Genetic aspects of osteoporosis

Bone impact after two years of low-dose oral contraceptive use during adolescence

OBJECTIVE

Data regarding the use and effect of hormonal contraceptives on bone mass acquisition during adolescence are contradictory. The present study was designed to evaluate bone metabolism in two groups of healthy adolescents using combined oral contraceptives (COC).

METHODS

A total of 168 adolescents were recruited from 2014 to 2020 in a non-randomized clinical trial and divided into three groups. The COC1 group used 20 μg Ethinylestradiol (EE)/150 μg Desogestrel and the COC2 group used 30 μg EE/3 mg Drospirenone over a period of two years. These groups were compared to a control group of adolescent non-COC users. The adolescents were submitted to bone densitometry by dual-energy X-ray absorptiometry and measurement of bone biomarkers, bone alkaline phosphatase (BAP), and osteocalcin (OC) at baseline and 24 months after inclusion in the study. The three groups studied were compared at the different time points by ANOVA, followed by Bonferroni's multiple comparison test.

RESULTS

Incorporation of bone mass was greater in non-users at all sites analyzed (4.85 g in lumbar Bone mineral content (BMC)) when compared to adolescents of the COC1 and COC2 groups, with a respective increase of 2.15 g and loss of 0.43g in lumbar BMC (P = 0.001). When comparing subtotal BMC, the control increased 100.83 g, COC 1 increased 21.46 g, and COC 2 presented a reduction of 1.47 g (P = 0.005). The values of bone markers after 24 months are similar for BAP, being 30.51 U/L (± 11.6) for the control group, 34.95 U/L (± 10.8) for COC1, and 30.29 U/L for COC 2 (± 11.5) (P = 0.377). However, when we analyzed OC, we observed for control, COC 1, and COC 2 groups, respectively, 13.59 ng/mL (± 7.3), 6.44 ng/mL (± 4.6), and 9.48 ng/mL (± 5.9), with P = 0.003. Despite loss to follow-up occurring in the three groups, there were no significant differences between the variables in adolescents at baseline who remained in the study during the 24-month follow-up and those who were excluded or lost to follow-up.

CONCLUSION

Bone mass acquisition was compromised in healthy adolescents using combined hormonal contraceptives when compared to controls. This negative impact seems to be more pronounced in the group that used contraceptives containing 30 μg EE.

CLINICAL TRIAL REGISTRATION

http://www.ensaiosclinicos.gov.br, RBR-5h9b3c. "Low-dose combined oral contraceptive use is associated with lower bone mass in adolescents".

Common Variants in OPG Confer Risk to Bone Mineral Density Variation and Osteoporosis Fractures

Although many common variants have been identified for bone mineral density (BMD) and osteoporosis fractures, all the identified risk variants could only explain a small portion of heritability of BMD and osteoporosis fractures. OPG belongs to the tumor necrosis factor receptor superfamily, which plays a crucial role in bone remodeling and is thus a promising candidate gene of osteoporosis. Several studies have explored the association of OPG variants with BMD or osteoporosis fractures, however, the results remain inconsistent among different populations. In the study, we first assessed the relationship between OPG variants and BMD or osteoporosis fractures in our sample size (227 subjects with postmenopausal osteoporosis and 189 controls), and then performed a systematic meta-analysis. Among the nine SNPs genotyped, rs6469804 and rs2073618 showed significant associations with both BMD and osteoporotic fractures, while rs3102735 was only associated with BMD in our samples (P < 0.05). For meta-analyses, data for a total of 12 SNPs were pooled (4725 patients and 37804 controls), and five SNPs, including rs6993813, rs6469804, rs3134070, rs2073618 and rs3102734, showed association with osteoporosis fractures (P < 0.05). On light of the above analysis, we believe that OPG is one promising susceptibility gene of BMD or osteoporotic fractures.

Effect of a local, one time, low-dose injection of zoledronic acid on titanium implant osseointegration in ovariectomized rats

INTRODUCTION

Local application of bisphosphonates has been proven to be safer than systemic administration to promote implant fixation. The objective of this study was to introduce such a simple, convenient and efficient method to enhance titanium (Ti) implant osseointegration in ovariectomized (OVX) rats.

MATERIAL AND METHODS

Twenty female Sprague-Dawley rats sequentially underwent bilateral ovariectomy and tibia implantation, and injection of 30 µg/implant zoledronic acid (ZOL) at the site of implantation was performed. At the end of the study, the tibiae, mandibles, femurs and vertebrae were harvested for dual energy X-ray absorptiometry, histology and micro-computed tomography examination.

RESULTS

Ovariectomized rats showed poor bone density, bone mass and trabecular microstructure. OVX + ZOL rats were characterized by significantly improved peri-implant bone area (1.72-fold), bone contact (2.30-fold), bone mineral density (1.57-fold) and bone mineral content (1.67-fold), as well as moderately increased bone volume to total volume ratio (1.34-fold), percentage osteointegration (1.54-fold), connectivity density (1.45-fold), and trabecular number (1.43-fold), but decreased trabecular separation (57.69%) when compared with the control levels (p < 0.05). No histological signs of jaw osteonecrosis were observed in the rats treated with ZOL, and there was no significant difference between the OVX group and OVX + ZOL group in the bone mass of the mandible, femur and 5^th lumbar vertebra (p > 0.05). In addition, the overproduction of osteoporosis-induced advanced glycation end-products (AGEs) was completely prevented by local treatment with 30 µg/implant ZOL.

CONCLUSIONS

A local, one time, low-dose injection of ZOL at the site of implantation is able to promote the osseointegration of Ti implants following postmenopausal osteoporosis, and this action may be partly mediated by inhibition of the osteoporosis-induced AGE overproduction in the bone marrow.

Cannabinoid receptor gene polymorphisms and bone mineral density in Korean postmenopausal women

OBJECTIVE

We investigated the association between single nucleotide polymorphisms in cannabinoid receptor (CNR) genes and bone mineral density (BMD) in Korean postmenopausal women.

METHODS

Seven polymorphisms (rs2023239, rs806379, rs12720071, rs1049353, rs806368, rs2180619, and rs7766029) in the cannabinoid receptor type 1 (CNR1) gene and 16 polymorphisms (rs2501432, rs2502992, rs2501431, rs3003336, rs4649124, rs2502993, rs2229579, rs2229580, rs2229581, rs2229583, rs2229584, rs2229585, rs2229586, rs4237, rs7530595, and rs16828926) in the cannabinoid receptor type 2 (CNR2) gene were analyzed in 405 Korean postmenopausal women. Serum levels of bone turnover markers, osteoprotegerin (OPG), and soluble receptor activator of nuclear factor-κB ligand (sRANKL) were measured, and BMD at the lumbar spine and femoral neck was examined.

RESULTS

The CNR2 rs2501431, rs3003336, rs2229579, and rs4237 polymorphisms in CNR genes were associated with lumbar spine BMD. Women with the AA genotype of rs3003336 and rs4237 polymorphisms had significantly lower lumbar spine BMD compared with women with the non-AA genotype. Lumbar spine BMD in women with the TT genotype of CNR2 rs2501431 and rs2229579 polymorphisms was significantly lower than that in women with the non-TT genotype. Significantly higher odds for osteoporosis of the lumbar spine and/or femoral neck were observed in women with the TT genotype of rs2229579 polymorphisms (odds ratio, 3.43; 95% CI, 1.28-9.19) and with the AA genotype of rs4237 polymorphisms (odds ratio, 1.74; 95% CI, 1.03-2.95) compared with those not carrying the genotypes. The adjusted serum levels of bone turnover markers, OPG, sRANKL, or sRANKL × 1,000-to-OPG ratios were not associated with CNR gene polymorphisms.

CONCLUSIONS

Our results suggest that rs2501431, rs3003336, rs2229579, and rs4237 polymorphisms in CNR genes may be genetic factors affecting BMD in Korean postmenopausal women.

Evaluation of common variants in CNR2 gene for bone mineral density and osteoporosis susceptibility in postmenopausal women of Han Chinese

Postmenopausal osteoporosis is a major health problem with important genetic factors in postmenopausal women. We thoroughly evaluated the relationship of CNR2 polymorphisms with osteoporosis in a cohort of 1032 osteoporosis patients and 2089 healthy controls from Han Chinese postmenopausal women. Statistically significant differences, depending on different genotypes, were presented.

INTRODUCTION

Osteoporosis is a major health problem in postmenopausal women, which is a multifactorial disease in which genetic determinants are modulated by hormonal, environmental, and nutritional factors. An important clinical risk factor in the pathogenesis of osteoporosis is the presence of genetic polymorphism in susceptibility genes. The aim of our study was to investigate whether CNR2 gene, which attributes to osteoporosis susceptibility in some populations, is associated with bone mineral density (BMD) or osteoporosis in Han Chinese postmenopausal women.

METHODS

We examine 39 SNPs covering the region of CNR2 gene in 3121 Han Chinese postmenopausal women, consisting of 1032 osteoporosis patients and 2089 healthy controls, to evaluate the association with BMD and osteoporosis.

RESULTS

We found that rs4237 and rs2501431 were significantly associated with BMD and osteoporosis (corrected p = 0.020085 and 0.017199) in our sample, and the TT genotype of rs2501431 and the AA genotype of rs4237 had lower lumbar spine BMD and femoral neck BMD compared with the other genotypes. Additionally, analyses by haplotypes indicated that two haplotype blocks, containing rs4237 and rs2501431 respectively, in the CNR2 gene significantly associated with BMD and osteoporosis (both global permutation p < 0.001), and a risk haplotype (ATTT) in the block of rs3003336-rs2501431-rs2502992-rs2501432 had almost 4-fold increase in the cases.

CONCLUSIONS

Our results provide further supportive evidence for an important role of CNR2 gene in the etiology of osteoporosis and suggest that it may be a genetic risk factor for BMD and osteoporosis in Han Chinese postmenopausal women.

The influence of vitamin D receptor genetic variants on bone mineral density and osteoporosis in Chinese postmenopausal women

Growing evidence indicates that the vitamin D receptor (VDR) gene is an important candidate gene for influencing the development of osteoporosis. The aim of the study was to evaluate the potential association between genetic variants of VDR gene and bone mineral density (BMD) and osteoporosis in Chinese postmenopausal women. The study included 970 Chinese postmenopausal women at the postmenopausal osteoporosis (482) and healthy controls (488). The BMD of lumbar spine (L_2–4 anterior-posterior view), femoral neck hip, and total hip was evaluated using the Norland XR-46 dual energy X-ray absorptiometry (DEXA). The genotypes of VDR genetic variants were determined by the created restriction site-PCR (CRS-PCR) and confirmed by DNA sequencing methods. Our data indicated that the VDR p.Glicine (Gly)14 alanine (Ala) and p.histidine (His) 305 glutanine (Gln) genetic variants were statistically associated with adjusted femoral neck hip BMD, adjusted lumbar spine BMD, and adjusted total hip BMD (P values < 0.05). Results from this study suggest that the VDR p.Gly14Ala and p.His305Gln genetic variants are significantly associated with BMD decrease in Chinese postmenopausal women and might be used as molecular markers for assessing the risk of BMD and osteoporosis.

Association analysis between g.18873C>T and g.27522G>A genetic polymorphisms of OPG and bone mineral density in Chinese postmenopausal women

Several studies report that the OPG is an important candidate gene in the pathogenesis of osteoporosis. This study aimed to detect the potential association of OPG gene polymorphisms with osteoporosis in postmenopausal women. We recruited 928 subjects containing 463 with primary postmenopausal osteoporosis and 465 healthy volunteers as controls. The BMD of neck hip, lumbar spine (L_2–4), and total hip were assessed by dual-energy X-ray absorptiometry (DEXA). Through the created restriction site-polymerase chain reaction (CRS-PCR), PCR-restriction fragment length polymorphism (PCR-RFLP), and DNA sequencing methods, the g.18873C>T and g.27522G>A have been investigated. As for g.18873C>T, our data indicated that subjects with CC genotype have significantly higher BMD value than those of CT and TT genotypes (all P values < 0.05). As for g.27522G>A, the BMD values of subjects with GG genotype were significantly higher than those of GA and AA genotypes (all P values < 0.05). Our findings suggest that the OPG g.18873C>T and g.27522G>A genetic polymorphisms are associated with the decreased risk for osteoporosis in Chinese postmenopausal women.

Association analyses of FGFR2 gene polymorphisms with femoral neck bone mineral density in Chinese Han population

Femoral neck (FN) bone mineral density (BMD) is the most important risk phenotype for osteoporosis and has been used as a reference standard for describing osteoporosis. Identification of genetic variations associated with FN BMD may provide potential targets for therapeutic studies. Given the important biological role of FGFR2 gene involved in bone, we tested the associations between FGFR2 polymorphisms and FN BMD in 1,300 Chinese Han subjects. Of the 28 total SNPs, 2 SNPs, namely rs11200014 and rs1078806, were significantly associated with FN BMD under dominant model (P = 0.0014 and 0.0012, respectively) after conservative Bonferroni correction. The two SNPs were in complete linkage disequilibrium. In addition, haplotype-based association tests identified two haplotypes significantly associated with FN BMD, including one haplotype in block 4 where the two SNPs located. However, different from previous studies in white older men, we did not detect any significant association in sex-stratified analyses. In summary, our findings suggest that the FGFR2 gene may play an important role in variation in FN BMD in Chinese Han population, independent of gender effects. Further studies performed in multiple and large samples are needed to elucidate the underlying molecular mechanism and pathophysiology of osteoporosis.

Association of calcitonin receptor gene polymorphism with bone mineral density in postmenopausal Chinese women: a meta-analysis

BACKGROUND

The relationship between Calcitonin receptor (CTR) gene polymorphism C1377T and bone mineral density (BMD) in postmenopausal women has been studied to some degree in Western countries, but the reports remain inconclusive and have not been generalized to other populations.

PURPOSE

To evaluate the association of CTR gene polymorphism C1377T with BMD in the Han Chinese population.

METHODS

We searched for all published articles indexed in MEDLINE (1950-2014), EMBASE (1974-2014), China National Knowledge Infrastructure (CNKI, 1994-2014), and the Wanfang Database, using the key words "polymorphism," "CTR," "osteoporosis," and "bone density." The data were extracted independently by two reviewers. The heterogeneity between studies was determined using the Chi-square-based Q test. Potential publication bias was estimated using a funnel plot and Egger's linear regression test. Odds ratios and 95 % confidence intervals (CI) were used to evaluate the results.

RESULTS

Six eligible studies were selected for the meta-analysis. Our analysis suggested that the C1377T polymorphism of the CTR gene was associated with BMD at the lumbar spine (95 % CI -0.57 to -0.05; P = 0.02), but not associated with BMD at the femoral neck (95 % CI -0.27 to 0.24; P = 0.90) in the postmenopausal Han Chinese population.

CONCLUSION

The C1377T polymorphism in the CTR gene is associated with BMD at the lumbar spine in a postmenopausal Han Chinese population and the CTR gene may become a useful genetic marker for predicting the risk of developing osteoporosis in postmenopausal Chinese women.

The relationship between the g.27450A>T genetic variant of OPG gene and osteoporosis in Chinese postmenopausal women

The objective of this study is to evaluate the relationship between the g.27450A>T genetic variant of osteoprotegerin (OPG) gene and osteoporosis in Chinese postmenopausal women. A total of 886 subjects were enrolled in this study. The femoral neck hip, lumbar spine (L2-4), and total hip bone mineral density (BMD) were detected by dual-energy X-ray absorptiometry (DEXA). The genotyping of the g.27450A>T genetic variant of OPG gene was investigated by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and DNA sequencing methods. Significant differences in the femoral neck hip, lumbar spine (L2-4), and total hip BMD among different genotypes were found, and the subjects with AA genotype were significantly higher than those of AT and TT genotypes (P<0.05). The allele-A could be a decreased risk factor for osteoporosis. Results from this study support that the g.27450A>T genetic variant of OPG gene has potential relationship with BMD and osteoporosis in Chinese postmenopausal women.

Polymorphism of SLC25A32, the folate transporter gene, is associated with plasma folate levels and bone fractures in Japanese postmenopausal women

AIM

Elevation of homocysteine is associated with an increased risk for bone fractures. We previously reported that the methylenetetrahydrofolate reductase (MTHFR) gene polymorphism is associated with homocysteine levels and fracture. The association between the fracture and folate levels or their related gene polymorphisms is not completely clear. We speculated that the SLC25A32 gene, the mitochondrial inner membrane folate transporter, also could be implicated in the regulation of folate metabolism and fracture.

METHODS

A total of 851 Japanese postmenopausal women participated in the association study between the single nucleotide polymorphism genotype and plasma homocysteine or folate. We also tested the association between the candidate single nucleotide polymorphism and 663 postmenopausal women.

RESULTS

The AA genotype of rs2241777 single nucleotide polymorphism at the 3'UTR region in the SLC25A32 gene was associated with lower plasma folate concentration compared with the other genotypes in 851 postmenopausal women. A total of 674 postmenopausal ambulatory Japanese women were followed up for 5.5 ± 0.1 years (mean ± SE). The AA genotype groups also showed an apparently higher rate and earlier onset of incident fractures than the other genotypes. A total of 407 participants had >70% young-adult mean bone mineral density at the start of the observation.

CONCLUSIONS

These results show that the SLC25A32 gene polymorphism could be a risk factor for lower folate concentration and future fracture.

The relationship between osteoprotegerin gene polymorphisms and bone mineral density in Chinese postmenopausal women

Previous evidence supports that the osteoprotegerin (OPG) gene is one of the most important candidate genes for influencing the pathogenesis of osteoporosis. The objective of this study was to investigate the relationship between OPG gene polymorphisms and osteoporosis in Chinese postmenopausal women. A total of 764 subjects were included in this study. The bone mineral density (BMD) in the lumbar spine (L2-4), neck hip and total hip was determined by dual-energy X-ray absorptiometry (DEXA). The g.19190C>A and g.25602A>G SNPs were detected by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP), created restriction site PCR (CRS-PCR) and DNA sequencing methods. As for g.19190C>A, our data suggested that the BMD value of lumbar spine (L2-4), neck hip and total hip for subjects with CC genotype was significantly higher than that of CA and AA genotypes (P<0.05). No significant difference was detected between the association of g.25602A>G genotypes with spine BMD and neck hip BMD, while total hip BMD almost reached the significant level (P=0.063). These findings provide more evidence that the SNPs in OPG gene could affect BMD and osteoporosis, and the allele-A of g.19190C>A and allele-G of g.25602A>G genetic variants are associated with increased risk for osteoporosis in Chinese postmenopausal women.

Association between osteoprotegerin genetic variants and bone mineral density in Chinese women

Osteoprotegerin gene (OPG) is one of the most important candidate genes for osteoporosis. The aim of this study was to assess the association between the single nucleotide polymorphisms (SNPs) of OPG gene and bone mineral density (BMD). A total of 706 Chinese postmenopausal women were enrolled in this study. OPG gene variants were genotyped through created restriction site-polymerase chain reaction (CRS-PCR) and verified using DNA sequencing methods. The lumbar spine (L2-4), total hip and femoral neck were evaluated for BMD. Two genetic variants (g.18910G>A and g.27406C>T) were detected in this study. Our data indicated that the significant differences of spine BMD, neck hip BMD and total hip BMD were detected among different g.27406C>T genotype, subjects with the genotype CC were significantly higher than those of genotype CT and TT. However, the g.18910G>A polymorphism was not significantly associated with spine BMD, neck hip BMD and total hip BMD in the studied subjects. Results from this study indicated that OPG gene variants were associated with BMD in Chinese postmenopausal women. These findings will be useful to analyze the role of OPG gene in osteoporosis in the further studies.

Association between osteoprotegerin genetic variants and osteoporosis in Chinese postmenopausal women

The objective of this study was to evaluate the association of single nucleotide polymorphisms (SNPs) of osteoprotegerin gene (OPG) with bone mineral density (BMD) and osteoporosis. A total of 338 Chinese postmenopausal women with primary osteoporosis and 367 healthy controls were enrolled. The lumbar spine (L₂₋₄), total hip and femoral neck hip of BMD were assessed by dual-energy X-ray absorptiometry (DEXA). OPG genetic variants were genotyped through polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP), created restriction site-PCR (CRS-PCR) and DNA sequencing methods. In this study, the g.18861A>G and g.25548C>T SNPs were detected and our data suggested that the significant differences of spine BMD, femoral neck hip BMD and total hip BMD were found among different g.18861A>G genotype, subjects with the AA genotype were significantly higher than those of AG and GG genotypes (p < 0.05). The g.25548C>T variant was not significantly associated with spine BMD, femoral neck hip BMD and total hip BMD (p > 0.05), while almost reached at the significant level in total hip BMD (p = 0.061). These findings suggeste that OPG gene variants are related to BMD and osteoporosis in Chinese postmenopausal women.

Association of MTHFR C667T polymorphism with bone mineral density and fracture risk: an updated meta-analysis

This meta-analysis investigated the association of C677T polymorphism in MTHFR gene with bone mineral density (BMD) and fracture risk. The results suggested that C677T polymorphism was marginally associated with fracture risk. In addition, this polymorphism was modestly associated with BMD of lumbar spine, femoral neck, total hip, and total body, respectively.

INTRODUCTION

The methylenetetrahydrofolate reductase (MTHFR) gene has been implicated in the regulation of BMD and, thus, may serve as a potential risk factor for the development of fracture. However, results have been inconsistent. In this study, a meta-analysis was performed to clarify the association of C677T polymorphism in MTHFR gene with BMD and fracture risk.

METHODS

Published literature from PubMed and EMBASE were searched for eligible publications. Pooled odds ratio (OR) or weighted mean difference (WMD) and 95% confidence interval (CI) were calculated using a fixed- or random-effects model.

RESULTS

Twenty studies (3,525 cases and 17,909 controls) were included in this meta-analysis. The TT genotype of C677T polymorphism was marginally associated with an increased risk of fracture under recessive model (TT vs. TC + CC: OR = 1.23, 95% CI 1.04-1.47). Using this model, similar results were found among East Asians (OR = 1.40, 95% CI 1.07-1.83), female subpopulation (1.27, 95% CI 1.04-1.55), cohort studies (OR = 1.24, 95% CI 1.08-1.44), and subjects younger than aged 60 years (OR = 1.51, 95% CI 1.10-2.07). In addition, under homogeneous co-dominant model, there was a modest association of C677T polymorphism with BMD of lumbar spine (WMD = -0.017 g/cm(2); 95%CI, -0.030-(-0.005) g/cm(2)), femoral neck (WMD = -0.010 g/cm(2); 95% CI -0.017-(-0.003) g/cm(2)), total hip (WMD = -0.013 g/cm(2), 95% CI -0.022-(-0.004) g/cm(2)), and total body (WMD = -0.020 g/cm(2); 95% CI -0.027-(-0.013) g/cm(2)), respectively.

CONCLUSIONS

This meta-analysis suggested that C677T polymorphism was marginally associated with fracture risk. In addition, this polymorphism was modestly associated with BMD of lumbar spine, femoral neck, total hip, and total body, respectively.

Electrospinning collagen and hyaluronic acid nanofiber meshes

Collagen and hyaluronic acid (HA) are main components of the extracellular matrix and have been utilized in electrospinning; a technique that creates nanosized fibers for tissue scaffolds. A collagen/HA polymer solution was electrospun into a scaffold material for osteoporosis patients who have reduced bone strength. To synthesize nanofibers, a high voltage was applied to the polymer solution to draw out nanofibers that were collected on a ground plate as a uniform mesh. The meshes were then crosslinked to render them insoluble and conjugated with gold nanoparticles to promote biocompatibility. Characterization of the mesh was performed using scanning electron microscope, electron dispersive spectroscopy and fourier transform infrared spectroscopy. A WST-1 assay determined the potential biocompatibility. The results show that collagen/HA scaffolds were developed that were insoluble in aqueous solutions and promoted cellular attachment that could be used as a tissue engineered scaffold to promote cell growth.

Association between vitamin D receptor gene polymorphisms and bone mineral density in Chinese women

Vitamin D receptor (VDR) is implicated in the regulation of bone mineral density (BMD). In this study, we performed a meta-analysis to evaluate the association between the VDR BsmI (rs1544410) and ApaI (rs7975232) polymorphisms and BMD in Chinese women. Literature was retrieved from PubMed and other databases. The studies on the association between VDR BsmI and ApaI genotypes and BMD at the lumbar spine, the femoral neck, the trochanter or the Ward's triangle in Han Chinese women were included in this meta-analysis. Pooled BMD differences and 95% confidence intervals (CIs) were calculated using random- or fixed- effects model. Twenty-five eligible studies, which included 4,075 Chinese women, were identified. No significant difference was observed for either genotype when the meta-analysis was limited to premenopausal women. In postmenopausal women, BMD differences were significant for BB vs. Bb [-0.029 (95% CI -0.056, -0.002) g/m(2), P = 0.037] at the femoral neck, AA vs. Aa [-0.029 (95% CI -0.051, -0.006) g/m(2), P = 0.012] at the lumbar spine, and Aa vs. aa [0.022(95% CI 0.011, 0.033) g/m(2), P = 0.000] at the trochanter. These results suggest a modest but statistically significant association between VDR BsmI and ApaI polymorphisms and BMD in Chinese postmenopausal women, with higher BMD in heterozygous subjects. More epidemiological and mechanistic studies are needed to further investigate the role of VDR gene polymorphisms in regulating BMD and osteoporosis in the future.