Osteoporosis International

, Volume 23, Issue 4, pp 1351–1360 | Cite as

Lumbar spine bone mineral density in US adults: demographic patterns and relationship with femur neck skeletal status

  • A. C. Looker
  • L. J. MeltonIII
  • L. G. Borrud
  • J. A. Shepherd
Original Article



This analysis examines lumbar spine bone mineral density (BMD) of US adults from NHANES 2005–2008 by age, sex, and race/ethnicity. Prevalence of low spine BMD and agreement between the prevalence of low BMD at the spine and femur neck in older adults are also assessed.


Lumbar spine BMD data from a representative sample of the US population have not been previously available.


We used data from the National Health and Nutrition Examination Survey 2005–2008 to examine demographic patterns in lumbar spine BMD among US adults age ≥20 years and the prevalence of low lumbar spine BMD in adults age ≥50 years. Agreement between the prevalence of low BMD at the femur neck and spine in older adults was also assessed. Dual-energy X-ray absorptiometry was used to measure lumbar spine and femur neck BMD. World Health Organization definitions were used to categorize skeletal status as normal, osteopenia, or osteoporosis.


Compared to non-Hispanic whites, non-Hispanic blacks had higher and Mexican Americans had lower lumbar spine BMD. Lumbar spine BMD declined with age in women, but not in men. Approximately 4.7 million (10%) older US women and 1 million (3%) older men had lumbar spine osteoporosis in 2005–2008. Roughly one third of them differed in skeletal status at the spine and hip but most were normal at one site and osteopenic at the other. Only 3–10%, depending on sex, had osteoporosis at one skeletal site but not at the other skeletal site. Between 76% and 87% with discordant skeletal status had lumbar spine T-scores within 1 unit of the category threshold.


These findings suggest that measuring either the femur neck or the lumbar spine will correctly classify the majority of individuals who present for care as osteoporotic or not.


Cross-sectional age patterns Gender differences Lumbar spine bone mineral density NHANES Osteoporosis Race/ethnic differences 


Conflicts of interest



  1. 1.
    Kanis JA, McCloskey EV, Johansson H, Oden A, Melton LJ, Khaltaev N (2008) A reference standard for the description of osteoporosis. Bone 42:467–475CrossRefPubMedGoogle Scholar
  2. 2.
    National Osteoporosis Foundation (2008) Clinician’s guide to prevention and treatment of osteoporosis. National Osteoporosis Foundation, Washington D. C., pp 1–36Google Scholar
  3. 3.
    Management of osteoporosis in postmenopausal women: 2010 position statement of The North American Menopause Society. Menopause. 2010; 17:25–54Google Scholar
  4. 4.
    Hodgson SF, Watts NB, Bilezikian JP, Clarke BL, Gray TK, Harris DW, Johnston CC Jr, Kleerekoper M, Lindsay R, Luckey MM, McClung MR, Nankin HR, Petak SM, Recker RR (2003) AACE Osteoporosis Task Force. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the prevention and treatment of postmenopausal osteoporosis: 2001 edition, with selected updates for 2003. Endocr Pract 9:544–564PubMedGoogle Scholar
  5. 5.
    Baim S, Binkley N, Bilezikian JP, Kendler DL, Hans DB, Lewiecki EM, Silverman S (2008) Official positions of the International Society for Clinical Densitometry and executive summary of the 2007 ISCD position development conference. J Clin Densitom 11:75–91CrossRefPubMedGoogle Scholar
  6. 6.
    American College of Obstetricians and Gynecologists Women’s health Care Physicians (2004) Osteoporosis Obstet Gynecol 104(Suppl 104):66S–76SGoogle Scholar
  7. 7.
    Leslie WD, Lix LM, Johansson H, Oden A, McCloskey E, Kanis JA (2011) Spine-hip discordance and fracture risk assessment: a physician-friendly FRAX enhancement. Osteoporos Int 22:839–847CrossRefPubMedGoogle Scholar
  8. 8.
    Centers for Disease Control and Prevention, National Center for Health Statistics (2011) 1999—Current National Health and Nutrition Examination Survey (NHANES). Available at: http://www.cdc.gov/nchs/about/major/nhanes/currentnhanes.htm. Accessed 5 May 2011
  9. 9.
    Centers for Disease Control and Prevention, National Center for Health Statistics (2011) National Health and Nutrition Examination Survey body composition procedure manual. Hyattsville, MD; U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, [2006] Available at: http://www.cdc.gov/nchs/data/nhanes/nhanes_05_06/BC.pdf. Accessed 5 May 2011
  10. 10.
    Centers for Disease Control and Prevention, National Center for Health Statistics. National Health and Nutrition Examination Survey dual-energy X-ray absorptiometry (DXA) procedure manual. Hyattsville, MD: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, [2007]. Available at: http://www.cdc.gov/nchs/data/nhanes/nhanes_07_08/manual_dexa.pdf. Accessed 5 May 2011
  11. 11.
    World Health Organization (1994) Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Technical Report Series No. 843. WHO, Geneva SwitzerlandGoogle Scholar
  12. 12.
    Kelly TJ (1990) Bone mineral density reference databases for American men and women. J Bone Miner Res 5(Suppl1):S249Google Scholar
  13. 13.
    Looker AC, Wahner HW, Dunn WL, Calvo MS, Harris TB, Heyse SP, Johnston CC Jr, Lindsay R (1998) Updated data on proximal femur bone mineral levels of US adults. Osteoporos Int 8:468–489CrossRefPubMedGoogle Scholar
  14. 14.
    Centers for Disease Control and Prevention, National Center for Health Statistics. National Health and Nutrition Examination Survey NHANES response rates and CPS totals. Hyattsville, MD: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, [2010]. Available at: http://www.cdc.gov/nchs/nhanes/response_rates_CPS.htm. Accessed 5 May 2011
  15. 15.
    Melton LJ 3rd (1995) How many women have osteoporosis now? J Bone Miner Res 10:175–177CrossRefPubMedGoogle Scholar
  16. 16.
    Woodson G (2000) Dual X-ray absorptiometry T-score concordance and discordance between the hip and spine measurement sites. J Clin Densitom 3:319–324CrossRefPubMedGoogle Scholar
  17. 17.
    Mounach A, Abayi DA, Ghazi M, Ghozlani I, Nouijai A, Achemlal L, Bezza A, El Maghraoui A (2009) Discordance between hip and spine bone mineral density measurement using DXA: prevalence and risk factors. Semin Arthritis Rheum 38:467–471CrossRefPubMedGoogle Scholar
  18. 18.
    El Maghraoui A, Mouinga Abayi DA, Ghozlani I, Mounach A, Nouijai A, Ghazi M, Achemlal L, Bezza A (2007) Prevalence and risk factors of discordance in diagnosis of osteoporosis using spine and hip bone densitometry. Ann Rheum Dis 66:271–272CrossRefPubMedGoogle Scholar
  19. 19.
    Moayyeri A, Soltani A, Tabari NK, Sadatsafavi M, Hossein-Neghad A, Larijani B (2005) Discordance in diagnosis of osteoporosis using spine and hip bone densitometry. BMC Endocr Disord 5:3CrossRefPubMedGoogle Scholar
  20. 20.
    Fink HA, Harrison SL, Taylor BC, Cummings SR, Schousboe JT, Kuskowski MA, Stone KL, Ensrud KE (2008) Study of Osteoporotic Fractures (SOF) Group. Differences in site-specific fracture risk among older women with discordant results for osteoporosis at hip and spine: study of osteoporotic fractures. J Clin Densitom 11:250–259CrossRefPubMedGoogle Scholar
  21. 21.
    Stoch SA, Wysong E, Connolly C, Parker RA, Greenspan SL (2000) Classification of osteoporosis and osteopenia in men is dependent on site-specific analysis. J Clin Densitom 3:311–317CrossRefPubMedGoogle Scholar
  22. 22.
    Leslie WD, Tsang JF, Caetano PA, Lix LM (2007) For the Manitoba bone density program. Number of osteoporotic sites and fracture risk assessment: a cohort study from the Manitoba bone density program. J Bone Miner Res 22:476–483CrossRefPubMedGoogle Scholar
  23. 23.
    O’Gradaigh D, Debiram I, Love S, Richards HK, Compston JE (2003) A prospective study of discordance in diagnosis of osteoporosis using spine and proximal femur bone densitometry. Osteoporos Int 14:13–18CrossRefPubMedGoogle Scholar
  24. 24.
    Leslie WD, Lix LM, Tsang JF, Caetano PA (2007) Manitoba bone density program. Single-site vs multisite bone density measurement for fracture prediction. Arch Intern Med 167:1641–1647CrossRefPubMedGoogle Scholar
  25. 25.
    Kanis JA, Johnell O, Oden A, Johansson H, Eisman JA, Fujiwara S, Kroger H, Honkanen R, Melton LJ 3rd, O’Neill T, Reeve J, Silman A (2006) Tenenhouse A. The use of multiple sites for the diagnosis of osteoporosis. Osteoporos Int 17:527–534CrossRefPubMedGoogle Scholar
  26. 26.
    Blake GM, Patel R, Knapp KM, Fogelman I (2003) Does the combination of two BMD measurements improve fracture discrimination? J Bone Miner Res 18:1955–1963CrossRefPubMedGoogle Scholar
  27. 27.
    Looker AC, Melton LJ 3rd, Borrud Harris TB, Borrud LG, Shepherd JA (2010) Prevalence and trends in low femur bone density among older US adults: NHANES 2005–2006 compared with NHANES III. J Bone Miner Res 25:64–71CrossRefPubMedGoogle Scholar
  28. 28.
    George A, Tracy JK, Meyer WA, Flores RH, Wilson PD, Hochberg MC (2003) Racial differences in bone mineral density in older men. J Bone Miner Res 18:2238–2244CrossRefPubMedGoogle Scholar
  29. 29.
    Araujo AB, Travison TG, Harris SS, Holick MF, Turner AK, McKinlay JB (2007) Race/ethnic differences in bone mineral density in men. Osteoporos Int 18:943–953CrossRefPubMedGoogle Scholar
  30. 30.
    Taaffe DR, Villa ML, Holloway L, Marcus R (2000) Bone mineral density in older non-Hispanic Caucasian and Mexican American women: relationship to lean and fat mass. Annals Human Biol 27:331–344CrossRefGoogle Scholar
  31. 31.
    Nam HS, Shin MH, Zmuda JM, Leung PC, Barrett-Connor E, Orwoll ES, Cauley JA (2010) Osteoporotic Fractures in Men (MrOS) Research Group. Race/ethnic differences in bone mineral densities in older men. Osteoporos Int 21:2115–2123CrossRefPubMedGoogle Scholar
  32. 32.
    Morton DJ, Barrett-Connor E, Kritz-Silverstein D, Wingard DL, Schneider DL (2003) Bone mineral density in postmenopausal Caucasian, Filipina, and Hispanic women. Int J Epidemiol 32:150–156CrossRefPubMedGoogle Scholar
  33. 33.
    Orwoll ES, Oviatt SK, Mann T (1990) The impact of osteophytic and vascular calcifications on vertebral mineral density measurements in men. J Clin Endocrinol Metab 70:1202–1207CrossRefPubMedGoogle Scholar
  34. 34.
    Yu W, Glüer CC, Fuerst T, Grampp S, Li J, Lu Y, Genant HK (1995) Influence of degenerative joint disease on spinal bone mineral measurements in postmenopausal women. Calcif Tissue Int 57:169–174CrossRefPubMedGoogle Scholar
  35. 35.
    Rand T, Seidl G, Kainberger F, Resch A, Hittmair K, Schneider B, Glüer CC, Imhof H (1997) Impact of spinal degenerative changes on the evaluation of bone mineral density with dual energy X-ray absorptiometry (DXA). Calcif Tissue Int 60:430–433CrossRefPubMedGoogle Scholar
  36. 36.
    Liu G, Peacock M, Eilam O, Dorulla G, Braunstein E, Johnston CC (1997) Effect of osteoarthritis in the lumbar spine and hip on bone mineral density and diagnosis of osteoporosis in elderly men and women. Osteoporos Int 7:564–569CrossRefPubMedGoogle Scholar
  37. 37.
    Jones G, Nguyen T, Sambrook PN, Kelly PJ, Eisman JA (1995) A longitudinal study of the effect of spinal degenerative disease on bone density in the elderly. J Rheumatol 22:932–936PubMedGoogle Scholar
  38. 38.
    Riggs BL, Melton LJ, Robb RA, Camp JJ, Atkinson EJ, McDaniel L, Amin S, Rouleau PA, Khosla S (2008) A population-based assessment of rates of bone loss at multiple skeletal sites: evidence for substantial trabecular bone loss in young adult women and men. J Bone Miner Res 23:205–214CrossRefPubMedGoogle Scholar
  39. 39.
    Melton LJ, Khosla S, Atkinson EJ, O’Connor MK, O’Fallon WM, Riggs BL (2000) Cross-sectional versus longitudinal evaluation of bone loss in men and women. Osteoporos Int 11:592–599CrossRefPubMedGoogle Scholar
  40. 40.
    Henry MJ, Pasco JA, Seeman E, Nicholson GC, Sanders KM, Kotowicz MA (2001) Assessment of fracture risk: value of random population-based samples—the Geelong Osteoporosis Study. J Clin Densitom 4:283–289CrossRefPubMedGoogle Scholar
  41. 41.
    Faulkner KG, Roberts LA, McClung MR (1996) Discrepancies in normative data between Lunar and Hologic DXA systems. Osteoporos Int 6:432–436CrossRefPubMedGoogle Scholar
  42. 42.
    Zimmerman SI, Girman CJ, Buie VC, Chander J, Hawkes W, Martin A, Holder L, Hebel JR, Sloane PD, Magaziner J (1999) The prevalence of osteoporosis in nursing home residents. Osteoporos Int 9:151–157CrossRefPubMedGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2011

Authors and Affiliations

  • A. C. Looker
    • 1
  • L. J. MeltonIII
    • 2
  • L. G. Borrud
    • 1
  • J. A. Shepherd
    • 3
  1. 1.National Center for Health Statistics, Centers for Disease Control and PreventionHyattsvilleUSA
  2. 2.Division of Epidemiology, College of MedicineMayo ClinicRochesterUSA
  3. 3.Department of RadiologyUniversity of California San FranciscoSan FranciscoUSA

Personalised recommendations