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Ethnic differences in composite indices of femoral neck strength

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An Erratum to this article was published on 03 February 2012

Abstract

Summary

Bone mineral density does not explain race/ethnicity differences in hip fracture risk. In this study, we demonstrated that race/ethnicity differences in composite hip strength indices were consistent with documented race/ethnicity differences in hip fracture risk, suggesting that unlike bone density, the composite indices may represent ethnicity-independent measures of bone strength.

Introduction

African–American and Asian women have lower risks of hip fracture than Caucasian women, but such racial/ethnic variation in hip fracture risk cannot be explained by bone mineral density (BMD). The composite indices of femoral neck strength integrate femoral neck and body size with BMD and predict hip fracture risk in Caucasian women. We hypothesize that unlike race/ethnic differences in BMD, race/ethnic differences in the composite strength indices would be consistent with race/ethnic differences in hip fracture risk.

Methods

We studied a community-based sample of Caucasian (n = 968), African–American (n = 512), Chinese (n = 221), and Japanese (n = 239) women, premenopausal or in early perimenopause, from the Study of Women's Health Across the Nation.

Results

Unadjusted indices were similar in Caucasian and African–American women but higher in Asian women. After adjusting for age, body mass index, and menopause status, all three minority groups had higher composite strength indices than Caucasian women. Foreign-born Japanese women had higher unadjusted and adjusted composite strength indices than US-born Japanese women, but such differences by nativity were not observed in Chinese women.

Conclusion

We concluded that composite strength indices have the potential to explain racial/ethnic differences in hip fracture risk, suggesting that composite strength indices may represent ethnicity-independent measures of bone strength. This contention needs to be verified by further research on the fracture predictive ability of composite strength indices in multi-ethnic longitudinal cohorts.

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Acknowledgments

The Study of Women's Health Across the Nation (SWAN) has grant support from the National Institutes of Health (NIH), DHHS, through the National Institute on Aging (NIA), the National Institute of Nursing Research (NINR), and the NIH Office of Research on Women's Health (ORWH) (grants NR004061; AG012505, AG012535, AG012531, AG012539, AG012546, AG012553, AG012554, AG012495). Dr. Ishii was supported by VA Greater Los Angeles Healthcare System Geriatric Research, Education and Clinical Center; and VA Advanced Geriatrics Fellowship. The Hip Strength Through the Menopausal Transition has grant support from the NIA (AG026463). The SWAN Hip Strength Sub-Study has grant support from the NIA (AG028748). The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the NIA, NINR, ORWH, VA or the NIH. We thank the study staff at each of the following sites and all the women who participated in SWAN: Clinical centers: University of Michigan, Ann Arbor—MaryFran Sowers, PI; Massachusetts General Hospital, Boston, MA—Joel Finkelstein, PI 1999–present; Robert Neer, PI 1994–1999; Rush University, Rush University Medical Center, Chicago, IL—Howard Kravitz, PI 2009–present; Lynda Powell, PI 1994–2009; University of California, Davis/Kaiser—Ellen Gold, PI; University of California, Los Angeles—Gail Greendale, PI; Albert Einstein College of Medicine, Bronx, NY—Rachel Wildman, PI 2010; Nanette Santoro, PI 2004–2010; University of Medicine and Dentistry–New Jersey Medical School, Newark—Gerson Weiss, PI 1994–2004; and the University of Pittsburgh, Pittsburgh, PA—Karen Matthews, PI. NIH program office: National Institute on Aging, Bethesda, MD—Sherry Sherman 1994–present, Marcia Ory 1994–2001; National Institute of Nursing Research, Bethesda, MD–Program Officers. Central laboratory: University of Michigan, Ann Arbor—Daniel McConnell (Central Ligand Assay Satellite Services). Coordinating center: University of Pittsburgh, Pittsburgh, PA—Kim Sutton-Tyrrell, PI 2001–present; New England Research Institutes, Watertown, MA—Sonja McKinlay, PI 1995–2001. Steering committee: Susan Johnson, Current Chair; Chris Gallagher, Former Chair.

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Authors and Affiliations

  1. Geriatric Research, Education and Clinical Center (GRECC), VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Building 220, Room 302, Los Angeles, CA, 90073, USA

    S. Ishii

  2. Department of Medicine/Division of Geriatrics, David Geffen School of Medicine at UCLA, 10933 Le Conte Ave, Los Angeles, CA, 90095, USA

    G. A. Greendale, N. Safaei Nili & A. Karlamangla

  3. Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, A524 Crabtree, Pittsburgh, PA, 15260, USA

    J. A. Cauley & M. E. Danielson

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  1. S. Ishii
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  2. J. A. Cauley
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  3. G. A. Greendale
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  4. M. E. Danielson
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  5. N. Safaei Nili
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  6. A. Karlamangla
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Corresponding author

Correspondence to S. Ishii.

Additional information

An erratum to this article can be found at http://dx.doi.org/10.1007/s00198-011-1887-4.

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Ishii, S., Cauley, J.A., Greendale, G.A. et al. Ethnic differences in composite indices of femoral neck strength. Osteoporos Int 23, 1381–1390 (2012). https://doi.org/10.1007/s00198-011-1723-x

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