Cortical Bone Thickness Variation in Adults by Age and Sex,” Journal of Anatomy 241, no. 6 (2022): 1344–1356.
|
| [55] |
L. T. Pedersen, J. Miszkiewicz, L. C. Cheah, A. Willis, and K. M. Domett, “Age-Dependent Change and Intraskeletal Variability in Secondary Osteons of Elderly Australians,” Journal of Anatomy 244, no. 6 (2024): 1078–1092.
|
| [56] |
R. L. Hunter and A. M. Agnew, “Intraskeletal Variation in Human Cortical Osteocyte Lacunar Density: Implications for Bone Quality Assessment,” Bone Reports 5 (2016): 252–261.
|
| [57] |
Z. A. Haverfield, A. M. Agnew, and R. L. Hunter, “Differential Cortical Volumetric Bone Mineral Density Within the Human Rib,” Journal of Clinical Densitometry: The Official Journal of the International Society for Clinical Densitometry 26, no. 2 (2023): 101358.
|
| [58] |
N. R. Rydzewski, P. Yadav, H. B. Musunuru, et al., “Radiomic Modeling of Bone Density and Rib Fracture Risk After Stereotactic Body Radiation Therapy for Early-Stage Non-Small Cell Lung Cancer,” Advances in Radiation Oncology 7, no. 3 (2022): 100884.
|
| [59] |
K. K. Bentsen, C. Brink, T. B. Nielsen, et al., “Cumulative Rib Fracture Risk After Stereotactic Body Radiotherapy in Patients With Localized Non-Small Cell Lung Cancer,” Radiotherapy and Oncology: Journal of the European Society for Therapeutic Radiology and Oncology 200 (2024): 110481.
|
| [60] |
C. Liebsch, S. Hübner, M. Palanca, L. Cristofolini, and H. J. Wilke, “Experimental Study Exploring the Factors That Promote Rib Fragility in the Elderly,” Scientific Reports 11, no. 1 (2021): 9307.
|
| [61] |
K. J. Segheto, L. L. Juvanhol, C. J. Carvalho, D. Silva, A. M. Kakehasi, and G. Z. Longo, “Factors Associated With Bone Mineral Density in Adults: A Cross-Sectional Population-Based Study,” Revista da Escola de Enfermagem da USP 54 (2020): e03572.
|
| [62] |
A. C. Beresheim, S. K. Pfeiffer, M. D. Grynpas, and A. Alblas, “Sex-Specific Patterns in Cortical and Trabecular Bone Microstructure in the Kirsten Skeletal Collection, South Africa,” American Journal of Human Biology 30, no. 3 (2018): e23108.
|
| [63] |
X. Wang, W. Zhao, X. Chen, et al., “Correlation of Hounsfield Units With Bone Mineral Density and T-Score in Chinese Adults,” World Neurosurgery 183 (2024): e261–e267.
|
| [64] |
J. Chen, Y. Li, H. Zheng, H. Li, H. Wang, and L. Ma, “Hounsfield Unit for Assessing Bone Mineral Density Distribution Within Lumbar Vertebrae and Its Clinical Values,” Frontiers in Endocrinology 15 (2024): 1398367.
|
| [65] |
D. Qiao, Y. Li, X. Liu, et al., “Association of Obesity With Bone Mineral Density and Osteoporosis in Adults: A Systematic Review and Meta-Analysis,” Public Health 180 (2020): 22–28.
|
| [66] |
C. Chen, J. Jia, and P. Wang, “The Saturation Effect of Body Mass Index on Total Lumbar Bone Mineral Density for Adults: The NHANES 2011–2020,” Medicine 103, no. 1 (2024): e36838.
|
| [67] |
R. Cherif, L. Vico, N. Laroche, M. Sakly, N. Attia, and C. Lavet, “Dual-Energy X-Ray Absorptiometry Underestimates In Vivo Lumbar Spine Bone Mineral Density in Overweight Rats,” Journal of Bone and Mineral Metabolism 36, no. 1 (2018): 31–39.
|
| [68] |
E. Colt, M. Akram, and F. X. Pi Sunyer, “Comparison of High-Resolution Peripheral Quantitative Computerized Tomography With Dual-Energy X-Ray Absorptiometry for Measuring Bone Mineral Density,” European Journal of Clinical Nutrition 71, no. 6 (2017): 778–781.
|
| [69] |
H. Al Zaid, M. S. Alamri, A. A. AlOfair, et al., “Prevalence and Risk Factors of Discordance Between Hip and Spinal Bone Mineral Density Among Saudi Subjects,” Cureus 14, no. 8 (2022): e27684.
|
| [70] |
A. Euler, T. Nowak, B. Bucher, et al., “Assessment of Bone Mineral Density From a Computed Tomography Topogram of Photon-Counting Detector Computed Tomography-Effect of Phantom Size and Tube Voltage,” Investigative Radiology 56, no. 10 (2021): 614–620.
|
RIGHTS & PERMISSIONS
2025 The Author(s). Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.
PDF
