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Urban-Rural Differences in Bone Mineral Density and its Association with Reproductive and Menstrual Factors Among Older Women

Wang J1,2Zhang W1,2Wang X1Li C1,2Li J1,2Zhao Y1,2Chen L1,2Qi X1,2Qiao L1,2Da W1,2Liu L1,2Xu C1,2Zhu S1,2Li Y1,2Zhang H1,2Sha N1,2Wang Q1,2Zhu Y1,2Luo J1,2Cui X1,2Liang Q1,2Lu S1,2Shi Q1,2,3Wang Y4,5,6Shu B7,8.

Calcif Tissue Int. 2020 Mar 16. doi: 10.1007/s00223-020-00681-8. [Epub ahead of print]




This study aimed to compare the bone mineral density (BMD) of older women living in rural and urban areas, and evaluate the potential factors affecting the risk of osteoporosis.


We recruited 574 women aged 65 years or older from rural areas and 496 from urban areas in Shanghai, China. The BMD values of the lumbar vertebrae and total left hip were measured by a dual energy X-ray absorptiometry densitometer. We also recorded information about education level, family income, medications, reproductive and menstrual history, diet, smoking, and alcohol consumption.


Women in urban areas had significantly higher BMD in their lumbar spine, and there was a dramatic increase in the proportion of women with osteoporosis in rural areas. The age at menarche was significantly higher among women living in rural areas, and there were more years from menarche to menopause among urban women. Rural women had significantly higher numbers of both pregnancies and parity, and a significantly lower age at first parity. In multiple linear regression analyses, years from menarche to menopause was independently related to high lumbar spine BMD, while age at menarche and parity was independently related to low lumbar spine BMD.


More older women in rural areas had osteoporosis. Later menarche, less years from menarche to menopause and higher parity might partially contribute to decreased BMD among women in rural areas. More attention should be paid to women in rural areas to prevent bone loss and further bone and health impairment.