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Does using lower limit of normal values enhance the ability of a single bone mineral density measure to predict fractures?

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Abstract

Summary

Using a single bone mineral density (BMD) measure, we demonstrated that the lower limit of normal (LLN) method is more consistent in predicting osteoporosis fractures than the T-score in white menopausal women from the Study of Osteoporosis Fracture (SOF).

Introduction

In order to circumvent the inconsistencies and limitations with using the T-score when defining osteoporosis, we propose using 95% LLN values derived from centered polynomial models using the NHANES III BMD measures. The main aim of this study was to compare the two methods in prediction of fracture and agreement in osteoporosis classification using cohort data.

Methods

We compared the fracture prediction ability of the two methods using a single BMD measurement in 4,948 white women aged 67–74 years in the SOF employing kappa statistics, sensitivity, and specificity.

Results

The T-score provided inconsistent osteoporosis classification (46.6%) across the five hip regions of interest (ROIs) and this was significantly (p < 0.0001) reduced when using the LLN method (36.5%). Kappa statistics of incident fracture during 12 years of follow-up related to the prevalence of osteoporosis at baseline was significantly improved using the LLN method compared to using T-score. Sensitivity and specificity for fracture based on a single BMD measurement of different hip ROIs were more consistent using the LLN method.

Conclusion

The LLN method provides a more consistent and efficient method for osteoporosis fracture prediction than the T-score in 67- to 74-year-old white women.

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Acknowledgement

The Study of Osteoporotic Fractures (SOF) is supported by National Institutes of Health funding. The National Institute on Aging (NIA) provides support under the following grant numbers: AG05407, AR35582, AG05394, AR35584, AR35583, R01 AG005407, R01 AG027576-22, 2 R01 AG005394-22A1, and 2 R01 AG027574-22A1. We thank Li-Yung Lui at San Francisco Coordinating Center for her assistance with the SOF data. These analyses were done independently of the SOF study, and therefore should not be interpreted as representing the views of the SOF investigator group.

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Authors and Affiliations

  1. Biostatistics, Mayo Clinic, 13400 East Shea Blvd, Scottsdale, AZ, 85259, USA

    Q. Wu

  2. Department of Community Health Sciences, Tulane University School of Public Health and Tropical Medicine, and Department of Medicine, Tulane University School of Medicine, Suite 2300 1440 Canal Street, New Orleans, LA, 70112, USA

    J. H. Magnus

  3. Department of Biostatistics, Tulane University School of Public Health and Tropical Medicine, Suite 2100 1440 Canal Street, New Orleans, LA, 70112, USA

    J. C. Rice & J. J. Lefante

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  1. Q. Wu
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  2. J. H. Magnus
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  4. J. J. Lefante
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Correspondence to Q. Wu.

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Wu, Q., Magnus, J.H., Rice, J.C. et al. Does using lower limit of normal values enhance the ability of a single bone mineral density measure to predict fractures?. Osteoporos Int 21, 1881–1888 (2010). https://doi.org/10.1007/s00198-009-1160-2

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  • DOI: https://doi.org/10.1007/s00198-009-1160-2

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