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Bone mineral content and areal density, but not bone area, predict an incident fracture risk: a comparative study in a UK prospective cohort

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Abstract

Summary

We studied a prospective UK cohort of women aged 20 to 80 years, assessed by dual-energy X-ray absorptiometry (DXA) at baseline. Bone mineral content (BMC) and areal bone mineral density (aBMD), but not bone area (BA), at femoral neck, lumbar spine and the whole body sites were similarly predictive of incident fractures.

Background

Low aBMD, measured by DXA, is a well-established risk factor for future fracture, but little is known about the performance characteristics of other DXA measures such as BA and BMC in fracture prediction. We therefore investigated the predictive value of BA, BMC and aBMD for incident fracture in a prospective cohort of UK women.

Methods

In this study, 674 women aged 20–80 years, recruited from four GP practices in Southampton, underwent DXA assessment (proximal femur, lumbar spine, total body) between 1991 and 1993. All women were contacted in 1998–1999 with a validated postal questionnaire to collect information on incident fractures and potential confounding factors including medication use. Four hundred forty-three women responded, and all fractures were confirmed by the assessment of images and radiology reports by a research nurse. Cox proportional hazard models were used to explore the risk of incident fracture, and the results are expressed as hazard ratio (HR) per 1 SD decrease in the predictor and 95% CI. Associations were adjusted for age, BMI, alcohol consumption, smoking, HRT, medications and history of fracture.

Results

Fifty-five women (12%) reported a fracture. In fully adjusted models, femoral neck BMC and aBMD were similarly predictive of incident fracture. Femoral neck BMC: HR/SD = 1.64 (95%CI: 1.19, 2.26; p = 0.002); femoral neck aBMD: HR/SD = 1.76 (95%CI: 1.19, 2.60; p = 0.005). In contrast, femoral neck BA was not associated with incident fracture, HR/SD = 1.15 (95%CI: 0.88, 1.50; p = 0.32). Similar results were found with bone indices at the lumbar spine and the whole body.

Conclusions

In conclusion, BMC and aBMD appear to predict incident fracture with similar HR/SD, even after adjustment for body size. In contrast, BA only weakly predicted the future fracture. These findings support the use of DXA aBMD in fracture risk assessment, but also suggest that factors which specifically influence BMC will have a relevance to the risk of the incident fracture.

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References

  1. World Health Organisation (1994) Assessment of fracture risk and its application to screening for postmenopausal osteoporosis (1994). WHO, Geneva

    Google Scholar 

  2. Marshall D, Johnell O, Wedel H (1996) Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ 312(7041):1254–1259

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Cummings SR, Marcus R, Palermo L, Ensrud KE, Genant HK (1994) Does estimating volumetric bone density of the femoral neck improve the prediction of hip fracture? A prospective study. Study of Osteoporotic Fractures Research group. J Bone Miner Res JID - 8610640 9(9):1429–1432

    Article  CAS  Google Scholar 

  4. Dual Energy X Ray absorptiometry for bone mineral density and body composition assessment (2010) Trans: agency IAE. International Atomic Energy Agency, Vienna

    Google Scholar 

  5. Kanis JA, Adachi JD, Cooper C, Clark P, Cummings SR, Diaz-Curiel M, Harvey N, Hiligsmann M, Papaioannou A, Pierroz DD, Silverman SL, Szulc P (2013) Standardising the descriptive epidemiology of osteoporosis: recommendations from the Epidemiology and Quality of Life Working Group of IOF. Osteoporos Int 24(11):2763–2764. doi:10.1007/s00198-013-2413-7

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Kanis JA, McCloskey E, Branco J, Brandi ML, Dennison E, Devogelaer JP, Ferrari S, Kaufman JM, Papapoulos S, Reginster JY, Rizzoli R (2014) Goal-directed treatment of osteoporosis in Europe. Osteoporos Int 25(11):2533–2543. doi:10.1007/s00198-014-2787-1

    Article  CAS  PubMed  Google Scholar 

  7. Kanis JA, Rizzoli R, Cooper C, Reginster JY (2014) Challenges for the development of bone-forming agents in Europe. Calcif Tissue Int 94(5):469–473. doi:10.1007/s00223-014-9844-9

    Article  CAS  PubMed  Google Scholar 

  8. Kanis JA, McCloskey EV, Johansson H, Cooper C, Rizzoli R, Reginster JY (2013) European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int 24(1):23–57. doi:10.1007/s00198-012-2074-y

    Article  CAS  PubMed  Google Scholar 

  9. Baird J, Kurshid MA, Kim M, Harvey N, Dennison E, Cooper C (2011) Does birthweight predict bone mass in adulthood? A systematic review and meta-analysis. Osteoporos Int 22(5):1323–1334. doi:10.1007/s00198-010-1344-9

    Article  CAS  PubMed  Google Scholar 

  10. Harvey N, Dennison E, Cooper C (2014) Osteoporosis: a lifecourse approach. J Bone Miner Res 29(9):1917–1925. doi:10.1002/jbmr.2286

    Article  PubMed  Google Scholar 

  11. Museyko O, Bousson V, Adams J, Laredo JD, Engelke K (2016) QCT of the proximal femur—which parameters should be measured to discriminate hip fracture? Osteoporos Int 27(3):1137–1147. doi:10.1007/s00198-015-3324-6

    Article  CAS  PubMed  Google Scholar 

  12. Sheu Y, Zmuda JM, Boudreau RM, Petit MA, Ensrud KE, Bauer DC, Gordon CL, Orwoll ES, Cauley JA (2011) Bone strength measured by peripheral quantitative computed tomography and the risk of nonvertebral fractures: the osteoporotic fractures in men (MrOS) study. J Bone Miner Res 26(1):63–71. doi:10.1002/jbmr.172

    Article  PubMed  Google Scholar 

  13. Seeman E (2008) Structural basis of growth-related gain and age-related loss of bone strength. Rheumatology (Oxford) 47(Suppl 4):iv2–iv8. doi:10.1093/rheumatology/ken177

    Google Scholar 

  14. Kanis JA (2007) Assessment of osteoporosis at the primary health care level. WHO scientific group technical report. World Health Organization, Geneva

    Google Scholar 

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Acknowledgements

We thank Mrs. G Strange and Mrs. R Fifield for helping in preparing the manuscript. EMC and NCH are joint first authors. This work was supported by the grants from the Medical Research Council, British Heart Foundation, Arthritis Research UK, National Osteoporosis Society, International Osteoporosis Foundation, National Institute for Health Research (NIHR) Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, and NIHR Musculoskeletal Biomedical Research Unit, University of Oxford. The work leading to these results was supported by the European Union’s Seventh Framework Programme (FP7/2007-2013), projects Early Nutrition and ODIN under grant agreements numbers 289346 and 613977.

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Authors and Affiliations

  1. MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK

    E. M. Curtis, N. C. Harvey, S. D’Angelo, C. S. Cooper, K. A. Ward & C. Cooper

  2. NIHR Southampton Nutrition Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK

    N. C. Harvey & C. Cooper

  3. MRC Human Nutrition Research, Cambridge, UK

    K. A. Ward

  4. Osteoporosis Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK

    P. Taylor & G. Pearson

  5. NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK

    C. Cooper

Authors
  1. E. M. Curtis
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  2. N. C. Harvey
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  3. S. D’Angelo
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  4. C. S. Cooper
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  5. K. A. Ward
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  6. P. Taylor
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  7. G. Pearson
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  8. C. Cooper
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Correspondence to C. Cooper.

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Additional information

E. M. Curtis and N. C. Harvey are joint first author.

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Curtis, E.M., Harvey, N.C., D’Angelo, S. et al. Bone mineral content and areal density, but not bone area, predict an incident fracture risk: a comparative study in a UK prospective cohort. Arch Osteoporos 11, 39 (2016). https://doi.org/10.1007/s11657-016-0293-0

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  • DOI: https://doi.org/10.1007/s11657-016-0293-0

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