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Observational Study
. 2025 Mar 7;20(1):37.
doi: 10.1007/s11657-025-01520-9.

An update in bone mineral density status in Spain: the OsteoSER study

Carmen Gómez-Vaquero  1 , Marta Domínguez-Álvaro  2 , Daniel Seoane-Mato  2 , Pilar Peris Bernal  3 , Santos Castañeda  4 , Eduardo Kanterewicz Binstock  5 , Ramón Mazzucchelli Esteban  6 , Luis Arboleya Rodríguez  7 , Miguel Bernard  8 , Antonio Álvarez-Cienfuegos  9 , Blanca Correa  10 , Luis María Jiménez Liñán  11 , Carmen Mateo Pascual  12 , Ma Mercedes Molina Del Rio  13 , Mercedes Retamal Ortiz  14 , Aida Fátima López Laguna  15 , Ruth Molera Valero  16 , Sara Alvar Pariente  17 , Antonio Pascual-Vergara  18 , Adolfo Arias Senso  19 , Nuria Pérez Gutiérrez  20 , Soledad García Frías  21 , David Bouza Alvárez  22 , Susana Sostrés  23 , Daniel Suárez Hernandez  24 , Ana Zamora Casal  25 , Cristina García Ramírez  26 , Enrique González-Dávila  27 ; OsteoSER Project Collaborative Group
Collaborators, Affiliations
Observational Study

An update in bone mineral density status in Spain: the OsteoSER study

Carmen Gómez-Vaquero et al. Arch Osteoporos. .

Abstract

Bone mineral density (BMD) reference data for the Spanish population come from the Multicenter Research Project on Osteoporosis (MRPO) in 1989. The OsteoSER study updated Spanish BMD reference data, showing similarities with MRPO and NHANES III. Peak bone mass occurred at 20-39 years, positively associated with physical activity and negatively with smoking. Osteopenia affected 54.4%, and osteoporosis 10.7% of adults ≥ 50 years, with higher prevalence in women and increasing with age.

Purpose: This study aimed to estimate the distribution of BMD in lumbar spine, femoral neck, and total hip in the Spanish population aged ≥ 20 years and compare it with MRPO and NHANES III data.

Methods: A multicenter cross-sectional observational study was conducted in a White Spanish population aged 20-80 years across 12 urban and rural municipalities. Participants were selected by primary care physicians based on inclusion criteria (stratified by sex, age, and BMI) and exclusion criteria (artifacts in BMD imaging in participants of all ages and conditions affecting bone density in younger participants). A vehicle with a Hologic® Horizon W densitometer traveled to each municipality.

Results: A total of 1522 participants underwent densitometry (51.8% men). Peak bone mass is reached at ages 20-39 years in both sexes at all sites. BMD was positively associated with height, BMI, and physical activity and negatively with smoking (p < 0.05). The distribution of BMD by age and sex was comparable to MRPO and NHANES III. We found that 54.4% of postmenopausal women and men ≥ 50 years had osteopenia, while osteoporosis was observed in 10.7%, with higher prevalence in women (18.6% vs. 2.6%) and increasing with age. Using MRPO criteria, osteoporosis prevalence rose to 14.8%.

Conclusion: The BMD of the OsteoSER study population is similar to that of MRPO and NHANES III. Physical activity positively influences peak bone mass, while smoking has detrimental effects.

Keywords: Bone mineral density; DXA; Osteopenia; Osteoporosis; Peak bone mass; Reference curve.

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Conflict of interest statement

Declarations. Ethics approval: The study was approved by the Research Ethics Committee of Hospital Universitari de Bellvitge (Catalonia, Spain, ref. PR193/20) and performed according to the tenets of the Declaration of Helsinki, current data protection legislation, and Good Clinical Practice. Conflict of interest: Carmen Gomez Vaquero has received funding for travel to and attendance at teaching activities from Asacpharma, Eli Lilly, Gebro, Gedeon Richter, ltalfármaco, Rubió, Theramex, and UCB Spain; she has also received speaker honoraria from Stada. Pilar Peris has received speaker honoraria from Amgen. Santos Castañeda has received consultant/speaker honoraria from Bristol-Myers Squibb, Eli Lilly, Merck/MSD, Roche, and UCB Spain; he has also received research support from Pfizer and UCB Spain. The following authors declare no conflicts of interest: Marta Domínguez-Álvaro, Daniel Seoane-Mato, Eduardo Kanterewicz Binstock, Ramón Mazzucchelli Esteban, Luis Arboleya Rodríguez, Miguel Bernard, Antonio Álvarez-Cienfuegos, Blanca Correa, Luis María Jiménez Liñán, Carmen Mateo Pascual, Mª Mercedes Molina del Rio, Mercedes Retamal Ortiz, Aida Fátima López Laguna, Ruth Molera Valero, Sara Alvar Pariente, Antonio Pascual, Adolfo Arias Senso, Nuria Pérez Gutiérrez, Soledad García Frías, David Bouza Alvárez, Susana Sostrés, Daniel Suárez Hernandez, Ana Zamora Casal, Cristina García Ramírez, Enrique González-Dávila.

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