Prediction of Clinical Non-Spine Fractures in Older Black and White Men and Women With Volumetric BMD of the Spine and Areal BMD of the Hip: The Health, Aging, and Body Composition Study

Authors

  • Dawn C Mackey MSc,

    Corresponding author
    1. San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, California, USA
    • San Francisco Coordinating Center, CA Pacific Medical Center Research Institute, 185 Berry Street, Lobby 4, Suite 5700, San Francisco, CA 94107, USA
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  • Jean Gaare Eby,

    1. Harvard School of Public Health and Channing Laboratory, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts, USA
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  • Fran Harris,

    1. Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
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  • Dennis R Taaffe,

    1. School of Human Movement Studies, Faculty of Health Sciences, University of Queensland, Brisbane, Australia
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  • Jane A Cauley,

    1. Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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    • Dr Cauley receives research support from Merck & Co., Eli Lilly & Co., Pfizer, and Novartis. She also receives honoraria from Merck & Co., Novartis, and Eli Lilly & Co., in addition to serving on the Speaker's Bureau for Merck & Co. All other authors state that they have no conflicts of interest.

  • Frances A Tylavsky,

    1. Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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  • Tamara B Harris,

    1. Laboratory for Epidemiology, Demography and Biometry, National Institute on Aging, Bethesda, Maryland, USA
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  • Thomas F Lang,

    1. Radiology, University of California, San Francisco, San Francisco, California, USA
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  • Steven R Cummings

    1. San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, California, USA
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  • Presented in part at the 24th Annual Meeting of the American Society for Bone and Mineral Research, San Antonio, Texas, September 19–24, 2002.

Abstract

In a prospective study of 1446 black and white adults 70–79 yr of age (average follow-up, 6.4 yr), vertebral TrvBMD from QCT predicted non-spine fracture in black and white women and black men, but it was not a stronger predictor than total hip aBMD from DXA. Hip aBMD predicted non-spine fracture in black men.

Introduction: Areal BMD (aBMD) at multiple skeletal sites predicts clinical non-spine fractures in white and black women and white men. The predictive ability of vertebral trabecular volumetric BMD (TrvBMD) for all types of clinical non-spine fractures has never been tested or compared with hip aBMD. Also, the predictive accuracy of hip aBMD has never been tested prospectively for black men.

Materials and Methods: We measured vertebral TrvBMD with QCT and hip aBMD with DXA in 1446 elderly black and white adults (70–79 yr) in the Health, Aging, and Body Composition Study. One hundred fifty-two clinical non-spine fractures were confirmed during an average of 6.4 yr of >95% complete follow-up. We used Cox proportional hazards regression to determine the hazard ratio (HR) and 95% CIs of non-spine fracture per SD reduction in hip aBMD and vertebral TrvBMD.

Results: Vertebral TrvBMD and hip aBMD were both associated with risk of non-spine fracture in black and white women and black men. The age-adjusted HR of fracture per SD decrease in BMD was highest in black men (hip aBMD: HR = 2.04, 95% CI = 1.03, 4.04; vertebral TrvBMD: HR = 3.00, 95% CI = 1.29, 7.00) and lowest in white men (hip aBMD: HR = 1.23, 95% CI = 0.85, 1.78; vertebral TrvBMD: HR = 1.06, 95% CI = 0.73, 1.54). Adjusted for age, sex, and race, each SD decrease in hip aBMD was associated with a 1.67-fold (95% CI = 1.36, 2.07) greater risk of fracture, and each SD decrease in vertebral TrvBMD was associated with a 1.47-fold (95% CI = 1.18, 1.82) greater risk. Combining measurements of hip aBMD and vertebral TrvBMD did not improve fracture prediction.

Conclusions: Low BMD measured by either spine QCT or hip DXA predicts non-spine fracture in older black and white women and black men. Vertebral TrvBMD is not a stronger predictor than hip aBMD of non-spine fracture.

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