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Changes in femur neck bone density in US adults between 1988–1994 and 2005–2008: demographic patterns and possible determinants

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Abstract

Summary

This analysis compares femur neck bone mineral density (FNBMD) and bone determinants in adults between National Health and Nutrition Examination Survey (NHANES) III (1988–1994) and NHANES 2005–2008. FNBMD was higher in NHANES 2005–2008 than in NHANES III, but between-survey differences varied by age, sex, and race/ethnicity. The likelihood that FNBMD has improved appears strongest for older white women.

Introduction

Recent data on hip fracture incidence and femur neck osteoporosis suggest that the skeletal status of older US adults has improved since the 1990s, but the explanation for these changes remains uncertain.

Methods

The present study compares mean FNBMD of adults ages 20 years and older between the third (NHANES III, 1988–1994) and NHANES 2005–2008. Dual-energy X-ray absorptiometry systems (pencil beam in NHANES III, fan beam in NHANES 2005–2008) were used to measure hip BMD, and several bone determinants are compared between surveys to assess their potential role in explaining observed FNBMD differences.

Results

FNBMD was higher overall in NHANES 2005–2008 than in NHANES III, but between-survey differences varied by age, sex, and race/ethnicity. Although FNBMD differences in several groups were small enough (≤3%) to be attributable to use of different dual-energy X-ray absorptiometry (DXA) systems in the two surveys, variability in size and direction of the differences does not support artifactual differences in DXA methodology as the sole explanation. Several FNBMD determinants (body size, smoking, selected bone-active medications, self-reported health status, calcium intake, and caffeine consumption) changed in a bone-improving direction in older adults, but FNBMD in older non-Hispanic white women remained significantly higher in 2005–2008 even after adjusting for DXA methodology or for the selected bone determinants.

Conclusion

The likelihood that FNBMD has improved appears strongest for older white women, but the reason for the improvement in this group remains unclear.

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Conflicts of interest

None.

Author information

Authors and Affiliations

  1. National Center for Health Statistics, Centers for Disease Control and Prevention, Room 4310, 3311 Toledo Road, Hyattsville, MD, 20782, USA

    A. C. Looker

  2. Division of Epidemiology, College of Medicine, Mayo Clinic, Rochester, MN, USA

    L. J. Melton III

  3. National Center for Health Statistics, Centers for Disease Control and Prevention, Room 4327, 3311 Toledo Road, Hyattsville, MD, 20782, USA

    L. G. Borrud

  4. Department of Radiology, University of California San Francisco, San Francisco, CA, USA

    J. A. Shepherd

Authors
  1. A. C. Looker
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  2. L. J. Melton III
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  3. L. G. Borrud
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  4. J. A. Shepherd
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Corresponding author

Correspondence to A. C. Looker.

Additional information

The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention or the Department of Health and Human Services.

Appendix 1

Appendix 1

Specific drugs composing medication groups

  1. I.

    Medications that increase BMD

    1. (A)

      Sex hormones (NHANES III and NHANES 2005–2008)

      1. 1.

        Estrogens: estradiol, estradiol valerate, estrogenic substances, conjugated estrogens, esterified estrogens (alone and with methyltestosterone), estropipate, ethinyl estradiol (alone or with ethynodiol diacetate, levonorgestrel, norethindrone, norethindrone acetate, or desogestrel), diethylstilbesterol (alone or with disphosphate), fluoxymesterone, or quinestrol.

      2. 2.

        Testosterones: testosterone, testosterone cypionate, stanozolol and nandrolone decanoate.

    2. (B)

      Non-estrogen drugs

      1. 1.

        NHANES III: calcitonin, calcitriol, ergocalciferol, etidronate, sodium fluoride, tamoxifen, and calcium acetate.

      2. 2.

        NHANES 2005–2008: bisphosphonates (alendronate, risedronate, etidronate, pamidronate, tiludronate, ibandronate, zolendronate), calcitonin, calcitriol, fluoride, raloxifene, tamoxifen, tibolone, strontium ranelate, parathyroid hormone, and teriparatide.

  2. II.

    Medications that decrease BMD (NHANES III and NHANES 2005–2008)

    1. 1.

      Glucocorticoids: betamethasone, budesonide, cortisone, dexamethasone, hydrocortisone, methlprednisolone, prednisolone, prednisone, and triamcinolone.

    2. 2.

      Antineoplastic drugs: anastrozole, bicalutamide, capecitabine, chlorambucil, cyclophosphamide, erlotinib, estramustine, exemestane, fluorouracil, fluoxymesterone, flutamide, goserelin, hydroxyurea, interferon alfa 2A and 2B, irinotecan, isotretinoin, letrozole, leuprolide, levamisole, lomustine, medroxyprogesterone, megestrol, mercaptopurine, methotrexate, nilutamide, tegafur or uracil, tretinoin, and unspecified antineoplastics.

    3. 3.

      Anticonvulsants: carbamazepine, clonazepam, diazepam, divalproex sodium, ethosuximide, gabapentin, lamotrigine, levetiracetam, lorazepam, mephobarbital, methsuximide, oxcarbazepine, phenobarbital, phenytoin, pregabalin, primidone, tiagabine, topiramate, valproic acid, zonisamide.

    4. 4.

      Barbiturates: butabarbital, butalbital

    5. 5.

      Anticoagulants: heparin and enoxaparin.

    6. 6.

      IV nutrition products: LVP solution with potassium

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Looker, A.C., Melton, L.J., Borrud, L.G. et al. Changes in femur neck bone density in US adults between 1988–1994 and 2005–2008: demographic patterns and possible determinants. Osteoporos Int 23, 771–780 (2012). https://doi.org/10.1007/s00198-011-1623-0

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