Uncovering the Relationship Between Skin Pigmentation and Bone Density

Race as a modifying factor is widely used in clinical research, including when exploring the correlation between skin pigmentation (or tone) and bone mineral density (BMD), each representing a variable affected by vitamin D status. The underlying historical framework of BMD interpretation has been defined by socially constructed race definitions, rather than more objective factors such as genetics and environmental exposures. In this review, we provide evidence to support the importance of moving away from race-based standard definitions and toward more quantitative and empirical measures of skin tone. Current interpretations of BMD in both children and adults are dependent on race, which affects the interpretation of BMD in all individuals including those of mixed race. Vitamin D status is dictated in part by skin tone and can ultimately impact BMD. Therefore, exploring the relationship between skin tone and BMD must be considered in the context of vitamin D status. There are also regional differences in ultraviolet B exposure, influenced by latitude and the trend of migration to more urban areas, that impact melanin production within skin. Finally, genetics must also be considered as it plays a major role in the determination of both skin tone and BMD. In summary, there are multiple factors involved in considering the complex relationship between skin tone and BMD, which underscores the importance of a comprehensive examination of genetic underpinnings as well as environmental factors.