Abstract
Summary
We observed higher proximal femur bone mineral density (BMD) in European women compared to average values derived from US Caucasian women in the National Health and Nutrition Examination Survey (NHANES) study. Across European centres, Parisian women had lower proximal femur BMD compared to women from Kiel or Sheffield.
Introduction
Proximal femur BMD of US adults (NHANES III) may not accurately reflect that of European women. We examined the heterogeneity of BMD across European and US Caucasian women and across different European populations.
Methods
Proximal femur BMD was measured in women ages 20–39 years (n = 258) and 55–79 years (n = 1,426) from three European centres. Cross-calibrated BMD for total hip, femoral neck, trochanter and intertrochanter were examined. International variation in BMD was assessed by comparing means and SDs in the European data with those from the US NHANES III study. European populations were stratified into 5-year age bands to establish individual centre reference intervals. Between-centre differences were assessed using ANOVA and post hoc Fisher’s least significant difference tests.
Results
European women had higher BMD than US women: The differences were 7.1% to 14.2% (p < 0.001) and 0% to 3.9% (p < 0.05) in the older and younger women, respectively. Standard deviations for BMD at the different sites were comparable to those for US women. Among older, but not younger European women, proximal femur BMD was significantly lower in French women (Paris) than in women from Germany (Kiel) or the UK (Sheffield) (difference = 5.0% to 9.6%, p < 0.05).
Conclusions
International variation in hip BMD does exist, with international and between-centre differences being less evident at the femoral neck.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Looker AC, Wahner HW, Dunn WL, Calvo MS, Harris TB, Heyse SP, Johnston CC, Lindsay RL (1995) Proximal femur bone mineral levels of US adults. Osteoporos Int 5:389–409
Looker AC, Wahner HW, Dunn WL, Calvo MS, Harris TB, Heyse SP, Johnston CC, Lindsay RL (1998) Updated data on proximal femur bone mineral levels of US adults. Osteoporos Int 8:468–489
Official Positions and Pediatric Official Positions of the International Society for Clinical Densitometry (2007) http://www.iscd.org/Visitors/positions/OfficialPositionsText.cfm
Kaptoge S, da Silva JA, Brixen K, Reid DM, Kroger H, Nielson TL, Anderson M, Hagen C, Lorenc R, Boonen S, de Vernejoul M-C, Stepan JJ, Adams J, Kuafman J-M, Reeve J (2008) Geographical variation in DXA bone mineral density in young European men and women. Results from the Network in Europe on Male Osteoporosis (NEMO) study. Bone 43:332–339
Lunt M, Felsenberg D, Adams J, Benevolenskaya L, Cannata J, Dequeker J, Dodenhof C, Falch JA, Johnell O, Khaw K-T, Masaryk P, Pols H, Poor G, Reid D, Scheidt-Nave C, Weber K, Silman A, Reeve J (1997) Population based geographic variations in DXA bone density in Europe: the EVOS study. Osteoporos Int 7:175–189
Omsland TK, Gjesdal CG, Emaus N, Tell GS, Meyer A (2009) Regional differences in hip bone mineral density levels in Norway: the NOREPOS study. Osteoporos Int 20:631–638
Kaptoge S, Reid DM, Scheidt-Nave C, Poor G, Pols HAP, Khaw K-T, Felsenberg D, Benevolenskaya LI, Naves Diaz M, Stepan JJ, Eastell R, Boonen S, Cannata JB, Glueer CC, Crabtree NJ, Kaufman JM, Reeve J (2007) Geographic and other determinants of BMD change in European men and women at the hip and spine. A population-based study from the Network in Europe for Male Osteoporosis (NEMO). Bone 40:662–673
Glueer CC, Eastell R, Reid DM, Felsenberg D, Roux C, Barkmann R, Timm W, Blenk T, Armbrecht G, Stewart A, Clowes J, Thomasius FE, Kolta S (2004) Association of five quantitative ultrasound devices and bone densitometry with osteoporotic vertebral fractures in a population-based sample: the OPUS study. J Bone Miner Res 19:782–793
Kalender WA, Felsenberg D, Genant HK, Fischer M, Dequeker J, Reeve J (1995) The European Spine Phantom—a tool for standardization and quality control in spinal bone mineral measurements by DXA and QCT. Eur J Radiol 20:83–92
Genant HK, Grampp S, Glueer CC, Faulkner KG, Jergas M, Engelke K, Hagiwara S, van Kuijk C (1994) Universal standardization for dual X-ray absorptiometry: patient and phantom cross-calibration results. J Bone Miner Res 9:1503–1514
McDowell MA, Fryar CD, Ogden CL (2009) Anthropometric reference data for children and adults: United States 1988–1994. Vital and Health Statistics 11(249):1–68
Noon E, Singh S, Cuzick J, Spector TD, Williams FMK, Frost ML, Howell A, Harvie M, Eastell R, Coleman RE, Fogelman I, Blake GM for the IBIS-II Bone Substudy (2010). Significant differences in UK and US female bone density reference ranges. Osteoporos Int. doi:10.1007/s00198-009-1153-1
Johnell O, Kanis JA, Oden A, Johansson H, De Laet C, Delams P, Eismann JA, Fujiwara S, Kroger H, Mellstrom D, Meunier PJ, Melton PJ III, O’Neill T, Pols H, Reeve J, Silman A, Tenenhouse A (2005) Predictive value of BMD for the hip and other fractures. J Bone Miner Res 20:1185–1194
Cauley JA, Fullman RL, Stone KL, Zumda JM, Bauer DC, Barrett-Connor E, Ensrud K, Lau EMC, Orwoll ES, for the Mr. OS Research Group (2005) Factors associated with the lumbar spine and proximal femur bone mineral density in older men. Osteoporos Int 16:1525–1537
Mitchell BD, Kammerer CM, Schneider JL, Perez R, Bauer RL (2003) Genetic and environmental determinants of bone mineral density in Mexican Americans: results from the San Antonio Family Osteoporosis Study. Bone 33:839–846
Lunt M, Masaryk P, Scheidt-Nave C, Nijs J, Poor G, Pols H, Falch JA, Hammermeister G, Reid DM, Benevolenskaya L, Weber K, Cannata J, O’Neill TW, Felsenberg D, Silman AJ, Reeve J (2001) The effects of lifestyle, dietary dairy intake and diabetes on bone density and vertebral deformity prevalence: the EVOS study. Osteoporos Int 12:688–698
Elffors I, Allander E, Kanis JA, Gullberg B, Johnell O, Dequeker J, Dilsen G, Gennari C, Lopes Vaz AA, Lyritis G, Mazzuoli GF, Miravet L, Passeri M, Perez Cano R, Rapado A, Ribot C (1994) The variable incidence of hip fracture in southern Europe: the MEDOS study. Osteoporos Int 4:253–263
Barbier S, Ecochard R, Schott A-M, Colin C, Delmas PD, Jaglal SB, Couris CM (2009) Geographical variation in hip fracture risk for women: strong effects hidden in standardized ratios. Osteoporos Int 20:371–377
Johnell O, Borgstrom F, Jonsson B, Kanis J (2007) Latitude, socioeconomic prosperity, mobile phones and hip fracture risk. Osteoporos Int 18:333–337
Acknowledgements
We would like to thank our sponsors Eli Lilly, Sanofi-Aventis, Procter & Gamble Pharmaceuticals, Hoffman-La Roche, Pfizer, Novartis and the National Institute for Health Research (NIHR). Acknowledgements go to the editorial board of the Bone Biomedical Research Unit, Sheffield NIHR Bone Biomedical Research Unit for their help in preparing this manuscript. We would also like to recognize the contribution made by all the skilled densitometer operators who acquired DXA scans during the OPUS study.
Conflicts of interest
None.
Author information
Authors and Affiliations
Corresponding author
Additional information
The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.
Rights and permissions
About this article
Cite this article
Paggiosi, M.A., Glueer, C.C., Roux, C. et al. International variation in proximal femur bone mineral density. Osteoporos Int 22, 721–729 (2011). https://doi.org/10.1007/s00198-010-1336-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00198-010-1336-9