Hip and calcaneal bone loss increase with advancing age: Longitudinal results from the study of osteoporotic fractures

Authors

  • Kristine E. Ensrud MD, MPH,

    Corresponding author
    1. Section of General Internal Medicine, Department of Medicine, VA Medical Center, Minneapolis, Minnesota, U.S.A
    2. Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, U.S.A
    • Women Veteran's Health Center (111-M) VA Medical Center One Veterans Drive Minneapolis, MN 55417 U.S.A
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  • Lisa Palermo,

    1. Department of Epidemiology, Prevention Sciences Group, University of California, San Francisco, U.S.A
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  • Dennis M. Black,

    1. Department of Epidemiology, Prevention Sciences Group, University of California, San Francisco, U.S.A
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  • Jane Cauley,

    1. Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
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  • Michael Jergas,

    1. Department of Radiology, University of California, San Francisco, U.S.A
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  • Eric S. Orwoll,

    1. Department of Medicine, VA Medical Center, Portland, and Department of Medicine, Oregon Health Sciences University, Portland, U.S.A
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  • Michael C. Nevitt,

    1. Department of Epidemiology, Prevention Sciences Group, University of California, San Francisco, U.S.A
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  • Kathleen M. Fox,

    1. Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, U.S.A
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  • Steven R. Cummings

    1. Department of Epidemiology, Prevention Sciences Group, University of California, San Francisco, U.S.A
    2. Division of General Internal Medicine, University of California, San Francisco, U.S.A
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Abstract

It is uncertain whether or how rapidly elderly women continue to lose bone with advancing age. To determine rates of change in bone mass at the hip and at the calcaneus in elderly women and to compare these rates of change among estrogen users and nonusers, we prospectively measured rates of change in bone mineral density (BMD) at the total hip and its four subregions (mean ± SD, 3.55 ± 0.29 years between examinations) and at the calcaneus (mean ± SD, 5.69 ± 0.33 years between examinations) in 5698 community-dwelling white women aged 65 years or older at the baseline examination. The rate of decline in total hip BMD steadily increased from 2.5 mg/cm2/year (95% confidence interval 2.0 to 2.9) in women 67–69 years old to 10.4 mg/cm2/year in those aged 85 or older (95% confidence interval 8.4 to 12.4). The rate of bone loss also increased with aging at all subregions of the hip and at the calcaneus. The average loss of bone from the total hip is sufficient to increase the risk of hip fracture by 21% per 5 years in women aged 80 years or older. Compared with nonusers, current estrogen users had a 33% lower age-adjusted mean rate of loss at the total hip (2.9 vs 4.3 mg/cm2/year, p ≤ 0.0001) and a 35% lower age-adjusted mean rate of loss at the calcaneus (3.9 vs 6.0 mg/cm2/year, p ≤ 0.0001). The rate of bone loss in the hip and calcaneus steadily increases with advancing age in older women. Estrogen therapy may significantly decrease this loss. Efforts to understand and prevent bone loss should include elderly women.

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