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Clinical Research

The influence of physical activity intensity on bone mineral density and trabecular bone score in young adults with overweight and obesity

International Journal of Obesity volume 49, pages 1840–1846 (2025)Cite this article

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Abstract

Introduction

This study examines how physical activity intensity, body mass index (BMI), and grip strength interact with bone health indicators—specifically areal bone mineral density (BMD) and Trabecular Bone Score (TBS)—in young adults with overweight and obesity. This research aims to clarify these relationships to inform effective physical activity interventions for this demographic.

Methods

Data from 638 young adults (aged 18–35 years) participating in a weight loss randomized clinical trial was analyzed. Multiple Linear Regression (MLR) was utilized to assess the impact of physical activity, BMI, and grip strength on BMD and TBS.

Results

Significant correlations were found between femoral neck BMD and age (β = −0.0056, p < 0.001), BMI (β = 0.0140, p < 0.001), grip strength (β = 0.2865, p < 0.001), light physical activity (β = 0.0002, p < 0.01) and moderate-to-vigorous physical activity (MVPA) (β = 0.0006, p < 0.01) physical activity intensities. Total hip BMD showed similar associations. Analyses of spine BMD and mean TBS highlighted the positive impacts of BMI and grip strength, with light physical activity also benefiting TBS.

Discussion

The study confirms the beneficial effects of light activity and MVPA on femoral neck and total hip BMD, challenging the traditional perception that higher body weight positively impacts bone health by revealing a negative correlation between BMI and TBS. Grip strength’s consistent association with better bone health outcomes underlines the critical role of muscular strength.

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Fig. 1: Comparative analysis of model regression coefficients.

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Data availability

The datasets generated and/or analyzed during the current study are not publicly available but are available from the corresponding author on reasonable request, in line with Springer Nature’s Type 3 data policy.

References

  1. Kanis JA. Diagnosis and clinical aspects of osteoporosis. In: Pocket Reference to Osteoporosis. Cham: Springer International Publishing 2018. pp. 11–20.

  2. Harvey N, Dennison E, Cooper C. Osteoporosis: impact on health and economics. Nat Rev Rheumatol. 2010;6:99–105.

    Article  PubMed  Google Scholar 

  3. Pouresmaeili F, Kamalidehghan B, Kamarehei M, Goh YM. A comprehensive overview on osteoporosis and its risk factors. Ther Clin Risk Manag. 2018;14:2029–49.

  4. Guadalupe-Grau A, Fuentes T, Guerra B, Calbet JAL. Exercise and bone mass in adults. Sports Med. 2009;39:439–68.

    Article  PubMed  Google Scholar 

  5. Kohrt WM, Bloomfield SA, Little KD, Nelson ME, Yingling VR. Physical activity and bone health. Med Sci Sports Exerc. 2004;36:1985–96.

    Article  PubMed  Google Scholar 

  6. Lin Z, Shi G, Liao X, Huang J, Yu M, Liu W, et al. Correlation between sedentary activity, physical activity and bone mineral density and fat in America: National Health and Nutrition Examination Survey, 2011–2018. Sci Rep. 2023;13:1–9.

    Google Scholar 

  7. Zouhal H, Berro AJ, Kazwini S, Saeidi A, Jayavel A, Clark CCT, et al. Effects of exercise training on bone health parameters in individuals with obesity: a systematic review and meta-analysis. Front Physiol. 2022;12:807110.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Qiao D, Li Y, Liu X, Zhang X, Qian X, Zhang H, et al. Association of obesity with bone mineral density and osteoporosis in adults: a systematic review and meta-analysis. Public Health. 2020;180:22–28.

    Article  CAS  PubMed  Google Scholar 

  9. Iwaniec UT, Turner RT. Influence of body weight on bone mass, architecture and turnover. J Endocrinol. 2016;230:R115–130.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Gkastaris K, Goulis DG, Potoupnis M, Anastasilakis AD, Kapetanos G. Obesity, osteoporosis and bone metabolism. J Musculoskelet Neuronal Interact. 2020;20:372.

    CAS  PubMed  PubMed Central  Google Scholar 

  11. Hou J, He C, He W, Yang M, Luo X, Li C. Obesity and bone health: a complex link. Front Cell Dev Biol. 2020;8:600181.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Copês RM, Comim FV, Compston JE, Premaor MO. Obesity and fractures in postmenopausal women: the incidence study in primary care. J Clin Densitom. 2020;23:335.

    Article  PubMed  Google Scholar 

  13. Blake GM, Fogelman I. The role of DXA bone density scans in the diagnosis and treatment of osteoporosis. Postgrad Med J. 2007;83:509–17.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Harvey NC, Glüer CC, Binkley N, McCloskey EV, Brandi ML, Cooper C, et al. Trabecular bone score (TBS) as a new complementary approach for osteoporosis evaluation in clinical practice. Bone. 2015;78:216–24.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Silva BC, Leslie WD, Resch H, Lamy O, Lesnyak O, Binkley N, et al. Trabecular bone score: a noninvasive analytical method based upon the DXA image. J Bone Miner Res. 2014;29:518–30.

    Article  PubMed  Google Scholar 

  16. Rajan R, Cherian KE, Kapoor N, Paul TV. Trabecular bone score - an emerging tool in the management of osteoporosis. Indian J Endocrinol Metab. 2020;24:237–43.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Shevroja E, Cafarelli FP, Guglielmi G, Hans D. DXA parameters, Trabecular Bone Score (TBS) and Bone Mineral Density (BMD), in fracture risk prediction in endocrine-mediated secondary osteoporosis. Endocrine. 2021;74:20–28.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Shevroja E, Reginster JY, Lamy O, Al-Daghri N, Chandran M, Demoux-Baiada AL, et al. Update on the clinical use of trabecular bone score (TBS) in the management of osteoporosis: results of an expert group meeting organized by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO), and the International Osteoporosis Foundation (IOF) under the auspices of WHO Collaborating Center for Epidemiology of Musculoskeletal Health and Aging. Osteoporos Int. 2023;34:1501–29.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Mansour-Assi SJ, Golaszewski NM, Costello VL, Wing D, Persinger H, Coleman A, et al. Social Mobile Approaches to Reducing Weight (SMART) 2.0: protocol of a randomized controlled trial among young adults in university settings. Trials. 2022;23:1–14.

    Article  Google Scholar 

  20. Freedson P, Bowles HR, Troiano R, Haskell W. Assessment of physical activity using wearable monitors: Recommendations for monitor calibration and use in the field. Med Sci Sports Exerc. 2012;44. https://doi.org/10.1249/MSS.0B013E3182399B7E.

  21. Troiano RP, Berrigan D, Dodd KW, Mâsse LC, Tilert T, Mcdowell M. Physical activity in the United States measured by accelerometer. Med Sci Sports Exerc. 2008;40:181–8.

    Article  PubMed  Google Scholar 

  22. Matthews CE, Hagströmer M, Pober DM, Bowles HR. Best practices for using physical activity monitors in population-based research. Med Sci Sports Exerc. 2012;44. https://doi.org/10.1249/MSS.0B013E3182399E5B.

  23. Smith PF, Ganesh S, Liu P. A comparison of random forest regression and multiple linear regression for prediction in neuroscience. J Neurosci Methods. 2013;220:85–91.

    Article  PubMed  Google Scholar 

  24. Tranmer M, Elliot M. Multiple linear regression. The Cathie Marsh Centre for Census and Survey Research (CCSR). Sci Res. 2008;5:1–5.

    Google Scholar 

  25. Bull FC, Al-Ansari SS, Biddle S, Borodulin K, Buman MP, Cardon G, et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med. 2020;54:1451–62.

    Article  PubMed  Google Scholar 

  26. Buttan A, Cui J, Guo X, Chen YDI, Hsueh WA, Rotter JI, et al. Physical activity associations with bone mineral density and modification by metabolic traits. J Endocr Soc. 2020;4. https://doi.org/10.1210/JENDSO/BVAA092.

  27. Kelley GA, Kelley KS, Kohrt WM. Effects of ground and joint reaction force exercise on lumbar spine and femoral neck bone mineral density in postmenopausal women: a meta-analysis of randomized controlled trials. BMC Musculoskelet Disord. 2012;13:1–19.

    Article  Google Scholar 

  28. Braun SI, Kim Y, Jetton AE, Kang M, Morgan DW. Prediction of bone mineral density and content from measures of physical activity and sedentary behavior in younger and older females. Prev Med Rep. 2015;2:300–5.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Gracia-Marco L, Rey-López JP, Santaliestra-Pasías AM, Jiménez-Pavón D, Díaz LE, Moreno LA, et al. Sedentary behaviours and its association with bone mass in adolescents: the HELENA cross-sectional study. BMC Public Health. 2012;12:1–9.

    Article  Google Scholar 

  30. Christofaro DGD, Tebar WR, Saraiva BTC, da Silva GCR, dos Santos AB, Mielke GI, et al. Comparison of bone mineral density according to domains of sedentary behavior in children and adolescents. BMC Pediatr. 2022;22:1–7.

    Article  Google Scholar 

  31. Gabel L, McKay HA, Nettlefold L, Race D, Macdonald HM. Bone architecture and strength in the growing skeleton: the role of sedentary time. Med Sci Sports Exerc. 2015;47:363–72.

    Article  PubMed  Google Scholar 

  32. Chastin SFM, Mandrichenko O, Helbostadt JL, Skelton DA. Associations between objectively-measured sedentary behaviour and physical activity with bone mineral density in adults and older adults, the NHANES study. Bone. 2014;64:254–62.

    Article  CAS  PubMed  Google Scholar 

  33. Julian V, Costa D, O’Malley G, Metz L, Fillon A, Miguet M, et al. Bone response to high-intensity interval training versus moderate-intensity continuous training in adolescents with obesity. Obes Facts. 2022;15:46–54.

    Article  CAS  PubMed  Google Scholar 

  34. Maïmoun L, Mura T, Leprieur E, Avignon A, Mariano-Goulart D, Sultan A. Impact of obesity on bone mass throughout adult life: Influence of gender and severity of obesity. Bone. 2016;90:23–30.

    Article  PubMed  Google Scholar 

  35. Kim Y-S, Han J-J, Lee J, Choi HS, Kim JH, Lee T. The correlation between bone mineral density/trabecular bone score and body mass index, height, and weight. Osteoporos Sarcopenia. 2017;3:98–103.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Povoroznyuk V, Dzerovych N, Martynyuk L, Syzonenko I. Bone mineral density and trabecular bone score in Ukrainian women with obesity. J Clin Densitom. 2016;19:528–9.

    Article  Google Scholar 

  37. Romagnoli E, Lubrano C, Carnevale V, Costantini D, Nieddu L, Morano S, et al. Assessment of trabecular bone score (TBS) in overweight/obese men: effect of metabolic and anthropometric factors. Endocrine. 2016;54:342–7.

    Article  CAS  PubMed  Google Scholar 

  38. Kusuman K, Wiryadana KA, Made I, Setiawan B, Djie S, Rante T. Body mass index inversely associated with bone microarchitecture quality: a systematic review and meta-analysis. Indones J Biomed Sci. 2022;16:28–33.

    Article  Google Scholar 

  39. López-Gómez JJ, Pérez Castrillón JL, de Luis Román DA. Impact of obesity on bone metabolism. Endocrinolía y Nutrición. 2016;63:551–9.

    Article  Google Scholar 

  40. Zhu K, Hunter M, James A, Lim EM, Cooke BR, Walsh JP. Discordance between fat mass index and body mass index is associated with reduced bone mineral density in women but not in men: the Busselton Healthy Ageing Study. Osteoporos Int. 2017;28:259–68.

    Article  CAS  PubMed  Google Scholar 

  41. Sukumar D, Schlussel Y, Riedt CS, Gordon C, Stahl T, Shapses SA. Obesity alters cortical and trabecular bone density and geometry in women. Osteoporos Int. 2011;22:635–45.

    Article  CAS  PubMed  Google Scholar 

  42. Nielson CM, Srikanth P, Orwoll ES. Obesity and fracture in men and women: an epidemiologic perspective. J Bone Miner Res. 2012;27:1–10.

    Article  PubMed  Google Scholar 

  43. Piñar-Gutierrez A, García-Fontana C, García-Fontana B, Muñoz-Torres M. Obesity and bone health: a complex relationship. Int J Mol Sci. 2022;23:8303.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Vaara JP, Lainen HK, Niemi J, Ohrankammen O, Kkinen AH, Kocay S, et al. Associations of maximal strength and muscular endurance test scores with cardiorespiratory fitness and body composition. J Strength Cond Res. 2012;26:2078–86.

    Article  PubMed  Google Scholar 

  45. Han H, Chen S, Wang X, Jin J, Li X, Li Z. Association between muscle strength and mass and bone mineral density in the US general population: data from NHANES 1999–2002. J Orthop Surg Res. 2023;18:1–14.

    Article  Google Scholar 

  46. Qin H, Jiao W. Correlation of muscle mass and bone mineral density in the NHANES US general population, 2017-2018. Medicine. 2022;101:E30735.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Torres-Costoso A, López-Muñoz P, Martínez-Vizcaíno V, Álvarez-Bueno C, Cavero-Redondo I. Association between muscular strength and bone health from children to young adults: a systematic review and meta-analysis. Sports Med. 2020;50:1163–90.

    Article  PubMed  Google Scholar 

  48. Arvidsson D, Fridolfsson J, Börjesson M. Measurement of physical activity in clinical practice using accelerometers. J Intern Med. 2019;286:137–53.

    Article  CAS  PubMed  Google Scholar 

  49. Plasqui G, Bonomi AG, Westerterp KR. Daily physical activity assessment with accelerometers: new insights and validation studies. Obes Rev. 2013;14:451–62.

    Article  CAS  PubMed  Google Scholar 

  50. Schacter GI, Leslie WD, Majumdar SR, Morin SN, Lix LM, Hans D. Clinical performance of an updated trabecular bone score (TBS) algorithm in men and women: the Manitoba BMD cohort. Osteoporos Int. 2017;28:3199–203.

    Article  CAS  PubMed  Google Scholar 

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Funding

The study is supported by a grant from the National Institute of Health’s National Heart Lung and Blood Institute: R01HL136769. This work was carried out during a research stay financed by the University of Sevilla.

Author information

Authors and Affiliations

  1. Physical Education and Sports Department, University of Seville, Seville, Spain

    Horacio Sanchez-Trigo & Borja Sañudo

  2. Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, CA, USA

    David Wing, Shadia J. Mansour-Assi, Jeanne F. Nichols, Britta A. Larsen & Job G. Godino

  3. Exercise and Physical Activity Resource Center, University of California, San Diego, CA, USA

    David Wing, Jeanne F. Nichols & Job G. Godino

  4. Laura Rodriguez Research Institute, Family Health Centers of San Diego, San Diego, CA, USA

    Shadia J. Mansour-Assi & Job G. Godino

  5. Exercise Science, Old Dominion University, Norfolk, VA, USA

    Natalie M. Yarish

  6. Biostatistics Research Center, Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, USA

    Sonia Jain

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  1. Horacio Sanchez-Trigo
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Contributions

HST and JGG conceived the study and led the manuscript preparation. DW, SJM-A, and JFN contributed to the study design, coordinated and participated extensively in the experimental phase, and supported data interpretation. BAL and BS assisted with the implementation of the experimental procedures and contributed to drafting the manuscript. NMY and SJ provided statistical expertise and contributed to the analysis and interpretation of the data. All authors reviewed, edited, and approved the final version of the manuscript.

Corresponding author

Correspondence to Horacio Sanchez-Trigo.

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The authors declare no competing interests.

Ethics approval and consent to participate

All methods were performed in accordance with the relevant guidelines and regulations. Ethical approval for the SMART 2.0 study was obtained from the Human Research Protections Program at the University of California, San Diego (UCSD) under protocol #181862. Written informed consent to participate was obtained from all participants prior to enrollment. No identifiable images of participants are included in this publication. Therefore, separate written informed consent for publication of images was not required.

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Sanchez-Trigo, H., Wing, D., Mansour-Assi, S.J. et al. The influence of physical activity intensity on bone mineral density and trabecular bone score in young adults with overweight and obesity. Int J Obes 49, 1840–1846 (2025). https://doi.org/10.1038/s41366-025-01833-2

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