The long-term predictive value of bone mineral density measurements for fracture risk is independent of the site of measurement and the age at diagnosis: results from the Prospective Epidemiological Risk Factors study

Although the utility of bone mass measurements has been the subjects of extensive investigations, the number of studies comparing the predictive value of bone mass measurement at different skeletal sites in the same cohort with a large number of clinically verified endpoints is limited. Furthermore, scant information is available on how age at the time of diagnosis influence the risk of future fractures posed by low bone mineral density (BMD). We have followed 5,564 Danish postmenopausal women for a mean period of 7.3 years. Bone mineral content (BMC) at the forearm and BMD at the spine and hip were assessed at baseline. Vertebral fractures were assessed on digitalized images of lateral X-rays of the thoracic and lumbar spine, whereas non-vertebral fractures were self-reported. At follow-up, 17.6% of the women revealed an incidental vertebral fracture and 14.2% reported a new non-vertebral fracture. The absolute risk per 1,000 person-years of osteoporotic fracture increased significantly with decreasing bone mass at all three skeletal sites (P<0.001). Osteoporotic BMD (T-score ≤−2.5) had similar predictive values of fractures regardless of the skeletal site of measurement. Furthermore, the absolute risk of osteoporotic fractures increased significantly with increasing age at the same level of bone mass. Interestingly, the relative risk (RR) of vertebral fracture accompanying 1 SD decrease in spine BMD was similar across different age groups: <55 years (RR:2.1, 95% CI 1.3–3.3), 55–64 years (RR:2.3, 95%CI 1.7–3.2), 65–74 years (RR:2.0; 95%CI 1.5–2.6). Furthermore, women with any prior osteoporotic fracture had a 2.4-fold (95% CI 2.01–2.75, P<0.001) increased risk of a new vertebral fracture. Both age and prior fracture are strong predictors of future fractures. The long-term predictive value of bone mass measurement is independent of the site of measurement and the age at diagnosis.

[1]  P. Ross,et al.  A comparison of single and multi-site BMC measurements for assessment of spine fracture probability. , 1989, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[2]  J. Hopper,et al.  Reduced bone mass in daughters of women with osteoporosis. , 1989, The New England journal of medicine.

[3]  C. Slemenda,et al.  Baseline measurement of bone mass predicts fracture in white women. , 1989, Annals of internal medicine.

[4]  Claus Christiansen,et al.  Diagnosis of Osteoporosis , 1992, Southern medical journal.

[5]  S. Cummings,et al.  Bone density at various sites for prediction of hip fractures , 1993, The Lancet.

[6]  S. Lord,et al.  Prediction of osteoporotic fractures by postural instability and bone density. , 1993, BMJ.

[7]  W. O'Fallon,et al.  Long‐term fracture prediction by bone mineral assessed at different skeletal sites , 1993, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[8]  O. Johnell,et al.  Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures , 1996 .

[9]  H. Genant,et al.  Increments in bone mineral density of the lumbar spine and hip and suppression of bone turnover are maintained after discontinuation of alendronate in postmenopausal women. , 1997, The American journal of medicine.

[10]  C. Cooper,et al.  Guidelines for diagnosis and management of osteoporosis. The European Foundation for Osteoporosis and Bone Disease. , 1997, Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA.

[11]  Effects of prolonged bisphosphonate therapy and its discontinuation on bone mineral density in post-menopausal osteoporosis , 1997 .

[12]  C. Cooper,et al.  Epidemiology of fractures and assessment of fracture risk. , 2000, Clinics in laboratory medicine.

[13]  T. Abbott,et al.  Patients with Prior Fractures Have an Increased Risk of Future Fractures: A Summary of the Literature and Statistical Synthesis , 2000, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[14]  O. Johnell,et al.  Ten Year Probabilities of Osteoporotic Fractures According to BMD and Diagnostic Thresholds , 2001, Osteoporosis International.

[15]  T. O’Neill.  The Relationship Between Bone Density and Incident Vertebral Fracture in Men and Women , 2002, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[16]  J. Kanis,et al.  Diagnosis of osteoporosis and assessment of fracture risk , 2002, The Lancet.

[17]  C. Christiansen,et al.  Alendronate has a residual effect on bone mass in postmenopausal Danish women up to 7 years after treatment withdrawal. , 2003, Bone.

[18]  P. Delmas,et al.  Independent predictors of all osteoporosis-related fractures in healthy postmenopausal women: the OFELY study. , 2003, Bone.

[19]  C. Christiansen,et al.  Two to three years of hormone replacement treatment in healthy women have long-term preventive effects on bone mass and osteoporotic fractures: the PERF study. , 2004, Bone.

[20]  A. Hofman,et al.  Fracture incidence and association with bone mineral density in elderly men and women: the Rotterdam Study. , 2004, Bone.

[21]  P. Vestergaard,et al.  Osteoporosis is markedly underdiagnosed: a nationwide study from Denmark , 2005, Osteoporosis International.

[22]  O Johnell,et al.  A meta-analysis of previous fracture and subsequent fracture risk. , 2004, Bone.

[23]  E. Barrett-Connor,et al.  Predictive Value of Low BMD for 1‐Year Fracture Outcomes Is Similar for Postmenopausal Women Ages 50‐64 and 65 and Older: Results From the National Osteoporosis Risk Assessment (NORA) , 2004, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[24]  O. Johnell,et al.  Predicting various fragility fractures in women by forearm bone densitometry: A follow-up study , 1993, Calcified Tissue International.

[25]  J. Compston,et al.  Action Plan for the prevention of osteoporotic fractures in the European Community , 2004, Osteoporosis International.

[26]  C. Cooper,et al.  Guidelines for diagnosis and management of osteoporosis , 2005, Osteoporosis International.

[27]  B. Riis,et al.  Single X-ray absorptiometry: Performance characteristics and comparison with single photon absorptiometry , 2005, Osteoporosis International.