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Background  This study aimed to evaluate the association of body composition components and obesity with bone density.    Methods  Prospective study with data on 2968 members of the 1993 Pelotas Birth Cohort from follow-ups at 18 and 22 years of age. Areal bone mineral density (aBMD, g/cm 2 ) was evaluated for whole body, lumbar spine, and femoral neck at 22 years using dual-energy X-ray absorptiometry. Simple and multiple linear regression, stratified by sex, were used to assess the effect of BMI, fat mass (FMI) and lean mass index (LMI), evaluated at 18 and 22 years, and obesity trajectories classified by FMI and categorized as “never”, “only at 18 years”, “only at 22 years” or “always” on aBMD.    Results  Among men, the largest coefficients were observed for BMI, followed by lean mass and fat mass. Compared to fat mass, lean mass presented the largest coefficients for all sites, with the strongest associations observed for the femoral neck (β: 0.035 g/cm 2 ; 95% CI: 0.031; 0.039 for both follow-ups), while the largest effect for FMI was observed for whole-body aBMD at 18 years (β: 0.019 g/cm 2 ; 95% CI: 0.014; 0.024). Among women, the strongest associations were observed for LMI. The largest coefficients for LMI and FMI were observed for femoral neck at age 18, presented β: 0.030 g/cm 2 , 95% CI: 0.026, 0.034 for LMI and β: 0.012 g/cm 2 ; 95% CI: 0.009; 0.015) for FMI. Men who were “always obese” according to FMI had smallest aBMD for spine (β: -0.014; 95%CI: − 0.029; − 0.001). Women who were obese “only at 18 years” had smallest aBMD for the whole-body (β: -0.013; 95%CI: − 0.023; − 0.002), whereas those who were obese “only at 22 years” had larger whole-body and femoral neck aBMD (β: 0.013; 95%CI: 0.009; 0.017 and β: 0.027; 95%CI: 0.016; 0.038, respectively) and those “always obese” for whole-body aBMD (β: 0.005; 95%CI: 0.001; 0.011) compared to the reference category.    Conclusions  The indexes were positively associated with aBMD in this sample. Fat mass had smaller positive influence on these outcomes than lean mass, suggesting the most important body composition component for bone density is the lean mass.

Associations between body mass index, body composition and bone density in young adults: findings from a southern Brazilian cohort