Axial and appendicular bone density predict fractures in older women

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  • Dennis M. Black
    Department of Epidemiology and Biostatistics, University of California, San Francisco
  • Steven R. Cummings
    Division of General Internal Medicine, University of California, San Francisco
  • Harry K. Genant
    Department of Radiology, University of California, San Francisco
  • Warren Browner
    Department of Epidemiology and Biostatistics, University of California, San Francisco
  • Michael C. Nevitt
    Department of Epidemiology and Biostatistics, University of California, San Francisco
  • Lisa Palermo
    Department of Epidemiology and Biostatistics, University of California, San Francisco

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Published
1992-06-01
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  • https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model
DOI
  • 10.1002/jbmr.5650070607
Publisher
Oxford University Press (OUP)

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<jats:title>Abstract</jats:title><jats:p>To determine whether measurement of hip and spine bone mass by dual-energy x-ray absorptiometry (DEXA) predicts fractures in women and to compare the predictive value of DEXA with that of single-photon absorptiometry (SPA) of appendicular sites, we prospectively studied 8134 nonblack women age 65 years and older who had both DEXA and SPA measurements of bone mass. A total of 208 nonspine fractures, including 37 wrist fractures, occurred during the follow-up period, which averaged 0.7 years. The risk of fracture was inversely related to bone density at all measurement sites. After adjusting for age, the relative risks per decrease of 1 standard deviation in bone density for the occurrence of any fracture was 1.40 for measurement at the proximal femur (95% confidence interval 1.20–1.63) and 1.35 (1.15–1.58) for measurement at the spine. Results were similar for all regions of the proximal femur as well as SPA measurements at the calcaneus, distal radius, and proximal radius. None of these measurements was a significantly better predictor of fractures than the others. Furthermore, measurement of the distal radius was not a better predictor of wrist fracture (relative risk 1.64: 95% CI 1.13–2.37) than other sites, such as the lumbar spine (RR 1.56; CI 1.07–2.26), the femoral neck (RR 1.65; CI 1.12–2.41), or the calcaneus (RR 1.83; CI 1.26–2.64). We conclude that the inverse relationship between bone mass and risk of fracture in older women is similar for absorptiometric measurements made at the hip, spine, and appendicular sites.</jats:p>

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