International variation in proximal femur bone mineral density
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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.
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.
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.
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).
International variation in hip BMD does exist, with international and between-centre differences being less evident at the femoral neck.
KeywordsEuropean Geographical variation International comparison NHANES III Proximal femur bone mineral density Reference intervals
- 3.Official Positions and Pediatric Official Positions of the International Society for Clinical Densitometry (2007) http://www.iscd.org/Visitors/positions/OfficialPositionsText.cfm
- 4.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 43:332–339PubMedCrossRefGoogle Scholar
- 5.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 7:175–189PubMedCrossRefGoogle Scholar
- 7.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 40:662–673PubMedCrossRefGoogle Scholar
- 8.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 19:782–793CrossRefGoogle Scholar
- 11.McDowell MA, Fryar CD, Ogden CL (2009) Anthropometric reference data for children and adults: United States 1988–1994. Vital and Health Statistics 11(249):1–68Google Scholar
- 12.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
- 13.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 20:1185–1194PubMedCrossRefGoogle Scholar
- 16.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 12:688–698PubMedCrossRefGoogle Scholar
- 17.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 4:253–263PubMedCrossRefGoogle Scholar