Femoral Neck Bone Loss Predicts Fracture Risk Independent of Baseline BMD
Version of Record online: 21 FEB 2005
Copyright © 2005 ASBMR
Journal of Bone and Mineral Research
Volume 20, Issue 7, pages 1195–1201, July 2005
How to Cite
Nguyen, T. V., Center, J. R. and Eisman, J. A. (2005), Femoral Neck Bone Loss Predicts Fracture Risk Independent of Baseline BMD. J Bone Miner Res, 20: 1195–1201. doi: 10.1359/JBMR.050215
- Issue online: 4 DEC 2009
- Version of Record online: 21 FEB 2005
- Manuscript Accepted: 18 FEB 2005
- Manuscript Revised: 14 DEC 2004
- Manuscript Received: 24 JUN 2004
- bone loss;
- population attributable risk
Whereas low BMD is known to be a risk factor for fracture, it is not clear whether loss of BMD is also a risk factor. In elderly women, greater loss of BMD at the femoral neck was associated with increased risk of fracture, independent of baseline BMD and age.
Introduction: Baseline measurement of BMD predicts fracture risk. However, it is not clear whether short-term bone loss is an independent risk factor for fractures. This study was designed to investigate the relationship between changes in BMD and fracture risk in elderly women in the general population.
Materials and Methods: A total of 966 women ≥60 years of age (mean, 70 ± 6.7 [SD] years), who had been followed for an average of 10.7 years, were studied. Atraumatic fracture of the proximal femur (hip), symptomatic vertebral fracture, and other major fractures, excluding pathological fractures or those resulting from severe trauma, were recorded and confirmed by radiographs. Femoral neck and lumbar spine BMD was measured by DXA.
Results: During the follow-up period, 224 had sustained a fracture (including 43 hip, 71 symptomatic vertebrae, 37 proximal humerus, 46 forearm and wrist, and 27 rib and pelvis fractures). The annual rate of change in BMD in fracture women (−2.1 ± 4.2%) was significantly higher than that in nonfracture women (−0.8 ± 2.8%; p = 0.005). In the multivariable Cox's proportional hazards analysis, the following factors were significant predictors of fracture risk: femoral neck bone loss (relative hazard [RH], 1.4; 95% CI, 1.1-1.8 per 5% loss), baseline femoral neck BMD (RH, 2.0; 95% CI, 1.7-2.7 per SD), and advancing age (RH, 1.2; 95% CI, 1.1-1.4). The proportion of fractures attributable to the three factors was 45%. For hip fracture, the attributable risk fraction was ∼90%.
Conclusion: Bone loss at the femoral neck is a predictor of fracture risk in elderly women, independent of baseline BMD and age.