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While greater LM is associated with higher BMD, the association between FM and BMD is less clear. Such relationships warrant further investigation, especially in Asians, who have a higher risk of metabolic diseases and osteoporotic fractures compared to Western populations. This study investigated the associations of LM, FM, and modifiable risk factors with BMD in Asian women aged 18-45\u00a0yr. A total of 191 women from the Singapore Preconception Study of Long-Term Maternal and Child Outcomes (S-PRESTO) cohort study underwent DXA scanning at the first study visit for BMD and body composition measurements. LM, FM, and four body composition phenotypes derived from dichotomizing LM and FM were related to cohort-specific Z-scores of BMD at FN (BMDFN), LS (BMDLS), and whole body (BMDWB). Adjusting for covariates, LM showed positive associations with Z-BMDFN, [\u03b2 (95%CI)], [0.38 (0.22, 0.55)], Z-BMDLS [0.43 (0.25, 0.62)], and Z-BMDWB, [0.63 (0.44, 0.81)]. Fat mass by contrast showed an inverse association only with Z-BMDWB, [\u22120.39 (\u22120.58, \u22120.20)]. Compared to women with healthy body composition (higher LM-lower FM), women with lower LM-higher FM had similar BMI, mean (SD) 20.9 (1.5) kg\/m2 but disproportionately higher percent fat, 38.4 (2.2%), and lower Z-BMDFN [\u22120.58 (\u22120.97, \u22120.18)], Z-BMDLS [\u22120.41 (\u22120.81, 0.00)], and Z-BMDWB [\u22120.66 (\u22121.06, \u22120.25)]. Chinese women had lower BMD than Malay women. Physical activity and education attainment were positively, while the age of menarche was negatively associated with BMD. These findings in young women underscore the importance of early interventions recognizing ethnic differences in BMD to improve lifecourse musculoskeletal health. Most importantly, intervention strategies for Asian women should focus on healthy body composition beyond BMI, with a goal to preserve or increase LM.<\/jats:p>","DOI":"10.1093\/jbmrpl\/ziaf054","type":"journal-article","created":{"date-parts":[[2025,4,9]],"date-time":"2025-04-09T07:13:22Z","timestamp":1744182802000},"source":"Crossref","is-referenced-by-count":1,"title":["Differential contributions of lean and fat mass on bone mineral density in Asian women of reproductive age: the Singapore Preconception Study of Long-Term Maternal and Child Outcomes study"],"prefix":"10.1093","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9548-7186","authenticated-orcid":false,"given":"Mya Thway","family":"Tint","sequence":"first","affiliation":[{"name":"Institute for Human Development and Potential (IHDP), Agency for Science, Technology and Research (A*STAR) , Singapore 117609,","place":["Republic of Singapore"]},{"name":"Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore , Singapore 117597,","place":["Singapore"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Cremaschi","sequence":"additional","affiliation":[{"name":"School of Science and Technology, IE University , 28006 Madrid ,","place":["Spain"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Melvin Khee Shing","family":"Leow","sequence":"additional","affiliation":[{"name":"Institute for Human Development and Potential (IHDP), Agency for Science, Technology and Research (A*STAR) , Singapore 117609,","place":["Republic of Singapore"]},{"name":"Department of Endocrinology, Tan Tock Seng Hospital , Singapore 308433,","place":["Singapore"]},{"name":"Singapore Institute of Food and Biotechnology Innovation, Agency for Science, Technology and Research (A*STAR) , Singapore 138669, Republic of","place":["Singapore"]},{"name":"Metabolic Disorders Research Programme, Lee Kong Chian School of Medicine , Singapore 308232,","place":["Singapore"]},{"name":"Cardiovascular and Metabolic Disorders Program , Duke-NUS Medical School, Singapore 169857,","place":["Singapore"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Natarajan","family":"Padmapriya","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore , Singapore 119228,","place":["Singapore"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Seng Bin","family":"Ang","sequence":"additional","affiliation":[{"name":"Family Medicine Service, KK Women\u2019s and Children\u2019s Hospital , Singapore 229899,","place":["Singapore"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jun Shi","family":"Lai","sequence":"additional","affiliation":[{"name":"Institute for Human Development and Potential (IHDP), Agency for Science, Technology and Research (A*STAR) , Singapore 117609,","place":["Republic of Singapore"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jerry Kok Yen","family":"Chan","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, KK Women\u2019s and Children\u2019s Hospital , Singapore 229899,","place":["Singapore"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan Y","family":"Bernard","sequence":"additional","affiliation":[{"name":"Centre for Research in Epidemiology and StatisticS (CRESS), Universit\u00e9 Paris Cit\u00e9, Universit\u00e9 Paris Centre Nord, Inserm, INRAE, \u00a0 F-75004 Paris ,","place":["France"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter D","family":"Gluckman","sequence":"additional","affiliation":[{"name":"Institute for Human Development and Potential (IHDP), Agency for Science, Technology and Research (A*STAR) , Singapore 117609,","place":["Republic of Singapore"]},{"name":"Centre for Human Evolution, Adaptation and Disease, Liggins Institute, University of Auckland , Auckland 1023,","place":["New Zealand"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yap-Seng","family":"Chong","sequence":"additional","affiliation":[{"name":"Institute for Human Development and Potential (IHDP), Agency for Science, Technology and Research (A*STAR) , Singapore 117609,","place":["Republic of Singapore"]},{"name":"Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore , Singapore 119228,","place":["Singapore"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3025-5269","authenticated-orcid":false,"given":"Keith M","family":"Godfrey","sequence":"additional","affiliation":[{"name":"MRC Lifecourse Epidemiology Centre, University of Southampton , Southampton SO16 6YD ,","place":["United Kingdom"]},{"name":"NIHR Southampton Biomedical Research Centre, University Hospital Southampton, NHS Foundation Trust , Southampton SO16 6YD,","place":["United Kingdom"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1402-7477","authenticated-orcid":false,"given":"Falk","family":"M\u00fcller-Riemenschneider","sequence":"additional","affiliation":[{"name":"Saw Swee Hock School of Public Health, National University of Singapore , Singapore 117549,","place":["Singapore"]},{"name":"Berlin Institute of Health, Charite University Medical Centre , 10117 Berlin ,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cuilin","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore , Singapore 119228,","place":["Singapore"]},{"name":"Global Center for Asian Women\u2019s Health , Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077,","place":["Singapore"]},{"name":"Department of Nutrition, Harvard T. H. Chan School of Public Health , Boston, MA 02115,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8194-2512","authenticated-orcid":false,"given":"Nicholas C","family":"Harvey","sequence":"additional","affiliation":[{"name":"MRC Lifecourse Epidemiology Centre, University of Southampton , Southampton SO16 6YD ,","place":["United Kingdom"]},{"name":"NIHR Southampton Biomedical Research Centre, University Hospital Southampton, NHS Foundation Trust , Southampton SO16 6YD,","place":["United Kingdom"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria","family":"De Iorio","sequence":"additional","affiliation":[{"name":"Institute for Human Development and Potential (IHDP), Agency for Science, Technology and Research (A*STAR) , Singapore 117609,","place":["Republic of Singapore"]},{"name":"Department of Paediatrics, National University of Singapore , Singapore 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