Long‐term fracture prediction by bone mineral assessed at different skeletal sites

wbldb

Melton, III, L. Joseph¹; Atkinson, Elizabeth J.¹; O'Fallon, W. Michael¹; Wahner, Heinz W.²; Riggs, B. Lawrence³

Long‐term fracture prediction by bone mineral assessed at different skeletal sites

J Bone Miner Res. September 1993;8(10):1227-1233

Affiliations

¹Department of Health Sciences Research, Mayo Clinic and Mayo Foundation, Rochester, Minnesota

²Department of Diagnostic Radiology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota

³Division of Endocrinology/Metabolism and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minnesota
Abstract

Bone mineral density (BMD) was measured at the lumbar spine and cervical and intertrochanteric regions of the proximal femur by dual‐photon absorptiometry and bone mineral content was assessed at the distal and midradius by single‐photon absorptiometry in an age‐stratified random sample of 304 Rochester, Minnesota women aged 30–94 years. Over follow‐up extending to 10 years (median 8.3 years), 93 women experienced 163 new fractures. After adjusting for age, these bone mineral measurements predicted the likelihood of any incident fracture due to moderate trauma, with relative hazards varying from 1.4 to 1.6 per SD decrease in baseline bone mineral. A 1 SD decrease in lumbar spine BMD increased the risk of a new vertebral fracture comparably to a 17 year increase in age; a 1 SD decrease in femoral BMD was comparable to a 13–14 year increase in age on the risk of a hip fracture. We conclude that bone mineral measurements made at a variety of skeletal sites can predict the occurrence for at least 8–10 years of moderate trauma fractures of the sort that might be related to osteoporosis.
Links

DOI: 10.1002/jbmr.5650081010

PubMed: 8256660

WoS: A1993LY89000009
History

Received: 1992-10-01

Revised: 1993-03-16

Accepted: 1993-03-20

Cited Works (11)

Year	Entry
1982	Riggs BL, Wahner HW, Seeman E, Offord KP, Dunn WL, Mazess RB, Johnson KA, Melton LJ III. Changes in bone mineral density of the proximal femur and spine with aging: differences between the postmenopausal and senile osteoporosis syndromes. J Clin Invest. October 1982;70(4):716-723.
1991	Seeley DG, Browner WS, Nevitt MC, Genant HK, Scott JC, Cummings SR; Study of Osteoporotic Fractures Research Group. Which fractures are associated with low appendicular bone mass in elderly women? Ann Intern Med. December 1, 1991;115(11):837-842.
1988	Melton LJ III, Kan SH, Wahner HW, Riggs BL. Lifetime fracture risk: an approach to hip fracture risk assessment based on bone mineral density and age. J Clin Epidemiol. 1988;41(10):985-994.
1992	Black DM, Cummings SR, Genant HK, Nevitt MC, Palermo L, Browner W. Axial and appendicular bone density predict fractures in older women. J Bone Miner Res. June 1992;7(6):633-638.
1991	Gärdsell P, Johnell O, Nilsson BE. The predictive value of bone loss for fragility fractures in women: a longitudinal study over 15 years. Calcif Tiss Int. August 1991;49(2):90-94.
1987	Melton LJ III, O'Fallon WM, Riggs BL. Secular trends in the incidence of hip fractures. Calcif Tiss Int. March 1987;41(2):57-64.
1989	Hui SL, Slemenda CW, Johnston CC Jr. Baseline measurement of bone mass predicts fracture in white women. Ann Intern Med. September 1, 1989;111(5):355-361.
1989	Melton LJ III, Kan SH, Frye MA, Wahner HW, O'Fallon WM, Riggs BL. Epidemiology of vertebral fractures in women. Am J Epidemiol. May 1989;129(5):1000-1011.
1990	Ross PD, Davis JW, Vogel JM, Wasnich RD. A critical review of bone mass and the risk of fractures in osteoporosis. Calcif Tiss Int. March 1990;46(3):149-161.
1993	Cummings SR, Black DM, Nevitt MC, Browner W, Cauley J, Ensrud K, Genant HK, Palmero L, Scott J, Vogt TM; Study of Osteoporotic Fractures Research Group. Bone density at various sites for prediction of hip fractures. Lancet. January 9, 1993;341(8837):72-75.
1988	Mazess RB, Barden H, Ettinger M, Schultz E. Bone density of the radius, spine, and proximal femur in osteoporosis. J Bone Miner Res. February 1988;3(1):13-18.

Cited By (42)

Year	Entry
1996	Marshall D, Johnell O, Wedel H. Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ. May 18, 1996;312(7041):1254-1259.
1995	Riggs BL, Melton LJ III. The worldwide problem of osteoporosis: insights afforded by epidemiology. Bone. November 1995;17(5)(suppl 1):S505-S511.
1996	Melton LJ III. Epidemiology of hip fractures: implications of the exponential increase with age. Bone. March 1996;18(3)(suppl 1):S121-S125.
2003	Delmas PD, Genant HK, Crans GG, Stock JL, Wong M, Siris E, Adachi JD. Severity of prevalent vertebral fractures and the risk of subsequent vertebral and nonvertebral fractures: results from the MORE trial. Bone. October 2003;33(4):522-532.
2020	Wu Q, Nasoz F, Jung J, Bhattarai B, Han MV. Machine learning approaches for fracture risk assessment: a comparative analysis of genomic and phenotypic data in 5130 older men. Calcif Tiss Int. October 2020;107(4):353-361.
2011	Cole JH, van der Meulen MCH. Whole bone mechanics and bone quality. Clin Orthop Relat Res. August 2011;469(8):2139-2149.
2000	Lidke RH, Patel D, Muehleman C. Calcaneal bone mineral density and mechanical strength of the metatarsals. J Am Podiatr Med Assoc. October 2000;90(9):435-440.
1997	Feik SA, Thomas CDL, Clement JG. Age‐related changes in cortical porosity of the midshaft of the human femur. J Anat. October 1997;191(3):407-416.
1994	Kanis JA, Melton LJ III, Christiansen C, Johnston CC, Khaltaev N. The diagnosis of osteoporosis. J Bone Miner Res. August 1994;9(8):1137-1141.
1995	Melton JL III. How many women have osteoporosis now? J Bone Miner Res. February 1995;10(2):175-177.
1995	Looker AC, Johnston CC Jr, Wahner HW, Dunn WL, Calvo MS, Harris TB, Heyse SP, Lindsay RL. Prevalence of low femoral bone density in older U.S. women from NHANES III. J Bone Miner Res. May 1995;10(5):796-802.
1996	Garnero P, Sornay‐Rendu E, Chapuy M, Delmas PD. Increased bone turnover in late postmenopausal women is a major determinant of osteoporosis. J Bone Miner Res. 1996;11(3):337-349.
1996	Genant HK, Engelke K, Fuerst T, Glüer C, Grampp S, Harris ST, Jergas M, Lang T, Lu Y, Majumdar S, Mathur A, Takada M. Noninvasive assessment of bone mineral and structure: state of the art. J Bone Miner Res. June 1996;11(6):707-730.
1996	Garnero P, Hausherr E, Chapuy M, Marcelli C, Grandjean H, Muller C, Cormier C, Bréart G, Meunier PJ, Delmas PD. Markers of bone resorption predict hip fracture in elderly women: the EPIDOS prospective study. J Bone Miner Res. October 1996;11(10):1531-1538.
1997	Melton LJ III, Thamer M, Ray NF, Chan JK, Chesnut CH III, Einhorn TA, Johnston CC, Raisz LG, Silverman SL, Siris ES. Fractures attributable to osteoporosis: report from the National Osteoporosis Foundation. J Bone Miner Res. January 1997;12(1):16-23.
1997	Arlot ME, Sornay-Rendu E, Garnero P, Vey-Marty B, Delmas PD. Apparent pre- and postmenopausal bone loss evaluated by DXA at different skeletal sites in women: the OFELY cohort. J Bone Miner Res. April 1997;12(4):683-690.
1997	Looker AC, Orwoll ES, Johnston CC Jr, Lindsay RL, Wahner HW, Dunn WL, Calvo MS, Harris TB, Heyse SP. Prevalence of low femoral bone density in older U.S. adults from NHANES III. J Bone Miner Res. November 1997;12(11):1761-1768.
1998	Cheng XG, Lowet G, Boonen S, Nicholson PHF, Van Der Perre G, Dequeker J. Prediction of vertebral and femoral strength in vitro by bone mineral density measured at different skeletal sites. J Bone Miner Res. September 1998;13(9):1439-1443.
1998	Jiang Y, Zhao J, Augat P, Ouyang X, Lu Y, Majumdar S, Genant HK. Trabecular bone mineral and calculated structure of human bone specimens scanned by peripheral quantitative computed tomography: relation to biomechanical properties. J Bone Miner Res. November 1998;13(11):1783-1790.
2000	Legrand E, Chappard D, Pascaretti C, Duquenne M, Krebs S, Rohmer V, Basle M, Audran M. Trabecular bone microarchitecture, bone mineral density, and vertebral fractures in male osteoporosis. J Bone Miner Res. January 2000;15(1):13-19.
2000	Faulkner KG. Bone matters: are density increases necessary to reduce fracture risk? J Bone Miner Res. February 2000;15(2):183-187.
2000	Hannan MT, Felson DT, Dawson-Hughes B, Tucker KL, Cupples LA, Wilson PWF, Kiel DP. Risk factors for longitudinal bone loss in elderly men and women: The Framingham Osteoporosis Study. J Bone Miner Res. April 2000;15(4):710-720.
2000	McCreadie BR, Goldstein SA. Biomechanics of fracture: is bone mineral density sufficient to assess risk? J Bone Miner Res. December 2000;15(12):2305-2308.
2002	Sarkar S, Mitlak BH, Wong M, Stock JL, Black DM, Harper KD. Relationships between bone mineral density and incident vertebral fracture risk with raloxifene therapy. J Bone Miner Res. January 2002;17(1):1-10.
2003	Paschalis EP, Boskey AL, Kassem M, Eriksen EF. Effect of hormone replacement therapy on bone quality in early postmenopausal women. J Bone Miner Res. June 2003;18(6):955-959.
2003	Stone KL, Seeley DG, Lui L-Y, Cauley JA, Ensrud K, Browner WS, Nevitt MC, Cummings SR; The Study of Osteoporotic Fractures research group. BMD at multiple sites and risk of fracture of multiple types: long-term results from the study of osteoporotic fractures. J Bone Miner Res. November 2003;18(11):1947-1954.
2022	Farzi M, Pozo JM, McCloskey E, Eastell R, Harvey NC, Frangi AF, Wilkinson JM. Quantitating age-related BMD textural variation from DXA region-free-analysis: a study of hip fracture prediction in three cohorts. J Bone Miner Res. September 2022;37(9):1679-1688.
1998	Augat P, Link T, Lang TF, Lin JC, Majumdar S, Genant HK. Anisotropy of the elastic modulus of trabecular bone specimens from different anatomical locations. Med Eng Phys. March 1998;20(2):124-131.
1995	Liberman UA, Weiss SR, Bröll J, Minne HW, Quan H, Bell NH, Rodriguez-Portales J, Downs RW Jr, Dequeker J, Favus M, Seeman E, Recker RR, Capizzi T, Santora AC, Lombardi A, Shah RV, Hirsch LJ, Karpf DB; Group, Alendronate Phase III Osteoporosis Treatment Study. Effect of oral alendronate on bone mineral density and the incidence of fractures in postmenopausal osteoporosis. NEJM. November 30, 1995;333(22):1437-1443.
1997	Dawson-Hughes B, Harris SS, Krall EA, Dallal GE. Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older. NEJM. September 4, 1997;337(10):670-676.
1994	Kanis JA; WHO Study Group. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: synopsis of a WHO report. Osteoporos Int. November 1994;4(6):368-381.
1997	Who are candidates for prevention and treatment for osteoporosis? Osteoporos Int. January 1997;7(1):1-6.
1998	Schott AM, Cormier C, Hans D, Favier F, Hausherr E, Dargent-Molina P, Delmas PD, Ribot C, Sebert JL, Breart G, Meunier PJ; EPIDOS Group. How hip and whole-body bone mineral density predict hip fracture in elderly women: the EPIDOS prospective study. Osteoporos Int. May 1998;8(3):247-254.
2010	Wright NC. The Association Between Rheumatoid Arthritis, Bone Strength, and Body Composition Within the Women's Health Initiative [PhD thesis]. University of Arizona; 2010.
2012	Slyfield CR Jr. The Biomechanics of Bone Turnover [PhD thesis]. Ithaca, NY: Cornell University; January 2012.
1997	Heinonen A. Exercise as an Osteogenic Stimulus [PhD thesis]. University of Jyväskylä; 1997.
1996	Ford CM. Failure of the Human Proximal Femur: Material and Structural Perspectives [PhD thesis]. Cambridge, MA: Massachusetts Institute of Technology; September 1996.
2003	Fox JC. Biomechanics of the Proximal Femur: Role of Bone Distribution and Architecture [PhD thesis]. Berkeley, CA: Berkeley, University of California; 2003.
2010	Magalhaes JKRS. The Role of Rac1 and Rac2 in Determining Bone Quality in Aged and Osteoporotic Female Mouse Models [Master's thesis]. University of Toronto; 2010.
2013	Liu CC. Effects of a New Conjugate Drug in a Rat Model of Postmenopausal Osteoporosis [Master's thesis]. University of Toronto; 2013.
2020	Dwyer MP. The Effect of Loss of Estrogen on Trabecular Bone Score in Women At Increased Risk of Breast Cancer [Master's thesis]. University of Toronto; 2020.
2013	Mostafa AJ. The Effect of Advadvanced Glycation Endproducts (AGES) on Bone Formation [Master's thesis]. San Antionio, TX: University of Texas at San Antonio; August 2013.