Osteoporosis International

, Volume 20, Issue 12, pp 2079–2085 | Cite as

The prevalence of significant left–right hip bone mineral density differences among black and white women

  • J. D. Alele
  • D. L. Kamen
  • K. L. Hermayer
  • J. Fernandes
  • J. Soule
  • M. Ebeling
  • T. C. Hulsey
Original Article



In a cross-sectional retrospective study, we examined the prevalence of significant opposite hip bone mineral density difference among white and black women. Left–right hip bone mineral density difference was a common finding in both races, raising the possibility that osteoporosis can be missed if only one hip is imaged.


We examined the prevalence of significant left–right hip bone mineral density (BMD) difference among black and white female subjects and its implications on the diagnosis of osteoporosis.


This was a retrospective review of dual energy X-ray absorptiometry (DXA) data in black and white subjects age 50 years and older. One thousand four hundred seventy-seven scans obtained using a GE Lunar Prodigy scanner in dual hip mode were analyzed (24% black, 76% white). Significant left–right hip BMD difference was considered present when the subregion least significant change (LSC) was exceeded. Its prevalence was determined, along with consequences on the diagnosis of osteoporosis.


Significant differences in BMD were common in both races; the LSC was exceeded in 47% of the patients at the total hip, 37% at the femoral neck, and 53% at the trochanter. Diagnostic agreement was lower when the LSC was exceeded than when it was not. The LSC was exceeded in a statistically significant number of black and white patients with normal or osteopenic spines and unilateral hip osteoporosis.


Significant left–right hip BMD difference is a common finding among black and white women and can result in osteoporosis being missed if only one hip is imaged.


Black women Bone mineral density Dual energy X-ray absorptiometry Hip Osteoporosis White women 


  1. 1.
    Bone health and osteoporosis: a report of the Surgeon General. Issued October 2004. Available online at: www.surgeongeneral.gov/library/bone
  2. 2.
    Ray NF, Chan JK, Thamer M et al (1995) Medical expenditures for the treatment of osteoporotic fractures in the United States in 1995: report from the National Osteoporosis Foundation. J Bone Miner Res 12:24–35CrossRefGoogle Scholar
  3. 3.
    Cooper C, Atkinson EJ, Jacobsen SJ et al (1993) Population-based study of survival after osteoporotic fractures. Am J Epidemiol 137(9):1001–1005PubMedGoogle Scholar
  4. 4.
    Genant HK, Engelke K, Fuerst T et al (1996) Noninvasive assessment of bone mineral and structure: state of the art. J Bone Miner Res 11(6):707–730CrossRefPubMedGoogle Scholar
  5. 5.
    Blake GM, Fogelman I (2007) The role of DXA bone density scans in the diagnosis and treatment of osteoporosis. J Clin Densitom 10(1):102–110CrossRefPubMedGoogle Scholar
  6. 6.
    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):1254–1259PubMedGoogle Scholar
  7. 7.
    Cummings SR, Bates D, Black DM (2002) Clinical use of bone densitometry. JAMA 288(15):1889–1897CrossRefPubMedGoogle Scholar
  8. 8.
    Stone KL, Seeley DG, Lui LY et al (2003) BMD at multiple sites and risk of fracture of multiple types: long-term results from the Study of Osteoporotic Fractures. J Bone Miner Res 18(11):1947–1954CrossRefPubMedGoogle Scholar
  9. 9.
    Petley GW, Taylor PA, Murrills AJ et al (2000) An investigation of the diagnostic value of bilateral femoral neck bone mineral density measurements. Osteoporos Int 11(8):675–679CrossRefPubMedGoogle Scholar
  10. 10.
    Bonnick SL, Nichols DL, Sanborn CF et al (1996) Right and left proximal femur analyses: is there a need to do both? Calcif Tissue Int 58(5):307–311PubMedGoogle Scholar
  11. 11.
    Lilley J, Walters BG, Heath DA et al (1992) Comparison and investigation of bone mineral density in opposing femora by dual-energy X-ray absorptiometry. Osteoporos Int 2(6):274–278CrossRefPubMedGoogle Scholar
  12. 12.
    Franck H, Munz M, Scherrer M (1997) Bone mineral density of opposing hips using dual energy X-ray absorptiometry in single-beam and fan-beam design. Calcif Tissue Int 61(6):445–447CrossRefPubMedGoogle Scholar
  13. 13.
    McEwan Wong JC, Lee L, Griffiths MR N et al (2003) The diagnostic role of dual femur bone density measurement in low-impact fractures. Osteoporos Int 14(4):339–344CrossRefPubMedGoogle Scholar
  14. 14.
    Hamdy R, Kiebzak GM, Seier E, Watts NB (2006) The prevalence of significant left–right differences in hip bone mineral density. Osteoporos Int 17(12):1772–1780CrossRefPubMedGoogle Scholar
  15. 15.
    Hanson J (1997) Standardization of femur BMD. J Bone Miner Res 12:1316–1317CrossRefPubMedGoogle Scholar
  16. 16.
    Kanis JA, Melton J, Christiansen C et al (1994) The diagnosis of osteoporosis. J Bone Miner Res 9:1137–1141CrossRefPubMedGoogle Scholar
  17. 17.
    Binkley N, Bilezikian JP, Kendler D et al (2006) Official positions of the International Society for Clinical Densitometry and executive summary of the 2005 position development conference. J Clin Densitom 9(1):4–14CrossRefPubMedGoogle Scholar
  18. 18.
    Maghraoui E, Mouinga Abayi DA, Rkain H et al (2007) Discordance in diagnosis of osteoporosis using spine and hip bone densitometry. J Clin Densitom 10(2):153–156CrossRefPubMedGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2009

Authors and Affiliations

  • J. D. Alele
    • 1
  • D. L. Kamen
    • 2
  • K. L. Hermayer
    • 1
  • J. Fernandes
    • 1
  • J. Soule
    • 1
  • M. Ebeling
    • 3
  • T. C. Hulsey
    • 3
  1. 1.Division of Endocrinology, Diabetes and Medical GeneticsMedical University of South CarolinaCharlestonUSA
  2. 2.Division of RheumatologyMedical University of South CarolinaCharlestonUSA
  3. 3.Division of Pediatric EpidemiologyMedical University of South CarolinaCharlestonUSA

Personalised recommendations