Musculoskeletal and bone health characteristics in young men: A comparison of low and high bone mineral density

doi:10.5312/wjo.v17.i5.116330

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World Journal of Orthopedics

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2218-5836

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Observational Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Orthop. May 18, 2026; 17(5): 116330
Published online May 18, 2026. doi: 10.5312/wjo.v17.i5.116330

Musculoskeletal and bone health characteristics in young men: A comparison of low and high bone mineral density

Yan Feng, Si-Ning Liu, Sheng-Jia Xu, Yu-Zhu Feng, Hong-Peng Yu, Ru-Lin Zheng, Jian-Xi Wei, Qing-Hao Sun, Yong Zhong, Ji-Zheng Ma

Yan Feng, Yu-Zhu Feng, Hong-Peng Yu, Ru-Lin Zheng, Jian-Xi Wei, Qing-Hao Sun, Ji-Zheng Ma, The Research Center of Military Exercise Science, The Army Engineering University of PLA, Nanjing 211101, Jiangsu Province, China

Si-Ning Liu, Department of Exercise and Heath, Nanjing Sport Institute, Nanjing 211101, Jiangsu Province, China

Sheng-Jia Xu, The Second Affiliated of Army Medical University, Army Medical University, Chongqing 400000, China

Yong Zhong, Department of Health Medicine, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing 211101, Jiangsu Province, China

Co-first authors: Yan Feng and Si-Ning Liu.

Co-corresponding authors: Yong Zhong and Ji-Zheng Ma.

Author contributions: Feng Y, Liu SN, Xu SJ, Feng YZ and Yu HP participated in study design, date collection, and writing the manuscript; Zheng RL, Wei JX and Sun QH assisted with data analysis, literature review and editing of the manuscript; Ma JZ and Zhong Y helped examine and correct the manuscript; all authors have read and approved the final manuscript, have played important and indispensable roles in the manuscript preparation as the co-corresponding authors; Feng Y and Liu SN have made crucial and indispensable contributions towards the completion of the project and thus qualified as the co-first authors of the paper.

Supported by Natural Science Foundation of Jiangsu Province, No. BK20211228; the Foundation of Cadre Healthcare Project of Department of Public Health in Jiangsu Province, No. BJ2407; and the Key Project supported by Youth Foundation of the Army Engineering University of PLA, No. KYJXJKQTZQ23002.

Institutional review board statement: Ethical approval for this study was obtained from the Clinical Research Ethics Committee of the General Hospital of Eastern Theater Command, PLA (No. 2024ZDKY-015-01).

Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.

Conflict-of-interest statement: All authors declare that they have no commercial or financial relationships that could be construed as a potential conflict of interest influencing the results or interpretation of this study.

STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.

Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at mjz_mjj @sina.com. Participants gave informed consent for data sharing.

Corresponding author: Ji-Zheng Ma, Full Professor, Postdoc, The Research Center of Military Exercise Science, The Army Engineering University of PLA, No. 60 Shuang Long Jie Road, Nanjing 211101, Jiangsu Province, China. mjz_mjj@sina.com

Received: November 11, 2025
Revised: February 1, 2026
Accepted: March 23, 2026
Published online: May 18, 2026
Processing time: 188 Days and 20.1 Hours

Abstract

BACKGROUND

Bone is a dynamic and metabolically active tissue, and reduced bone mineral density (BMD) is a significant risk factor for osteoporosis.

AIM

To compare differences in body composition, bone health parameters, and muscle strength across major joints between young men with low and high BMD.

METHODS

Twenty young men with a BMD Z score less than -1.6 and an age-matched reference group of twenty individuals with a Z score greater than 0.0 were selected. Body composition and BMD were evaluated via dual-energy X-ray absorptiometry (DXA). Muscle strength in six joints (shoulder, elbow, wrist, hip, knee, and ankle) was measured using a calibrated Biodex System 4 Pro isokinetic dynamometer.

RESULTS

Overall, young men with a high BMD (Z score: 0.73 ± 0.33) demonstrated significantly greater values across most body composition and bone health indices compared to those with a low BMD (Z score: -1.95 ± 0.98). These included regional (upper limb, lower limb, trunk) and whole-body measurements of fat mass (FM), lean mass (LM), fat-free mass, total mass, bone area, bone mineral content, and BMD (all P < 0.05). Conversely, no significant differences were found in whole-body fat percentage or fat area ratio between the groups (all P > 0.05). Similarly, while the high BMD group demonstrated elevated height-adjusted indices for FM, LM, and limb LM (all P < 0.01), their muscle-to-bone and soft tissue-to-bone ratios were significantly reduced (both P < 0.01). Furthermore, while muscle strength across most metrics for the shoulder, hip, and knee joints was significantly greater in the high BMD group (all P < 0.05), young men with high BMD demonstrated a significantly greater agonist-to-antagonist strength ratio specifically at the right knee (P < 0.01), while no such differences were observed at the left knee or any other joints (all P > 0.05).

CONCLUSION

These results suggest that LM and strength are key components of body composition associated with low BMD risk in young men with Z scores less than -1.6.

Keywords: Bone mineral density; Body composition; Muscle strength; Young men; Dual-energy X-ray absorptiometry; Lean mass

Core Tip: Young men exhibiting low bone mineral density (BMD) Z scores (Z < -1.6) are characterized by suboptimal body composition, notably reduced lean mass (LM) and diminished bone health. This physical disadvantage is mirrored by reduced muscle strength in major joints. Consequently, LM and muscular strength emerge as crucial determinants in mitigating low BMD risk during young adulthood, necessitating a holistic approach to bone health that extends beyond mere bone density measurements.