SINGAPORE - One in four healthy-weight Chinese women in Singapore who are in their 20s and 30s has low muscle mass combined with high body fat, and weaker bones, according to a local study.
This puts them at an elevated risk of developing not just musculoskeletal disorders like sarcopenia and osteoporosis, but also metabolic diseases such as diabetes.
These are risks that standard body-mass index (BMI) measurements cannot pick up.
The findings are notable, given that Singapore has one of the highest prevalence of osteoporotic hip fractures in the world, the study's authors said.
Osteoporosis is a disease that weakens bones, making them fragile and more likely to break. It typically develops over years and is often diagnosed when a fall or sudden impact causes a bone to break.
Apart from hip fractures, other common injuries in people with osteoporosis are broken wrists and spinal bones.
The prevalence of hip fractures is higher among women than men. They lose bone earlier and at a faster rate. Bone loss accelerates over time after different stages of a woman's life, such as pregnancy, breastfeeding and menopause, the authors added.
The research is part of the Singapore Preconception Study of Long-Term Maternal and Child Outcomes.
Published in April 2025 in
JBMR Plus
, a journal by the American Society for Bone and Mineral Research, the study was led by researchers from the A*Star Institute for Human Development and Potential.
Two of the researchers - lead author Mya Thway Tint and senior author Johan Eriksson - discussed the study findings and what women can do about the hidden risks in a
Sept 3 Health Check podcast
episode.
Here are excerpts from the interview:
Asians are recognised to have lower bone mineral density and a higher risk of metabolic diseases at a similar BMI, compared with Western populations, said Dr Tint.
They can have a high body fat content but this is not apparent from their BMI. This is the unique "thin outside-fat inside" phenotype.
Body composition directly measures lean mass and fat mass, while BMI uses height and weight to estimate body fat and cannot distinguish between fat and muscle.
When you have a very high body fat content, some of the fat will end up in the muscles, which will affect muscle quality and strength, said Dr Tint. But this will not be picked up in a BMI reading.
Professor Eriksson said the findings show that BMI alone cannot pick up chronic disease risk among Asian women, and there is a need for healthcare approaches to consider body composition beyond simple weight measurements.
Body composition screening using methods like the Dexa (dual x-ray absorptiometry) scan, bioelectrical impedance analysis or even simple handgrip strength tests can help identify at-risk individuals who are currently being overlooked, the researchers said.
They might give you a proxy. If they give you a hint that you might be at risk, then you should get a more precise measurement, said Prof Eriksson.
The Dexa scan is the gold standard when it comes to measuring body composition but it involves the use of low-dose X-rays.
Ensure adequate dairy consumption and include resistance training in your exercise routine.
Current research on bone health focuses primarily on prevention, diagnosis and treatment of osteoporosis in older age. The study shows that there is a need to think about identifying those at higher risk and starting preventive strategies early, before women get pregnant, particularly as they can pass down their bone density trait to their offspring.