Bone density and fracture risk in men

wbldb

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

Bone density and fracture risk in men

J Bone Miner Res. December 1998;13(12):1915-1923

©1998 American Society for Bone and Mineral Research

Affiliations

¹Department of Health Sciences Research, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, U.S.A.

²Department of Diagnostic Radiology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, U.S.A.

³Division of Endocrinology, Metabolism, Nutrition and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, U.S.A.
Abstract

We evaluated different definitions of osteoporosis in a population‐based sample of 348 men (age 22–90 years) compared with 351 women (age 21–93 years). Thirty‐six men (10%) and 46 women (13%) had a history of osteoporotic fracture (hip, spine, or distal forearm due to moderate trauma at ≥ age 35). In logistic regression analysis, osteoporotic fracture risk was associated with bone mineral density (BMD) at all sites (neck, trochanter, total hip, lumbar spine, and total wrist) in both genders (p < 0.001) except spinal BMD in men. After adjusting for age, total hip BMD was the strongest predictor of fracture risk in women (odds ratio [OR] per 1 SD decline, 2.4; 95% confidence interval [CI], 1.6–3.7), while wrist BMD was best in men (OR, 1.5; 95% CI, 1.1–2.0). Among men but not women, bone mineral apparent density (BMAD) was a better predictor of fracture than BMD (wrist BMAD OR, 1.7; 95% CI, 1.3–2.3). Hip BMD/BMAD decreased linearly from age 20 years onward in both genders, while spinal BMD/BMAD declined after age 40 in women but not in men. In both genders, total wrist BMD/BMAD decreased after age 50. By World Health Organization criteria, the age‐adjusted prevalence of osteoporosis at the hip, spine, or wrist was 35% among women ≥50 years of age. A similar approach (BMD > 2.5 SD below the young male mean) produced an osteoporosis prevalence rate in men ≥50 years of age of 19%. Thus, bone density predicts fracture risk in men as it does in women, and the prevalence of osteoporosis in men, using sex‐specific normal values, is substantial. These observations indicate a need for better prevention and treatment strategies for men.
Links

DOI: 10.1359/jbmr.1998.13.12.1915

PubMed: 9844110

WoS: 000077134300016
History

Received: 1997-12-18

Revised: 1998-07-8

Accepted: 1998-08-5

Online: 1998-12-1

Cited Works (10)

Year	Entry
1997	Ray NF, Chan JK, Thamer M, Melton LJ III. Medical expenditures for the treatment of osteoporotic fractures in the United States in 1995: report from the National Osteoporosis Foundation. J Bone Miner Res. January 1997;12(1):24-35.
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.
1992	Carter DR, Bouxsein ML, Marcus R. New approaches for interpreting projected bone densitometry data. J Bone Miner Res. February 1992;7(2):137-145.
1997	De Laet CEDH, van Hout BA, Burger H, Hofman A, Pols HAP. Bone density and risk of hip fracture in men and women: cross sectional analysis. BMJ. July 26, 1997;315(7102):221-225.
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.
1992	Melton LJ III, Chrischilles EA, Cooper C, Lane AW, Riggs BL. How many women have osteoporosis? J Bone Miner Res. September 1992;7(9):1005-1010.
1993	Nguyen T, Sambrook P, Kelly P, Jones G, Lord S, Freund J, Eisman J. Prediction of osteoporotic fractures by postural instability and bone density. BMJ. October 30, 1993;307(6912):1111-1115.
1988	Melton LJ III, Chao EYS, Lane J. Biomechanical aspects of fractures. In: Riggs BL, Melton LJ III, eds. Osteoporosis: Etiology, Diagnosis, and Management. New York, NY: Raven Press; 1988:111-131.
1992	Cooper C, Atkinson EJ, O'Fallon WM, Melton JL III. Incidence of clinically diagnosed vertebral fractures: a population‐based study in Rochester, Minnesota, 1985‐1989. J Bone Miner Res. February 1992;7(2):221-227.
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.

Cited By (39)

Year	Entry
2004	Kanis J, Johnell O, De Laet C, Johansson H, Oden A, Delmas P, Eisman J, Fujiwara S, Garnero P, Kroger H, McCloskey E, Mellstrom D, Melton L, Pols H, Reeve J, Silman A, Tenenhouse A. A meta-analysis of previous fracture and subsequent fracture risk. Bone. August 2004;35(2):375-382.
2008	Kanis JA, McCloskey EV, Johansson H, Oden A, Melton LJ III, Khaltaev N. A reference standard for the description of osteoporosis. Bone. March 2008;42(3):467-475.
2013	Burket JC, Brooks DJ, MacLeay JM, Baker SP, Boskey AL, van der Meulen MCH. Variations in nanomechanical properties and tissue composition within trabeculae from an ovine model of osteoporosis and treatment. Bone. January 2013;52(1):326-336.
2020	Cataño Jimenez S, Saldarriaga S, Chaput CD, Giambini H. Dual-energy estimates of volumetric bone mineral densities in the lumbar spine using quantitative computed tomography better correlate with fracture properties when compared to single-energy BMD outcomes. Bone. January 2020;130:115100.
2022	Fagundes U, Vancini RL, Seffrin A, de Almeida AA, Nikolaidis PT, Rosemann T, Knechtle B, Andrade MS, de Lira CAB. Adolescent female handball players present greater bone mass content than soccer players: a cross-sectional study. Bone. January 2022;154:116217.
2022	Tebé C, Pallarès N, Reyes C, Carbonell-Abella C, Montero-Corominas D, Martín-Merino E, Nogués X, Diez-Perez A, Prieto-Alhambra D, Martínez-Laguna D. Development and external validation of a 1- and 5-year fracture prediction tool based on electronic medical records data: the EPIC risk algorithm. Bone. September 2022;162:116469.
2002	Brown JP, Josse RG; Scientific Advisory Council of the Osteoporosis Society of Canada. 2002 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada. Can Med Assoc J. November 12, 2002;167(suppl 10):S1-S34.
2000	Manolagas SC. Birth and death of bone cells: basic regulatory mechanisms and implications for the pathogenesis and treatment of osteoporosis. Endocr Rev. April 2000;21(2):115-137.
2017	Humbert L, Martelli Y, Fonollà R, Steghöfer M, Di Gregorio S, Malouf J, Romera J, del Río Barquero LM. 3D-DXA: assessing the femoral shape, the trabecular macrostructure and the cortex in 3D from DXA images. IEEE Trans Med Imaging. January 2017;36(1):27-39.
2023	Massie C, Knapp E, Awad HA, Berger AJ. Detection of osteoporotic-related bone changes and prediction of distal radius strength using Raman spectra from excised human cadaver finger bones. J Biomech. December 2023;161:111852.
2004	Kanis JA, Johansson H, Oden A, Johnell O, de Laet C, Melton LJ III, Tenenhouse A, Reeve J, Silman AJ, Pols HAP, Eisman JA, McCloskey EV, Mellstrom D. A meta-analysis of prior corticosteroid use and fracture risk. J Bone Miner Res. June 2004;19(6):893-899.
2005	Johnell O, Kanis JA, Oden A, Johansson H, De Laet C, Delmas P, Eisman JA, Fujiwara S, Kroger H, Mellstrom D, Meunier PJ, Melton LJ III, O'Neill T, Pols H, Reeve J, Silman A, Tenenhouse A. Predictive value of BMD for hip and other fractures. J Bone Miner Res. July 2005;20(7):1185-1194.
2010	Keaveny TM, Kopperdahl DL, Melton LJ III, Hoffmann PF, Amin S, Riggs BL, Khosla S. Age‐dependence of femoral strength in white women and men. J Bone Miner Res. May 2010;25(5):994-1001.
2020	Jin H, Ma X, Liu Y, Yin X, Zhu J, Wang Z, Fan W, Jin Y, Pu J, Zhao J, Liu M, Liu P. Back pain‐inducing test, a novel and sensitive screening test for painful osteoporotic vertebral fractures: a prospective clinical study. J Bone Miner Res. March 2020;35(3):488-497.
2020	Chermside-Scabbo CJ, Harris TL, Brodt MD, Braenne I, Zhang B, Farber CR, Silva MJ. Old mice have less transcriptional activation but similar periosteal cell proliferation compared to young‐adult mice in response to in vivo mechanical loading. J Bone Miner Res. September 2020;35(9):1751-1764.
2021	Colaianni G, Errede M, Sanesi L, Notarnicola A, Celi M, Zerlotin R, Storlino G, Pignataro P, Oranger A, Pesce V, Tarantino U, Moretti B, Grano M. Irisin correlates positively with BMD in a cohort of older adult patients and downregulates the senescent marker p21 in osteoblasts. J Bone Miner Res. February 2021;36(2):305-314.
2022	Moilanen A, Kopra J, Kröger H, Sund R, Rikkonen T, Sirola J. Characteristics of long-term femoral neck bone loss in postmenopausal women: a 25-year follow-up. J Bone Miner Res. February 2022;37(2):173-178.
2022	Jang M, Kim M, Bae SJ, Lee SH, Koh J-M, Kim N. Opportunistic osteoporosis screening using chest radiographs with deep learning: development and external validation with a cohort dataset. J Bone Miner Res. February 2022;37(2):369-377.
2002	Kanis JA. Diagnosis of osteoporosis and assessment of fracture risk. Lancet. June 1, 2002;359(9321):1929-1936.
2000	Kanis JA, Glüer C-C; Committee of Scientific Advisors, International Osteoporosis Foundation. An update on the diagnosis and assessment of osteoporosis with densitometry. Osteoporos Int. March 2000;11(3):192-202.
2003	McLellan AR, Gallacher SJ, Fraser M, McQuillian C. The fracture liaison service: success of a program for the evaluation and management of patients with osteoporotic fracture. Osteoporos Int. December 2003;14(12):1028-1034.
2005	De Laet C, Kanis JA, Odén A, Johanson H, Johnell O, Delmas P, Eisman JA, Kroger H, Fujiwara S, Garnero P, McCloskey EV, Mellstrom D, Melton LJ III, Meunier PJ, Pols HAP, Reeve J, Silman A, Tenenhouse A. Body mass index as a predictor of fracture risk: a meta-analysis. Osteoporos Int. November 2005;16(11):1330-1338.
2007	Kanis JA, Oden A, Johnell O, Johansson H, De Laet C, Brown J, Burckhardt P, Cooper C, Christiansen C, Cummings S, Eisman JA, Fujiwara S, Glüer C, Goltzman D, Hans D, Krieg M-A, La Croix A, McCloskey E, Mellstrom D, Melton LJ, Pols H, Reeve J, Sanders K, Schott A-M, Silman A, Torgerson D, van Staa T, Watts NB, Yoshimura N. The use of clinical risk factors enhances the performance of BMD in the prediction of hip and osteoporotic fractures in men and women. Osteoporos Int. August 2007;18(8):1033-1046.
2020	Peng K, Yao P, Yang L, Kartsonaki C, Bennett D, Tian M, Guo Y, Bian Z, Chen Y, Chen Z, Woodward M, Ivers R, Clarke R. Parenthood and risk of hip fracture: a 10-year follow-up prospective study of middle-aged women and men in China. Osteoporos Int. April 2020;31(4):783-791.
2020	Aboudiab M, Grados F, Batteux B, Henry-Desailly I, Fardellone P, Goëb V. Vertebral fracture assessment (VFA) in patients over 50 years of age with a non-severe peripheral fracture. Osteoporos Int. August 2020;31(8):1477-1486.
2013	Burket JC. Alterations in Tissue Composition and Nanomechanical Properties With Ageing, Osteoporosis, and Treatment [PhD thesis]. Ithaca, NY: Cornell University; January 2013.
2011	Lambers FM. Functional Bone Imaging in an in Vivo Mouse Model of Bone Adaptation, Aging and Disease [PhD thesis]. Swiss Federal Institute of Technology Zürich; 2011.
2014	Ferro Pereira A. Cortical Bone Adaptation: A Finite-Element Study of the Mouse Tibia [PhD thesis]. Imperial College London; January 2014.
2021	Scott MC. Exercise and Bone: Older Adults, Type II Diabetes, and Ketogenic Diets [PhD thesis]. Louisiana State University; May 2021.
2013	Antolić A. Mitochondrial Contributions to Bone Health, an Investigation Using Two Different Animal Models of Mitochondrial Capacity [PhD thesis]. Hamilton, ON: McMaster University; September 2013.
2015	Ireland AD. Bone Mechanoadaptation and the Influence of Muscular Action on Bone Across the Lifespan [PhD thesis]. Manchester Metropolitan University; 2015.
2020	Doolittle ML. Dissecting the Genetic Influences on Osteoporosis Reveals Zbtb40* as a Novel Regulator of Osteoblast Function* [PhD thesis]. University of Rochester; 2020.
2008	Mulvihill BMC. Computational Investigation Into the Mechanoregulation of Osteoporosis [PhD thesis]. Trinity College Dublin; December 2008.
2020	Stipsitz M. Development of a Nonlinear Micro Finite Element Framework for Image-Based Simulations in Bone Biomechanics [PhD thesis]. Vienna University of Technology; 2020.
2014	Nour MA. Impact of Growth Hormone on Adult Bone Quality in Turner Syndrome: A High Resolution Peripheral Quantitative Computed Tomography Study [Master's thesis]. Calgary, AB: University of Calgary; January 2014.
2020	Michalski AS. A Quantitative Computed Tomography Approach Towards Opportunistic Osteoporosis Screening [PhD thesis]. Calgary, AB: University of Calgary; March 2020.
2018	Zhang L. Effects of Osteoblast-Specific Gα_S Overexpression on Skeletal Development and Response to Catabolic and Anabolic Stimuli Using a Transgenic Mouse Model [PhD thesis]. University of Toronto; 2018.
2021	McLaughlin EC. Cause or Consequence? The Interrelationship Between Physical Activity and Fractures [Master's thesis]. University of Waterloo; 2021.
2016	Johnson MG. Endothelin-Converting Enzyme-1 Dependent Endothelin 1 Signaling in Osteogenesis [PhD thesis]. University of Wisconsin – Madison; 2016.