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Peripheral and Central Measurements of Bone Mineral Density Are Equally Strongly Associated with Clinical Risk Factors for Osteoporosis

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Abstract

The aim of this study was to determine whether forearm bone mineral density (BMD) measurements are affected by clinical risk factors for osteoporosis to the same extent as spine and hip BMD. The study population consisted of 1,009 female patients and volunteers, of whom 238 were premenopausal. Women were placed into seven groups according to which clinical risk factor they had (women could be placed in more than one group): (1) atraumatic fracture since the age of 25 years, (2) report of X-ray osteopenia, (3) predisposing medical condition or use of therapy known to affect bone metabolism, (4) premature menopause before the age of 45 years or a history of amenorrhea of longer than 6 months’ duration, (5) family history of osteoporosis, (6) body mass index (BMI) <20 kg/m2, and (7) current smoking habit. Forearm BMD was measured using an Osteometer DTX-200 peripheral dual-energy X-ray absorptiometry scanner, and spine and hip BMD measurements were obtained on a Hologic QDR-4500 scanner. Manufacturers’ reference ranges were used to calculate Z scores for the spine and forearm, and the NHANES III reference range was used to calculate Z scores for the hip. Multivariate regression analysis was used to estimate the mean decrease in Z score associated with each clinical risk factor. The Z-score reductions associated with the seven risk factors were similar for forearm and central BMD measurements. For forearm measurements, Z-score decreases associated with a history of atraumatic fracture (−0.25), a medical condition or therapy known to affect bone metabolism (−0.26), premature menopause or history of amenorrhea (−0.30), and BMI <20 kg/m2 (−0.82) were all statistically significantly different from zero (P < 0.05). With an increasing number of risk factors in each individual, the mean Z score at each measurement site became progressively more negative. In conclusion, clinical risk factors for low BMD affect forearm BMD measurements to a similar extent as central BMD.

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References

  1. Cooper C, Campion G, Melton LJ (1992) Hip fractures in the elderly; a world-wide projection. Osteoporos Int 2:285–289

    Article  PubMed  CAS  Google Scholar 

  2. Rowe R (1999) The management of osteoporosis in general practice: results of a national survey. Osteoporos Rev 7:1–3

    Google Scholar 

  3. Glüer C-C, Jergas M, Hans D (1997) Peripheral measurement techniques for the assessment of osteoporosis. Semin Nucl Med 27:229–247

    Article  PubMed  Google Scholar 

  4. International Society for Clinical Densitometry (2005) Official positions of the International Society for Clinical Densitometry: updated 2005, http://www.iscd.org/visitors/positions/official.cfm

    Google Scholar 

  5. Blake GM, Chinn DJ, Steel SA, Patel R, Panayiotou E, Thorpe J, Fordham JN (2005) A list of device specific thresholds for the clinical interpretation of peripheral X-ray absorptiometry examinations. Osteoporos Int 16:2149–2156

    Article  PubMed  CAS  Google Scholar 

  6. Royal College of Physicians (1999) Strategic considerations. In: Osteoporosis: Clinical Guidelines for Prevention and Treatment. Royal College of Physicians, London

  7. Ahmed AIH, Ilic D, Blake GM, Rymer JM, Fogelman I (1998) Review of 3530 referrals for bone density measurements of spine and femur: evidence that radiographic osteopenia predicts low bone mass. Radiology 207:619–624

    PubMed  CAS  Google Scholar 

  8. Frost ML, Blake GM, Fogelman I (2001) Quantitative ultrasound and bone mineral density are equally strongly associated with risk factors for osteoporosis. J Bone Miner Res 16:406–416

    Article  PubMed  CAS  Google Scholar 

  9. Bainbridge PR, Eastell R (1998) Indications for bone densitometry: do they identify patients with low bone mineral density? Current research in osteoporosis and bone mineral measurement. Br J Radiol 5:5–6

    Google Scholar 

  10. Kanis JA, Delmas P, Burckhardt P, Cooper C, Torgerson D; on behalf of the European Foundation for Osteoporosis, Bone Disease (1997) Guidelines for diagnosis and management of osteoporosis. Osteoporos Int 7:390–406

    Article  PubMed  CAS  Google Scholar 

  11. National Osteoporosis Foundation (1998) Risk assessment. In: Physician’s Guide to Prevention and Treatment of Osteoporosis. National Osteoporosis Foundation, Washington DC

  12. Looker AC, Wahner HW, Dunn WL, et al. (1998) Updated data on proximal femur bone mineral levels of US adults. Osteoporos Int 8:468–489

    Article  PubMed  CAS  Google Scholar 

  13. Patel R, Blake GM, Fogelman I (2003) In-vivo cross-calibration of a new peripheral densitometer: the Dexacare G4. J Bone Miner Res 18(suppl2):S313

    Google Scholar 

  14. World Health Organisation (1994) Assessment of Fracture Risk and Its Application to Screening for Postmenopausal Osteoporosis. WHO Technical Report Series 843. World Health Organisation, Geneva

    Google Scholar 

  15. Aloia JF, Cohn SH, Vaswani A, et al. (1985) Risk factors for postmenopausal osteoporosis. Am J Med 78:95–100

    Article  PubMed  CAS  Google Scholar 

  16. Slemenda CW, Hui SL, Longcope C, et al. (1990) Predictors of bone mass in perimenopausal women. Ann Intern Med 112:96–101

    PubMed  CAS  Google Scholar 

  17. Cummings SR, Nevitt MC, Browner WS, et al. (1995) Risk factors for hip fractures in white women. N Engl J Med 332:767–773

    Article  PubMed  CAS  Google Scholar 

  18. Gonzalez-Macias J, Marin F, Vila J, et al. (2004) Risk factors for osteoporosis and osteoporotic fractures in a series of 5,195 women older than 65 years. Med Clin (Barc) 123:85–89

    Article  Google Scholar 

  19. Porthouse J, Birks YF, Torgerson DJ, et al. (2004) Risk factors for fracture in a UK population: a prospective cohort study. QJM 97:569–574

    Article  PubMed  CAS  Google Scholar 

  20. Klotzbuecher CM, Ross PD, Landsman PB, Abbott TA, Berger M (2000) Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res 15:721–727

    Article  PubMed  CAS  Google Scholar 

  21. Mallmin H, Ljunghall S, Persson I, et al. (1993) Fracture of the distal forearm as a forecaster of subsequent hip fracture: a population-based cohort study with 24 years follow-up. Calcif Tissue Int 52:269–272

    Article  PubMed  CAS  Google Scholar 

  22. Honkanen R, Tuppurainen M, Kroger H, Alhava E, Puntila E (1997) Associations of early postmenopausal fractures with subsequent fractures by sites and mechanisms of fractures. Calcif Tissue Int 60:327–331

    Article  PubMed  CAS  Google Scholar 

  23. Salisbury JJ, Mitchell JE (1991) Bone mineral density and anorexia nervosa in women. Am J Psychiatry 148:768–774

    PubMed  CAS  Google Scholar 

  24. Golden NH (2003) Osteopenia and osteoporosis in anorexia nervosa. Adolesc Med 14:97–108

    PubMed  Google Scholar 

  25. Reid IR (1998) Glucocorticoid induced osteoporosis. J Clin Densitom 1:65–73

    Article  PubMed  CAS  Google Scholar 

  26. Van Staa TP, Leufkens HGM, Cooper C (2003) The epidemiology of corticosteroid-induced osteoporosis: a meta-analysis. Osteoporos Int 13:777–787

    Article  Google Scholar 

  27. Kanis JA, Johansson H, Oden A, et al. (2004) A meta-analysis of prior corticosteroid use and fracture risk. J Bone Miner Res 19:893–899

    Article  PubMed  Google Scholar 

  28. Ryan PJ (1998) A longitudinal evaluation of the effects of thyroxine therapy on bone mineral density. J Clin Densitom 1:173–177

    Article  Google Scholar 

  29. Orlic ZC, Raisz LG (1998) Causes of secondary osteoporosis. J Clin Densitom 1:79–92

    Google Scholar 

  30. Cunningham J, Sprague SM, Cannata-Andia J, et al. (2004) Osteoporosis in chronic kidney disease. Am J Kidney Dis 43:566–571

    Article  PubMed  Google Scholar 

  31. Reed CA, Nichols DL, Bonnick SL, DiMarco NM (1998) Bone mineral density and dietary intake in patients with Crohn’s disease. J Clin Densitom 1:33–40

    Article  PubMed  CAS  Google Scholar 

  32. Siffiledeen JS, Fedorak RN, Siminoski K, et al. (2004) Bones and Crohn’s: risk factors associated with low bone mineral density in patients with Crohn’s disease. Inflamm Bowel Dis 10:220–228

    Article  PubMed  Google Scholar 

  33. Kemppainen T, Kroger H, Janatuinen E, et al. (1999) Osteoporosis in adult patients with coeliac disease. Bone 24:249–255

    Article  PubMed  CAS  Google Scholar 

  34. Poulles JM, Tremollieres F, Bonneu M, Ribot S (1994) Influence of early age at menopause on vertebral bone mass. J Bone Miner Res 9:311–315

    Article  Google Scholar 

  35. Kritz-Silverstein D, Barrett-Connor E (1993) Early menopause, number of reproductive years, and bone mineral density in postmenopausal women. Am J Public Health 83:983–988

    Article  PubMed  CAS  Google Scholar 

  36. Luisseto G, Zangari M, Bottega F, et al. (1995) Different rates of forearm bone loss in healthy women with early or late menopause. Osteoporos Int 5:54–62

    Article  Google Scholar 

  37. Ohta H, Sugimoto I, Masuda A, et al. (1996) Decreased bone mineral density associated with early menopause progresses for at least ten years: cross-sectional comparisons between early and normal menopausal women. Bone 18:227–231

    Article  PubMed  CAS  Google Scholar 

  38. Van der Voodt, Van der Weijer PH, Barentsen R (2003) Early menopause: increased fracture risk at older age. Osteoporos Int 14:525–530

    Article  Google Scholar 

  39. Alzubaidi NH, Chapin HL, Vanderhoof VH, Calis KA, Nelson LM (2002) Meeting the needs of young women with secondary amenorrhea and spontaneous premature ovarian failure. Obstet Gynecol 99:720–725

    Article  PubMed  Google Scholar 

  40. Ravn P, Cizza G, Bjarnson NH, et al. (1999) Low body mass index is an important risk factor for low bone mass and increased bone loss in early postmenopausal women. Early Postmenopausal Intervention Cohort (EPIC) study group. J Bone Miner Res 14:1622–1627

    Article  PubMed  CAS  Google Scholar 

  41. Douchi T, Yamamoto S, Oki T, et al. (2000) Difference in the effect of adiposity on bone density between pre and postmenopausal women. Maturitas 34:261–266

    Article  PubMed  CAS  Google Scholar 

  42. Van der Voort DJ, Geusens PP, Dinant GJ (2001) Risk factors for osteoporosis related to their outcome: fractures. Osteoporos Int 12:630–638

    Article  PubMed  Google Scholar 

  43. Evans RA, Marel GM, Lancaster EK, et al. (1988) Bone mass is low in relatives of osteoporotic patients. Ann Intern Med 109:870–873

    PubMed  CAS  Google Scholar 

  44. Danielson ME, Cauley JA, Baker CE, et al. (1999) Familial resemblance of bone mineral density (BMD) and calcaneal ultrasound attenuation: the BMD in mothers and daughters study. J Bone Miner Res 14:102–110

    Article  PubMed  CAS  Google Scholar 

  45. Kanis JA, Johansson H, Oden A, et al. (2004) A family history of fracture and fracture risk: a meta-analysis. Bone 35:1029–1037

    Article  PubMed  CAS  Google Scholar 

  46. Grainge MJ, Coupland CAC, Cliffe SJ, Chilvers SED, Hoskins DJ (1999) Association between a family history of fractures and bone mineral density in early postmenopausal women. Bone 24:507–512

    Article  PubMed  CAS  Google Scholar 

  47. Hopper JL, Seeman E (1994) The bone density of female twins discordant for tobacco use. N Engl J Med 330:387–392

    Article  PubMed  CAS  Google Scholar 

  48. Law MR, Hackshaw AK (1997) A meta-analysis of cigarette smoking, bone mineral density and risk of hip fracture: recognition of a major effect. BMJ 315:841–846

    PubMed  CAS  Google Scholar 

  49. Ward KD, Klesges RC (2001) A meta-analysis of the effects of cigarette smoking on bone mineral density. Calcif Tissue Int 68:259–270

    Article  PubMed  CAS  Google Scholar 

  50. Gerdham P, Obrant KJ (2002) Effects of cigarette-smoking on bone mass as assessed by dual-energy X-ray absorptiometry and ultrasound. Osteoporos Int 13:932–936

    Article  Google Scholar 

  51. Macinnis RJ, Cassar C, Nowson CA, et al. (2003) Determinants of bone density in 30-to 65-year old women: a co-twin study. J Bone Miner Res 18:1650–1656

    Article  PubMed  CAS  Google Scholar 

  52. Pocock NA, Eisman JA, Kelly PJ, et al. (1989) Effects of tobacco use on axial and appendicular bone mineral density. Bone 10:329–331

    Article  PubMed  CAS  Google Scholar 

  53. Kanis JA, Johnell O, Oden A, et al. (2004) Smoking and fracture risk: a meta-analysis. Osteoporos Int 16:155–163

    Article  PubMed  Google Scholar 

  54. De Laet C, Oden A, Johanssen H, Johnell O, Jonsson B, Kanis JA (2005) The impact of the use of multiple risk factors for fracture on case-finding strategies: a mathematical approach. Osteoporos Int 16:313–318

    Article  PubMed  Google Scholar 

  55. Kanis JA, Borgstrom F, De Laet C, et al. (2005) Assessment of future risk. Osteoporos Int 16:581–589

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Academic Bone Densitometry Unit, Imperial College London, Charing Cross Campus, St. Dunstan’s Road, London, W6 8RP, UK

    R. Patel

  2. King’s College London Medical School, Guy’s Campus, St. Thomas Street, London, SE1 9RT, UK

    G. M. Blake & I. Fogelman

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  1. R. Patel
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  2. G. M. Blake
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  3. I. Fogelman
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Correspondence to R. Patel.

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Patel, R., Blake, G.M. & Fogelman, I. Peripheral and Central Measurements of Bone Mineral Density Are Equally Strongly Associated with Clinical Risk Factors for Osteoporosis. Calcif Tissue Int 80, 89–96 (2007). https://doi.org/10.1007/s00223-006-0217-x

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  • DOI: https://doi.org/10.1007/s00223-006-0217-x

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