Nigerian Journal of Orthopaedics and Trauma

: 2019  |  Volume : 18  |  Issue : 1  |  Page : 9--12

Reduced bone mineral density in nigerian women: A Prevalence Study

Ngozi Rosemary Njeze1, Olanike Agwu-Umahi2, Salome Nwaelom Ezeofor1, Sussan Arinze-Onyia3, Nneze C Njeze4, Damaris Ulugo Akpagbula4, Kenechi Madu5,  
1 Department of Radiation Medicine, College of Medicine, University of Nigeria, Nsukka, Nigeria
2 Department of Community Medicine, College of Medicine, University of Nigeria, Nsukka, Nigeria
3 Department of Community Medicine, Enugu State University Medical School, Ituku Ozalla, Nigeria
4 Department of Radiation Medicine, University of Nigeria Teaching Hospital, Ituku Ozalla, Nigeria
5 Department of Orthopaedic Surgery, National Orthopaedic Hospital, Enugu, Nigeria

Correspondence Address:
Dr. Ngozi Rosemary Njeze
Department of Radiation Medicine, College of Medicine, University of Nigeria, Nsukka


Background: Reduced bone density if left untreated is a known precursor of osteoporosis, a silent disease with increased morbidity. In the developing country, fragility bone fractures occur in the general population, and health-seeking behaviour is low. An incredibly high level of ignorance is observed. Methodology: A descriptive cross-sectional study was carried out to determine the bone mineral density (BMD) among patients who visited a specialist clinic for screening for osteopenia using the unigamma dual energy X-ray absorptiometry (DXA) machine. 54 participants were selected for this study having met the inclusion criteria. Data were analysed using SPSS version 22 with P = 0.05. Results: BMD of 54 women whose ages ranged 42–86 were analysed. Twenty-eight (51.9%) were obese while 7 (13.0%) had normal weight. 50 (92.6%) had low BMD. BMD of the right and left femora correlated more with age (P = 0.015 and 0.008, respectively). Mild and severe osteopenia were found mostly in the left femoral neck and left femoral ward, respectively, while moderate osteopenia was more common in the right greater trochanter. In this population, diagnosis of loss of bone mass by DXA examination is best on the left femur. Conclusion: Reduced BMD was present in most participants. It is advised that Nigerian women have their baseline bone density test to avoid unnecessary preventable fractures later in life. More awareness programmes is advised in the future.

How to cite this article:
Njeze NR, Agwu-Umahi O, Ezeofor SN, Arinze-Onyia S, Njeze NC, Akpagbula DU, Madu K. Reduced bone mineral density in nigerian women: A Prevalence Study.Niger J Orthop Trauma 2019;18:9-12

How to cite this URL:
Njeze NR, Agwu-Umahi O, Ezeofor SN, Arinze-Onyia S, Njeze NC, Akpagbula DU, Madu K. Reduced bone mineral density in nigerian women: A Prevalence Study. Niger J Orthop Trauma [serial online] 2019 [cited 2020 Jul 6 ];18:9-12
Available from:

Full Text


Reduced bone density ranges from osteopenia to osteoporosis. According to World Health Organization (WHO), 'osteopenia' and 'osteoporosis' are used to describe specific loss of bone density below normal values which are age and gender related and matched in a given population.[1],[2] Osteoporosis is threatening the health of millions of women all over the world.[3] It is mostly the most common metabolic bone disorder and is mainly two types: postmenopausal or senile.[1] The other types are associated with some pathologies. Diminution in bone density is commoner in females. It starts at 50years in females and 60years in males. 1 out of every 3 females and 1 out of every 5 males will develop reduced bone density.[4] Bone fracture is mostly the first symptom of this silent disease.[4],[5] Osteoporosis causes more than 8.9 million fractures annually.[6] Osteoporotic fractures occur every 3 s.[7] The surgeon general's report says that 10 million Americans above 50 years have osteoporosis while another 34 million have osteopenia of the hip.[8]

The projection in 2050 is that there will be a 240% increase in osteoporotic fractures in women while in men, there will be a 310% increase.[6] Finkelstein et al. observed that BMD loss was the most rapid in Japanese and Chinese women, followed by Caucasian women and slowest in African-American women.[9] Incidentally, morbidity and mortality are more in African-American when fracture occurs.[10]

Due to paucity of data, especially in Southeast Nigeria, this study intends to determine bone mineral density (BMD) and examine for osteopenia among Nigerian women and its possible progression to osteoporosis using the dual energy X-ray absorptiometry (DXA).


This was a descriptive cross-sectional study, carried out as part of 3 awareness programmes held in May, October and December 2017 on bone health in Enugu, Southeast Nigeria. 324 women were sensitised on bone health, bone loss due to age and some other factors such as menopause, endocrine disorders such as diabetes and hyperparathyroidism, cancers, sickle cell anaemia, drug abuse, long-term intake of drugs like steroids, HIV drugs, antidiabetics and anticancer. After each of these programmes, all these women were invited for a free bone density screening. Only seventy women responded but 54 that met the inclusion criteria of being apparently healthy adult females without any diagnosed chronic disease and gave consent were selected. Exclusion criteria were chronic/debilitating disease or prolonged drug usage. The machine used was the Unigamma Dual Energy X-ray Absorptiometry type. For the lumbar spine scan and patient in supine position, the normal lumbar lordosis is straightened out with a pillow. With the patient remaining still in position, the scan is done along the region required. The BMD is acquired from the lumbar spine, and the corresponding T scores are analysed. Regarding the hip scan, the patient lies supine and the metallic triangle is placed at the foot. The side to be scanned, i.e., left or right is strapped to the adjacent slanted side of the triangle. The BMD obtained is analysed, and their corresponding T-scores are used for assessment.

The WHO criteria of defining osteopenia and osteoporosis was used as follows: normal (−1.0 or greater in standard deviation (SD), osteopenia (mild −1.0–−1.499SD, moderate −1.5–−1.99, severe −2.0–−2.499) and osteoporosis (mild −2.5–−2.699, moderate = −2.7–−3.0, severe ≤−3.01).[11] Regions of interest were the first 4 lumbar vertebrae as well as both proximal femora. The femora were analysed in 3 regions; neck, ward triangle and greater trochanter. Data were analysed using SPSS version 22 (IBM, Chicago, Illinois) with P = 0.05. Ethical clearance was given by the Ethics Review Board of the University of Nigeria Teaching Hospital, Ituku-Ozalla, Nigeria.


54 who met the inclusion criteria were included in the study. Age ranged between 42 and 86 years, with modal age of 60–69 years (42.6%). Majority of the individuals were obese (28.51.9%) with only 13% having a normal BMI [Table 1].{Table 1}

A total of 50 (92.6%) of the individuals were found to have osteopenia while only 7.4% had normal BMD [Table 2]. All (100%) of the individuals in age groups 50–59, 70–79 and 80–89 had osteopenia while the least occurrence was found among the 40–49 age group [Table 2]. Femoral osteopenia was statistically significantly associated with age where right femoral osteopenia occurred mostly in the ages 50–59 and 80–89 years (P = 0.015) and left femoral osteopenia occurred mostly in the 50–59 and 70–79 age groups (P = 0.008). Similarly, right femoral osteopenia was significantly associated with being aged 50 years and above (P = 0.003) while left femoral osteopenia was also significantly associated with age of 50 years and above (P = 0.015) [Table 3]. Osteopenia was not found to be statistically significantly associated with BMI.{Table 2}{Table 3}

Regarding regions of interest, mild osteopenia was found mostly in the left femoral neck occurring in 15 (34.9%) individuals, followed by right and left greater trochanter in 9 (22.5%) each and least found in left femoral ward (3, 3.6%). Moderate osteopenia was also found in the right greater trochanter (10, 25%) and severe osteopenia in the left femoral ward (12, 25%). With regard to osteoporosis, mild, moderate and severe forms are observed in the left femoral ward (25%, 20.8% and 16.7%, respectively) [Table 4].{Table 4}


DXA is the gold standard for the evaluation of osteopenia and Osteoporosis.[11] Our study revealed that up to 92.6% of the individuals had a reduced BMD contrary to previous impression that the rate of bone loss is lowest among African-American women.[12]

Our result which is close to that of Salamat et al.[13] showed that 92.6% had reduced bone density. The possible reason for high prevalence of markedly low BMD in our work may well be due to the fact that the participants who volunteered to be part of our study population may have had some background ill-defined bone pain in the past or feared family history of bone disease bearing in mind that our people do not seek health solutions early.[14] The finding in this study is slightly above the 73.4% reported by Shilbayeh et al. in Qatar.[15]

Our result is contrary to studies by Cadarette et al. and Aggarwal et al. where figures of normal BMD were as high as 43.5% and 47%, respectively.[16],[17] This may suggest that there is a higher prevalence of decreased BMD in this part of the world than earlier stipulated.[12] The reason for this might include changes in diet and lifestyle which is tending towards that obtained in developed countries. Another reason could be the tendency to avoid direct sunshine by our people and the preference of air-conditioned rooms.

The fact that almost all our individuals were found to be osteopenic is in agreement with studies by Pisani et al. and Gemalmaz et al.[11],[18]

Our study further demonstrated that age has a significant influence on the BMD which is similar to the work by Karonanithi et al. and Singh et al.[19],[20] However, Kadam et al. observed that there was no significant decrease in BMD with age in premenopausal women but a rather rapid decrease was observed in the postmenopausal women.[21]

The study by Ezeonu et al. also had a high prevalence of osteoporosis among pregnant rural dwellers in Nigeria.[22] Their study and ours had a higher prevalence of reduced bone density than the report in India[23] and Pakistan.[24] However, our study like Sharma et al.[23] was on urban dwellers not pregnant rural women. The study by Adewole et al.[2] recorded 24 normal of 70 participants, 32 low bone density and 14 cases of osteoporosis when they used their local reference. Though somewhat similar to this study, their results were slightly lower than ours. The study carried out in Iran by Saei revealed osteoporosis prevalence of 42.2% total prevalence and 50.7% in women who are aged 50 years and above.[25] The Iranian Multi-center Osteoporosis Study stated that more than two-thirds of the women above the age of 50 years had low BMD.[26]

BMI in this report did not significantly affect the occurrence of osteopenia (P = 1.0) whereas the study by Wilson noted a statistical difference between the BMI of osteoporotic individuals and mean BMI of normal population.[4] Cao observed that obesity is traditionally viewed to be beneficial to bone health because there is an established positive effect of mechanical loading as a result of the weight of the body on formation of bone.[27] This study is limited in the sense that it is ongoing. It is also slow and sample size modest because it is new in this part of the world where awareness is low.

 Conclusion and Recommendations

The prevalence of osteopenia is quite high among the Nigerians studied. It is also significantly higher among the age group of 50 years and above than their younger counterparts. The diagnosis of loss of bone mass by DXA examination is generally best on the left femur.

While evaluation of routine baseline BMD levels in individuals 50 years and above is suggested, a collaborative effort should be employed in promoting bone health and creating more awareness programmes to prevent fragility fractures that may result from osteoporosis.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.


1Grainger RG, Allison DJ, Adam A, Dixon AK, editors. Grainger & Allison's Diagnostic Radiology. A Textbook of Medical Imaging. 4th ed. London WIPOLP: Churchill Livingstone; 2001. p. 1928-9.
2Alswat KA. Gender Disparities in Osteoporosis. J Clin Med Res 2017;9:382-7.
3Stetzer ES. Identifying risk factors for osteoporosis in young women. Internet Journal of Allied Health Sciences and Practice 2011;9:1-8.
4Willson T, Nelson SD, Newbold J, Nelson RE, LaFleur J. The clinical epidemiology of male osteoporosis: A review of the recent literature. Clin Epidemiol 2015;7:65-76.
5Njeze NR. Osteoporosis – A Friend or a Silent Killer. Enugu: IceCanopy LTD.; 2016. p. 36.
6Cooper C, Ferrari F. Compendium of Osteoporosis. IOF. 1st ed. Geneva; 2017.
7Stovall DW. Osteoporosis: Diagnosis and Management. 1st ed. 2013. DOI: 10.1002/9781118316290.
8Surgeon General. Bone Health and Osteoporosis: A Report of the Surgeon General. (US) A Public Health Approach to Promote Bone Health. Published by US Public Health Service. 2004; 43 & 69.
9Finkelstein JS, Brockwell SE, Mehta V, Greendale GA, Sowers MR, Ettinger B, et al. Bone mineral density changes during the menopause transition in a multiethnic cohort of women. J Clin Endocrinol Metab 2008;93:861-8.
10Johnson AK, Ford MA, Jones TL, Nahar VK, Hallam JS. Predictors of bone mineral density in African-American and Caucasian college-aged women. Health Promot Perspect 2015;5:14-23.
11National Population Commission (NPC) and ICF International. Nigeria Demographic and Health Survey 2013. Abuja, Nigeria, Rockville, Maryland, USA: NPC and ICF International; 2014.
12Pisani P, Renna MD, Conversano F, Casciaro E, Muratore M, Quarta E, et al. Screening and early diagnosis of osteoporosis through X-ray and ultrasound based techniques. World J Radiol 2013;5:398-410.
13Lo JC, Burnett-Bowie SA, Finkelstein JS. Bone and the perimenopause. Obstet Gynecol Clin North Am 2011;38:503-17.
14Salamat MR, Tavakoli MB, Salehi M, Pishva E, Salari AH, Tabesh F. Comparison of bone mineral density in Isfahani women with other populations: The Impact on diagnosis of using different normal ranges. Asian J Sci Res 2009;2:61-7.
15Shilbayeh S. Prevalence of osteoporosis and its reproductive risk factors among Jordanian women: A cross-sectional study. Osteoporos Int 2003;14:929-40.
16Cadarette SM, Jaglal SB, Murray TM, McIsaac WJ, Joseph L, Brown JP. Evaluation of decision rules for referring women for bone densitometry by dual-energy X-ray absorptiometry. JAMA 2001;286:57-63.
17Aggarwal N, Raveendran A, Khandelwal N, Sen RK, Thakur JS, Dhaliwal LK, et al. Prevalence and related risk factors of osteoporosis in peri- and postmenopausal Indian women. J Midlife Health 2011;2:81-5.
18Gemalmaz A, Discigil G, Ceylan C. Diagnostic performance of QUS for identifying osteoporosis in postmenopausal Turkish women. Turk J Med Sci 2007;37:303-9.
19Karunanithi R, Ganesan S, Panicker TM, Korath MP, Jagadeesan K. Assessment of bone mineral density by DXA and the trabecular microarchitecture of the calcaneum by texture analysis in pre- and postmenopausal women in the evaluation of osteoporosis. J Med Phys 2007;32:161-8.
20Singh R, Gupta S, Awasthi A. Differential effect of predictors of bone mineral density and high geometry in postmenopausal women: A cross-sectional study. Arch Osteoporosis 2015;10:39.
21Kadam NS, Chiplonkar SA, Khadilkar AV, Khadilkar W. Prevalence of osteoporosis in apparently healthy adults above 40 years of age in Pune city, India. Indian J Endocrinol Metab 2018;22:67-73.
22Ezeonu PO, Agwu UM, Ajah LO, O Dimejesi IB, Ogbonnaya LU, J Umeora OU, et al. The prevalence of osteoporosis among antenatal clinic attendees in a rural mission hospital in South-East Nigeria. Niger J Clin Pract 2017;20:1522-6.
23Sharma S, Tandon VR, Mahajan A, Kour A, Kumar D. Preliminary screening of osteoporosis and osteopenia in urban women from Jammu using calcaneal QUS. Indian J Med Sci 2006;60:183-9.
24Ejaz S, Mahmood A, Qureshi M, Ali M. Prevalence of osteoporosis and osteopenia among Pakistani pre and post menopausal women. J Dent Med Sci 2012;2:12-7.
25Saei Ghare Naz M, Ozgoli G, Aghdashi MA, Salmani F. Prevalence and risk factors of osteoporosis in women referring to the bone densitometry academic center in Urmia, Iran. Glob J Health Sci 2015;8:135-45.
26Rahnavard Z, Zolfaghari M, Hossein-Nezad A, Vahid Dastgerdi M. The incidence of osteoporotic hip fracture: Iranian multicenter osteoporosis study (IMOS). Res J Biol Sci 2009;4:171-73.
27Cao JJ. Effects of obesity on bone metabolism. J Orthop Surg Res 2011;6:30.