Predictive value of BMD for hip and other fractures.
Artikel i vetenskaplig tidskrift, 2005

The relationship between BMD and fracture risk was estimated in a meta-analysis of data from 12 cohort studies of approximately 39,000 men and women. Low hip BMD was an important predictor of fracture risk. The prediction of hip fracture with hip BMD also depended on age and z score. INTRODUCTION: The aim of this study was to quantify the relationship between BMD and fracture risk and examine the effect of age, sex, time since measurement, and initial BMD value. MATERIALS AND METHODS: We studied 9891 men and 29,082 women from 12 cohorts comprising EVOS/EPOS, EPIDOS, OFELY, CaMos, Rochester, Sheffield, Rotterdam, Kuopio, DOES, Hiroshima, and 2 cohorts from Gothenburg. Cohorts were followed for up to 16.3 years and a total of 168,366 person-years. The effect of BMD on fracture risk was examined using a Poisson model in each cohort and each sex separately. Results of the different studies were then merged using weighted coefficients. RESULTS: BMD measurement at the femoral neck with DXA was a strong predictor of hip fractures both in men and women with a similar predictive ability. At the age of 65 years, risk ratio increased by 2.94 (95% CI = 2.02-4.27) in men and by 2.88 (95% CI = 2.31-3.59) in women for each SD decrease in BMD. However, the effect was dependent on age, with a significantly higher gradient of risk at age 50 years than at age 80 years. Although the gradient of hip fracture risk decreased with age, the absolute risk still rose markedly with age. For any fracture and for any osteoporotic fracture, the gradient of risk was lower than for hip fractures. At the age of 65 years, the risk of osteoporotic fractures increased in men by 1.41 per SD decrease in BMD (95% CI = 1.33-1.51) and in women by 1.38 per SD (95% CI = 1.28-1.48). In contrast with hip fracture risk, the gradient of risk increased with age. For the prediction of any osteoporotic fracture (and any fracture), there was a higher gradient of risk the lower the BMD. At a z score of -4 SD, the risk gradient was 2.10 per SD (95% CI = 1.63-2.71) and at a z score of -1 SD, the risk was 1.73 per SD (95% CI = 1.59-1.89) in men and women combined. A similar but less pronounced and nonsignificant effect was observed for hip fractures. Data for ultrasound and peripheral measurements were available from three cohorts. The predictive ability of these devices was somewhat less than that of DXA measurements at the femoral neck by age, sex, and BMD value. CONCLUSIONS: We conclude that BMD is a risk factor for fracture of substantial importance and is similar in both sexes. Its validation on an international basis permits its use in case finding strategies. Its use should, however, take account of the variations in predictive value with age and BMD.

ultrasonography

Risk Factors

Adult

Cohort Studies

Risk Assessment

Absorptiometry

Aged

Photon

Bone Density

Aged

Male

ultrasonography

Female

radiography

Hip Fractures

Middle Aged

Hip

complications

Age Factors

Prognosis

epidemiology

80 and over

Osteoporosis

Sex Factors

Humans

Författare

Olof Johnell

John A Kanis

Anders Odén

Chalmers, Matematiska vetenskaper, matematisk statistik

Göteborgs universitet

Helena Johansson

Göteborgs universitet

Chris De Laet

Pierre Delmas

John A Eisman

Seiko Fujiwara

Heikki Kroger

Dan Mellström

Göteborgs universitet

Pierre J Meunier

L Joseph Melton

Terry O'Neill

Huibert Pols

Jonathan Reeve

Alan Silman

Alan Tenenhouse

Journal of Bone and Mineral Research

0884-0431 (ISSN)

Vol. 20 1185-94

Ämneskategorier

Endokrinologi och diabetes

Fysiologi

DOI

10.1359/JBMR.050304

PubMed

15940371