Reference values of bone mineral density and prevalence of osteoporosis in Chinese adults

Zhe-qing Zhang1, Suzann C Ho2, Zong-qiu Chen1,3, Cai-xia Zhang1, Yu-ming Chen1

1 Guangdong Provincial Key Laboratory of Food, School of Public Health, Sun Yat-sen University, Guangzhou 510080, People's Republic of China.

2 School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR

3 Guangzhou Center for Disease Control and Prevention, Guangzhou 510080, People's Republic of China.

Reprint requests and correspondence:

Yu-ming Chen, PhD, MD

Email:

Suzanne C Ho, MPH, PhD, FACE

E-mail:

Journal name: Osteoporosis International

Supplemental Tables and Figure

Supplemental Table 1. Characteristics of the included studies

Supplemental Table 2. Values of peck BMD and cutoffs for osteoporosis classification.

Supplemental Table 3. Meta-regression analysis of age-specific sBMD for spine and femur on media age, type of instruments, city size, latitude, altitude and detection time in Chinese female and male.

Supplemental Fig. 1 Age changes of BMD at lumbar spine and femur neck of female and male.

Supplemental Table 1. Characteristics of the included studies

Study ID / DXA / Detection time / Sampling / Exclusion / Study size / Age interval / Age range / Area
F LS / F FN / M LS / M FN
An 2001 [1] / Lunar DPX-L / NA / R / a, e / 775 / 775 / 685 / 685 / 10 / 20-80+ / CD
Bai 2006 [2] / Lunar DPX-L / 2003-2004 / NA / a, b / 610 / 0 / 555 / 0 / 10 / 20-70 / CC
Bai 2008 [3]* / Lunar Prodigy / 2006-2008 / C / a, b, e / 677 / 677 / 535 / 535 / 10 / 20-80+ / LZ
Bao 2010 [4] / Lunar Expert-XL / NA / NA / a, b, e / 5841 / 5841 / 3954 / 3954 / 5 / 20-89 / NJ
Cao 2005 [5] / Hologic QDR 4500A / NA / R / a / 375 / 375 / 375 / 375 / 5 / 20-80+ / FS
Chen 2002 [6] / Norland XR26 / NA / R / NA / 184 / - / 377 / - / 5 / 18-77 / WH
Chen 2003[7] / Norland XR46 / NA / C / a / 1370 / 964 / 0 / 0 / 10 / 20-80+ / GZ
Chen 2008[8] / Lunar Prodigy / 2002-2007 / C / a, b, d / 570 / - / 592 / - / 5 / 20-80+ / HF
Chen 2010 [9] / LUNAR DPX-MD / NA / R / a, b, e / 308 / 308 / 223 / 223 / 5 / 60-80+ / HK
Chen 2011[10]* / Lunar Prodigy / 2007-2010 / C / a, b, c / 4394 / 4394 / 1819 / 1819 / 5 / 20-80+ / XM
Cheng 2004 [11] / Lunar DPX-NT / 2001-2003 / C / a, c / 1143 / - / - / - / 10 / 20-69 / JN
Cheng 2007 [12] / Lunar DPX / NA / NA / a, b / 209 / 209 / 71 / 71 / 5 / 50-80 / QD
Duan 1994 [13] / Norland XR26 / NA / R / a, c / 541 / 528 / 0 / 0 / 5 / 20-79 / BJ
Feng 2006 [14]* / Lunar DPX-L / 2005-2006 / C / a, b / 398 / - / - / - / 5 / 20-84 / JN
Feng 2011 [15]* / Lunar / 2008-2010 / R / a, b / 783 / 783 / 551 / 551 / 10 / 20-79 / GY
Gong 2009 [16] / Lunar DPX-NT / 2008-2009 / C / a, b / - / - / 449 / 449 / 5 / 20-50 / PZH
Guo 2002 [17] / Lunar DPX-L / NA / R / a, b, d, e / 1213 / 1213 / 1087 / 1087 / 10 / 20-80+ / SHE
Han 2004 [18] / Lunar Expert-XL / 2003 / NA / a, b / - / 325 / - / 331 / 10 / 40-80+ / SZ
Ho 1999 [19] / Norland XR36 / NA / R, C / a, b / 390 / 390 / - / - / 10 / 40-80+ / HK
Hou 2002 [20] / Lunar DPX-IQ / 1999-2006 / R / a / 1320 / 1320 / 1204 / 1204 / 10 / 20-89 / XA
Hou 2004 [21] / Lunar DPX-L / 2001-2003 / R / a, b, c, e / 1365 / 1365 / 1059 / 1059 / 10 / 20-80+ / BJ
Hu 2005 [22] / Lunar Expert-XL / 1998-2003 / R / a, b / 728 / 728 / 307 / 307 / 10 / 20-80+ / KM
Huang 2008 [23]* / Lunar Expert-XL / NA / C / a, b, c / 902 / 902 / 807 / 807 / 10 / 20-79 / CD
Huang 2012 [24] / Hologic QDR 4500A / 2009-2011 / NA / a / 178 / - / 189 / - / 5 / 65~85+ / ZJ
Jia 2010 [25] / Lunar Prodigy / 2004-2009 / R / a, b, c / 902 / 902 / 902 / 902 / 5 / 20-75+ / LZ
Jiang 2004 [26] / Norland XR36 / 1994-1999 / C / a, b, d / 761 / - / 874 / - / 5 / 15-70+ / TJ
Jiang 2009 [27] / Norland XR-36 / 2003-2008 / C / a, b, d / 788 / 788 / 674 / 674 / 5 / 15-79 / XA
Li 2000 [28] / Lunar DPX-L / 1995-1998 / C / a / 1060 / - / 527 / - / 10 / 20-80+ / TY
Li 2002 [29] / Norland XR36 / 1998-2002 / NA / a, b / 744 / 0 / 478 / 0 / 5 / 20-80+ / BJ
Li 2005 [30] / Lunar DPX-L / 1997-2002 / C / a, b, c / 1786 / - / 1136 / - / 5 / 20-80+ / XM
Li 2007 [31] / Hologic QDR 4500A / NA / C / a, b, c / 504 / 504 / 0 / 0 / 5 / 20-80+ / FS
Li 2008 [32] / Lunar Prodigy / 2005-2008 / C / a, b / 276 / 276 / 135 / 135 / 10 / 20-79 / JN
Li 2011 [33] / Hologic Delphi / 2004-2008 / C / a / 718 / 1408 / - / - / 10 / 20-80+ / SH
Liao 2010 [34] / Lunar DPX / NA / R / a, b, c, e / - / 84 / - / 153 / 10 / 20-60+ / SY
Lin 2002 [35] / Lunar DPX-L / 1997-1999 / NA / a / 0 / 256 / 0 / 247 / 5 / 20-49 / GZ
Lin 2003 [36] / Lunar DPX-L / 1997-1999 / R / a / 775 / - / 755 / - / 10 / 20-80+ / GZ
Lin 2011 [37] / Lunar Prodigy / 2009-2011 / C / a, b / 1300 / 1300 / 1300 / 1300 / 5 / 20-80+ / SZ
Liu 1996 [38] / Norland XR26 / NA / NA / NA / 0 / 0 / 261 / 259 / 10 / 20-90 / BJ
Liu 1999 [39] / Lunar DPX-Plus / 1997-1998 / C / a, b / 824 / 232 / 390 / 210 / 10 / 20-80+ / BJ
Liu 2008 [40]* / Hologic Delphi / 2004-2007 / C / a, b, e / 889 / 889 / 1010 / 1010 / 5 / 20-79 / FS
Liu 2011[41]* / Lunar Prodigy / 2009-2010 / R / a, b / 711 / 711 / 505 / 505 / 5 / 20-70+ / GY
Liu 2011[42] / Lunar DPX / 2008-2010 / C / a, b / 1740 / 1740 / 2260 / 2260 / 5 / 25-80+ / SY
Liu 2012 [43] / Norland Excell-plus / 2009-2011 / C / a, b / 1266 / 1266 / 1150 / 1150 / 10 / 20~89 / YA
Ma 2012 [44] / Lunar Prodigy / 2008-2011 / R / NA / 884 / 884 / - / - / 5 / 20-80 / SH
Ming 2004 [45] / Lunar Expert-XL / NA / NA / a / 345 / - / - / - / 10 / 20-80+ / KM
Pan 2007 [46] / Lunar DPX-L / 2002-2005 / NA / d / 384 / 384 / - / - / 10 / 20-87 / NJ
Peng 2006 [47]* / HolgicQDR-2000 / 2001-2003 / C / a, b / 227 / 227 / - / - / 5 / 40-80+ / GZ
Qin 2002 [48] / Lunar DPX-L / 1995-1999 / R / a, b, c / 529 / 532 / 435 / 440 / 5 / 15-70 / BJ
Qiu 2006 [49] / Holgic QDR-2000 / 2001-2005 / C / a, b, d, e / - / - / - / 231 / 10 / 0-80+ / XA
Quan 2005 [50] / Lunar DPX-MD / 2004-2004 / NA / a, c, e / 832 / 832 / 817 / 817 / 5 / 20-89 / HEB
Shen 1996 [51]* / Lunar DPX-L / 1994 / R / a, b / 316 / 0 / 272 / 0 / 5 / 60-80+ / BJ
Shen 2001 [52]* / Holgic QDR-2000 / 1997-2000 / C / a / 718 / 718 / 575 / 575 / 5 / 2-90+ / WH
Sheng 2005 [53] / Lunar DPX-L / NA / C / a / - / - / 508 / 508 / 5 / 60-90+ / SH
Tan 2003 [54] / Norland XR46 / NA / C / a / - / - / 398 / 319 / 10 / 20-80+ / GZ
Tang 2001 [55] / Hologic QDR 4500A / 1993 / C / a, b, c / 721 / 721 / - / - / 5 / 20-75+ / HK
Tsai 1997 [56] / Norland XR26 / NA / NA / a, b, c / - / - / 430 / - / 10 / 20-80+ / TW
Wang 2000 [57] / Hologic / 1995-1997 / C / a, b / 225 / - / - / - / 5 / 40-75+ / GZ
Wang 2005 [58] / Lunar DPX-NT / 2001-2005 / C / a, b / 809 / 809 / - / - / 5 / 20-79 / SJZ
Wang 2005 [59] / Lunar DPX-NT / 2001-2004 / C / a, b / - / - / 231 / 231 / 10 / 30-79 / SJZ
Wu 2000 [60] / Lunar DPX-L / NA / R / a, e / 1524 / 395 / 669 / 481 / 10 / 20-80+ / BJ
Wu 2004 [61]* / Hologic QDR 4500A / 1996-2003 / C / a, b, c / 2998 / 2998 / 0 / 0 / 5 / 10-80+ / CS
Wu 2008 [62] / Hologic Delphi / 1999-2006 / R / a, b / 0 / 0 / 1414 / 1414 / 5 / 15-85+ / CS
Xiao 2000 [63] / Lunar DPX / NA / NA / a, b / 177 / - / 428 / - / 10 / 20-79 / LZ
Xie 2010 [64]* / Lunar DPX-NT / 2008-2009 / C / a / 853 / - / 1025 / - / 10 / 20-69 / SZ
Xu 2011 [65]* / Lunar Prodigy / 2009-2010 / C / a, b, e / 780 / 780 / 585 / 585 / 10 / 20-80 / GY
Xue 2002 [66] / Lunar / NA / C / a, b, c / 230 / 230 / - / - / 5 / 20-75+ / SH
Yan 2009 [67]* / Lunar Prodigy / 2006-2008 / C / a, b / 289 / 0 / 340 / 0 / 10 / 20-70+ / FZ
Yan 2009 [68]* / Lunar / 2006-2007 / C / a, b, c / 551 / 0 / 0 / 0 / 5 / 40-75+ / CDE
Yang 2009 [69]* / Lunar / 2001-2008 / C / a, b / 777 / 777 / 731 / 731 / 10 / 20-89 / YK
Yao 2004 [70] / Lunar Prodigy / 2002-2003 / NA / a, b / 1120 / - / - / - / 5 / 20-70+ / ZS
Yao 2011 [71] / Lunar DPX / 2003-2011 / C / a, b, d / 1500 / - / - / - / 10 / 40-80+ / ZS
Yeh 2004 [72]* / Holgic QDR-2000 / NA / C / a, b, c / - / - / 569 / 462 / 10 / 20-90 / TW
Yu 1999 [73] / Lunar DPX-L / NA / C / a, b, c / 238 / 0 / 166 / 0 / 10 / 10-79 / BJ
Yu 2004 [74] / Lunar DPX-L / NA / R / a / 97 / 90 / 53 / 44 / 10 / 40-79 / LY
Yu 2008 [75]* / Holgic QDR-2000 / 1994-2007 / C / a, b / 3390 / 3390 / - / - / 5 / 20-80+ / SH
Zeng 2012[76]* / Holgic QDR-2000 / NA / C / a / 354 / 354 / 210 / 210 / 10 / 20~80 / XA
Zhan 2004 [77] / Norland Excell-plus / NA / C / NA / 190 / 190 / 110 / 110 / 10 / 30-79 / BJ
Zhang 2003 [78] / Holgic QDR-2000 / NA / NA / a, b, c, d, e / 137 / 137 / 134 / 134 / 5 / 20-39 / HK
Zhang 2006 [79]* / Lunar Prodigy / NA / C / a, b / - / - / 1385 / 1385 / 5 / 20-80+ / SH
Zhang 2007 [80] / LunarDPX-NT / 2004-2006 / C / a, b / 721 / 721 / 402 / 402 / 5 / 20-79 / GY
Zhang 2008 [81] / Lunar Prodigy / 2006 / C / a, b, c / 722 / 722 / 0 / 0 / 5 / 20-55 / CD
Zhang 2011 [82] / Lunar Prodigy / 2003-2009 / C / a, b / - / 14423 / 4014 / 5 / 15-85+ / SH
Zhang 2011 [83]* / Lunar Prodigy / 2010-2011 / C / a, b / 566 / 566 / 677 / 677 / 10 / 20-70+ / XN
Zhang 2012 [84]* / Hologic Delphi / NA / C / a, b, c / 500 / - / 497 / - / 5 / 45-79 / LZ
Zhao 2004 [85] / Lunar DPX-L / 1998-2003 / C / a, b / 2303 / - / 2663 / - / 5 / 20-70+ / SHE
Zhao 2008 [86] / Lunar Expert-XL / NA / R / a, b, c, d / 591 / 591 / 589 / 589 / 10 / 20-80+ / CC
Zhuo 2002 [87] / Lunar Expert-XL / 1997-2001 / R / a / 3186 / 3186 / 1982 / 1982 / 5 / 20-89 / NJ
Zhou 2005 [88] / Lunar / NA / NA / a, b, e / - / 330 / - / - / 10 / 20-80+ / KM
Zhou 2008 [89]* / Norland XR36 / 2001-2005 / C / a, b / 1303 / 1303 / 985 / 985 / 5 / 20-80+ / SHE
Zhu 2003 [90] / Lunar DPX-L / 1998-2002 / NA / a, b, c, d / 0 / 717 / 0 / 449 / 5 / 20-80+ / BJ
Zhu 2008 [91] / Lunar DPX-L / 1999-2000 / R / a, b, d / 723 / - / - / - / 5 / 50-69 / SH

FLS: Female lumbar spine; FFN: Male femur neck

MLS: Male lumbar spine; MFN: Male femur neck

BJ: Beijing; CC: Changchun; CS: Changsha; CD: Chengdu; CDE: Chengde; FS: Foshan; FZ: Fuzhou; GZ: Guangzhou; GY: Guiyang; HEB: Haerbin; HK2: Haikou; HF: Hefei; JN: Jinan; KM: Kunming; LZ: Lanzhou; LY: Longyan; NJ: Nanjing; PZH: Panzhihuan; QD: Qingdao; SH: Shanghai; SY: Shaoyang; SZ: Shenzhen; SHY: Shenyang; SJZ: Shijiazhuang; SZ: Suzhou; TW: Taiwan; TY: Taiyuan; TJ: Tianjin; WH: Wuhan; XA: Xi'an; XM: Xiamen; XZ: Xuzhou; YA, Yan'an; YK: Yingkou; ZJ: Zhanjiang; ZS: Zhongshan

*Studies detected L1-4 sites of spine in the anteroposterior.

NA, Not available.

R, the subjects recruited by random selection; C, convenience sampling screened from clinic service, health examination or volunteers recruited by public advertisement.

a, diseases related to bone metabolism; b, medical user (steroid hormones, heparin, thyroid medications, or anticonvulsants); c, History of fractures or surgery history; d, malformation, movement disorder, smoking-alcohol abuse or disabilities of daily living; e, particular occupations

Supplemental Table 2. Values of peck BMD and cutoffs for osteoporosis classification.

Standardized peak BMD / Cutoffs for diagnosis of osteoporosis
Mean / SD / Standardized / Hologic / Lunar / Norland
Female lumbar spine / 1.088 / 0.137 / 0.746 / 0.690 / 0.793 / 0.664
Female femur neck / 0.865 / 0.126 / 0.549 / 0.488 / 0.610 / 0.552
Male spine lumbar / 1.066 / 0.154 / 0.680 / 0.627 / 0.725 / 0.596
Male femur neck / 0.928 / 0.144 / 0.568 / 0.504 / 0.629 / 0.570

Supplemental Table 3. Meta-regression analysis of age-specific sBMD for spine and femur on media age, type of instruments, city size, latitude, altitude and detection time in Chinese female and male.

Female spine / Male spine / Female femur neck / Male femur neck
B / SE / P / B / SE / P / B / SE / P / B / SE / P
Median age (10-2) / -6.3 / 0.2 / 0.000 / -2.3 / 0.2 / 0.000 / -5.4 / 0.2 / 0.000 / -4.1 / 0.2 / 0.000
Hologic Pencil-beam (10-2) / -2.2 / 1.6 / 0.170 / 1.6 / 1.6 / 0.336 / 4.0 / 1.2 / 0.001 / 3.3 / 1.3 / 0.011
Hologic Fan-beam (10-3) / -7.1 / 16.1 / 0.094 / 3.6 / 17.3 / 0.837 / 24.3 / 11.1 / 0.028 / 20.3 / 16.5 / 0.219
Lunar (10-2) / -1.9 / 1.1 / 0.659 / -1.6 / 1.1 / 0.136 / 0.2 / 1.1 / 0.850 / -0.9 / 1.0 / 0.361
City size (10-5) / 65.0 / 13.5 / 0.000 / 48.3 / 15.6 / 0.002 / -0.5 / 11.3 / 0.965 / 22.9 / 11.7 / 0.051
Latitude (10-4) / 14.6 / 5.4 / 0.007 / 10.0 / 5.7 / 0.082 / -2.7 / 4.9 / 0.581 / 1.2 / 5.0 / 0.819
Altitude (10-3) / 5.0 / 6.8 / 0.459 / 0.6 / 7.1 / 0.935 / 2.3 / 6.5 / 0.724 / -23.4 / 7.1 / 0.001
Sample selection (10-2) / -1.7 / 0.7 / 0.023 / -2.9 / 0.8 / 0.000 / -1.1 / 0.6 / 0.080 / -0.2 / 0.7 / 0.742
Detection time (10-4) / 20.2 / 8.9 / 0.024 / -15.7 / 9.5 / 0.099 / 4.7 / 8.4 / 0.578 / -6.4 / 8.9 / 0.468
Constant / -2.8 / 1.8 / 0.116 / 4.3 / 1.9 / 0.026 / 0.1 / 1.7 / 0.949 / 2.3 / 1.8 / 0.191

Units: Age: 10 years; city size: 100,000 population; Altitude: 1000 meters; Latitude: degree; Hologic Pencil-beam, Hologic Fan-beam and Lunar: 1=yes, 0=no; Sample selection: 1= random sampling, 0=others; Detection time: year; BMD: g/cm2

B: Regression coefficient; SE, standard error of B

Supplemental Fig 1. Age changes of BMD at lumbar spine and femur neck of female and male.

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