Assessment of Clinical Risk Factors to Validate the Probability of Osteoporosis and Subsequent Fractures in Korean Women

  • Yoo Mee Kim
  • Noo-Rie Hyun
  • Ho-Sang Shon
  • Hae-Soon Kim
  • So-Young Park
  • Il-Hyung Park
  • Yoon-Sok Chung
  • Hong-Geun Jung
  • Do-Hee Kim
  • Sung-Kil LimEmail author


This cross-sectional, observational study was designed to identify clinical risk factors of osteoporosis and fractures in Korean women to validate the probability of osteoporosis and subsequent fractures. A total of 1541 Korean women were recruited nationally. Fracture history of any site, risk factors of osteoporosis, and fall-related risk factors were surveyed and physical performance tests were conducted. Peripheral dual-energy X-ray absorptiometry was used to measure calcaneus bone mineral density (BMD). The number of positive responses on the modified 1-min osteoporosis risk test was related to the risk of osteoporosis. The frequency of osteoporosis was higher in those with a height reduction of >4 cm and a reduced body mass index (BMI). Multivariate analysis showed that older age and lower BMI were related to higher relative risk of osteoporosis. Time required to stand up from a chair and questions related to fall injury were significantly related to clinical fracture history of any site. Multivariate analysis showed that the relative risk of fractures at any site was higher in older subjects with a lower T-score and parental hip fracture history. This study shows that age and BMI are the most significant clinical risk factors for osteoporosis and that age, BMD, and parental history of hip fracture are highly applicable risk factors for validating the probability of osteoporotic fractures in Korean women.


Bone mineral density Falls Fractures Osteoporosis Risk assessment 



The authors thank the co-investigators and those who participated voluntarily in the free osteoporosis examination campaign. The co-investigators were: Hye Jung Kim, M.D., Wonkwang University Hospital; Yeun Sun Kim, M.D., Gachon University Gil Medical Center; Soon Hee Lee, M.D., Inje University Pusan Paik Hospital; Ji Hyun Park, M.D., Chonbuk National University Hospital; Yumie Rhee, M.D., Yonsei University College of Medicine; and Young Jun Won, M.D., Kwandong University Myongji Hospital. This study was supported by sanofi-aventis Korea Co., Ltd. All authors had access to all of the data used in this analysis.


  1. 1.
    World Health Organization (1994) Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Technical Report Series 843. WHO, GenevaGoogle Scholar
  2. 2.
    Consensus development conference (1993) Diagnosis, prophylaxis and treatment of osteoporosis. Am J Med 94:646–650CrossRefGoogle Scholar
  3. 3.
    Yamamoto M, Yamaguchi T, Yamauchi M, Kaji H, Sugimoto T (2007) Bone mineral density is not sensitive enough to assess the risk of vertebral fractures in type 2 diabetic women. Calcif Tissue Int 80:353–358PubMedCrossRefGoogle Scholar
  4. 4.
    Cummings SR, Nevitt MC, Bowner WS, Stone K, Fox KM, Ensrud KE, Cauley J, Black D, Vogt TM (1995) Risk factors for hip fracture in white women. N Engl J Med 332:767–773PubMedCrossRefGoogle Scholar
  5. 5.
    Kanis JA, Borgstrom F, De Laet C, Johansson H, Johnell O, Jonsson B, Oden A, Zethraeus N, Pfleger B, Khaltaev N (2005) Assessment of fracture risk. Osteoporos Int 16:581–589PubMedCrossRefGoogle Scholar
  6. 6.
    Kanis JA, Johnell O, Oden A, Johansson H, McCloskey E (2008) FRAXTM and the assessment of fracture probability in men and women from the UK. Osteoporos Int 19:385–397PubMedCrossRefGoogle Scholar
  7. 7.
    Fujiwara S, Nakamura T, Orimo H, Hosoi T, Gorai I, Oden A, Johansson H, Kanis JA (2008) Development and application of a Japanese model of the WHO fracture risk assessment tool (FRAXTM). Osteoporos Int 19:429–435PubMedCrossRefGoogle Scholar
  8. 8.
    Sambrook PN, Cameron ID, Chen JS, Cumming RG, Lord SR, March LM, Schwarz J, Seibel MJ, Simpson JM (2007) Influence of fall-related factors and bone strength on fracture risk in the frail elderly. Osteoporos Int 18:603–610PubMedCrossRefGoogle Scholar
  9. 9.
    Tinetti ME, Speechley M, Ginter SF (1988) Risk factors for falls among elderly persons living in the community. N Engl J Med 319:1701–1707PubMedGoogle Scholar
  10. 10.
    O’Loughlin JL, Robitaille Y, Boivin JF, Suissa S (1993) Incidence of and risk factors for falls and injurious falls among the community-dwelling elderly. Am J Epidemiol 137:342–354PubMedGoogle Scholar
  11. 11.
    Tinetti ME, Williams CS (1997) Falls, injuries due to falls, and the risk of admission to a nursing home. N Engl J Med 337:1279–1284PubMedCrossRefGoogle Scholar
  12. 12.
    Bischoff HA, Stahelin HB, Dick W, Akos R, Knecht M, Salis C, Nebiker M, Theiler R, Pfeifer M, Begerow B, Lew RA, Conzelmann M (2003) Effects of vitamin D and calcium supplementation on falls: a randomized controlled trial. J Bone Miner Res 18:343–351PubMedCrossRefGoogle Scholar
  13. 13.
    Gullberg B, Johnell O, Kanis JA (1997) World-wide projections for hip fracture. Osteoporos Int 7:407–413PubMedCrossRefGoogle Scholar
  14. 14.
    Kung A (2004) Epidemiology and diagnostic approaches to vertebral fractures in Asia. J Bone Miner Metab 22:170–175PubMedCrossRefGoogle Scholar
  15. 15.
    Liu J, Ning G, Chen J (2007) Osteoporotic fractures in Asia: risk factors and strategies for prevention. Osteoporos Int 25:1–5Google Scholar
  16. 16.
    Lim S, Koo BK, Lee EJ, Park JH, Kim MH, Shin KH, Ha YC, Cho NH, Shin CS (2008) Incidence of hip fractures in Korea. J Bone Miner Metab 26:400–405PubMedCrossRefGoogle Scholar
  17. 17.
    Lau EMC, Suriwongpaisal P, Lee JK, Das De S, Festin MR, Saw SM, Khir A, Torralba T, Sham A, Sambrook P (2001) Risk factors for hip fracture in Asian men and women: the Asian Osteoporosis Study. J Bone Miner Res 16:572–580PubMedCrossRefGoogle Scholar
  18. 18.
    Black DM, Steinbuch M, Palermo L, Dargent-Molina P, Lindsay R, Hoseyni MS, Johnell O (2001) An assessment tool for predicting fracture risk in postmenopausal women. Osteoporos Int 12:519–528PubMedCrossRefGoogle Scholar
  19. 19.
    Miller PD, Siris ES, Barrett-Connor E, Faulkner KG, Wehren LE, Abbott TA, Chen Y, Berger ML, Santora AC, Sherwood LM (2002) Prediction of fracture risk in postmenopausal white women with peripheral bone densitometry: evidence from the National Osteoporosis Risk Assessment. J Bone Miner Res 17:2222–2230PubMedCrossRefGoogle Scholar
  20. 20.
    Albrand G, Munoz F, Sornay-Rendu E, DuBoeuf F, Delmas PD (2003) Independent predictors of all osteoporosis-related fractures in healthy postmenopausal women: the OFELY study. Bone 32:78–85PubMedCrossRefGoogle Scholar
  21. 21.
    Reginster J, Ben Sedrine M, Viethel P, Micheletti M, Chevallier T, Audran M (2004) Validation of OSIRIS®, a prescreening tool for the identification of women with an increased risk of osteoporosis. Gynecol Endocrinol 18:3–8PubMedCrossRefGoogle Scholar
  22. 22.
    Richy F, Deceulaer F, Ethgen O, Bruyere O, Reginster J (2004) Development and validation of the ORACLE score to predict risk of osteoporosis. Mayo Clin Proc 79:1402–1408PubMedCrossRefGoogle Scholar
  23. 23.
    Papaioannou A, Joseph L, Ioannidis G, Berger C, Anastassiades T, Brown JP, Hanley DA, Hopman W, Josse RG, Kirkland S, Murray TM, Olszynski WP, Pickard L, Prior JC, Siminoski K, Adachi JD (2005) Risk factors associated with incident clinical vertebral and nonvertebral fractures in postmenopausal women: the Canadian Multicentre Osteoporosis Study (CaMos). Osteoporos Int 16:568–578PubMedCrossRefGoogle Scholar
  24. 24.
    Kanis JA, Borgstrom F, De Laet C, Johansson H, Johnell O, Jonsson B, Oden A, Zethraeus N, Pfleger B, Khaltaev N (2005) Assessment of fracture risk. Osteoporos Int 16:581–589PubMedCrossRefGoogle Scholar
  25. 25.
    Dargent-Molina P, Favier F, Grandjean H, Baudoin C, Scott AM, Hausherr E, Meunier PJ, Breat G (1996) Fall-related factors and risk of hip fracture: the EPIDOS prospective study. Lancet 348:145–149PubMedCrossRefGoogle Scholar
  26. 26.
    Geusens P, Milisen K, Dejaeger E, Boonen S (2003) Falls and fractures in postmenopausal women: a review. J Br Menopause Soc 9:101–106PubMedCrossRefGoogle Scholar
  27. 27.
    WHO/IASO/IOTF (2000) The Asia-Pacific perspective: redefining obesity and its treatment. Health Communications, AustraliaGoogle Scholar
  28. 28.
    Koh LKH, Sedrine WB, Torralba TP, Kung A, Fujiwara S, Chan SP, Huang QR, Rajatanavin R, Tsai KS, Park HM (2001) A simple tool to identify Asian women at increased risk of osteoporosis. Osteoporos Int 12:699–705PubMedCrossRefGoogle Scholar
  29. 29.
    Park HM, Sedrine WB, Reginster JY, Ross PD (2003) Korean experience with the OSTA risk index for osteoporosis: a validation study. J Clin Densitom 6:247–250PubMedCrossRefGoogle Scholar
  30. 30.
    Shin A, Choi J, Cung H, Park SK, Shin CS, Choi Y, Cho S, Kim D, Kim D, Lee K, Lee KH, Yoo K, Kang D (2004) Prevalence and risk factors of distal radius and calcaneus bone mineral density in Korean population. Osteoporos Int 15:639–644PubMedCrossRefGoogle Scholar
  31. 31.
    Deng HW, Mahaney MC, Williams JT, Li J, Conway T, Davies KM, Li JL, Deng H, Recker RR (2002) Relevance of the genes for bone mass variation to susceptibility to osteoporotic fractures and its implications to gene search for complex human diseases. Genet Epidemiol 22:12–25PubMedCrossRefGoogle Scholar
  32. 32.
    Andrew T, Antioniades L, Scurrah KJ, Macgregor AJ, Spector TD (2005) Risk of wrist fracture in women is heritable and is influenced by genes that are largely independent of those influencing BMD. J Bone Miner Res 20:67–74PubMedCrossRefGoogle Scholar
  33. 33.
    Pinheiro MM, Castro CHM, Frisoli A Jr, Szejnfeld VL (2003) Discriminatory ability of quantitative ultrasound measurements is similar to dual-energy X-ray absoroptiometry in a Brazilian women population with osteoporotic fracture. Calcif Tissue Int 73:555–564PubMedCrossRefGoogle Scholar
  34. 34.
    Patel R, Blake GM, Fogelman I (2007) Peripheral and central measurements of bone mineral density are equally strongly associated with clinical risk factors for osteoporosis. Calcif Tissue Int 80:89–96PubMedCrossRefGoogle Scholar
  35. 35.
    Patel S, Hyer S, Tweed K, Kerry S, Allan K, Rodin A, Barron J (2008) Risk factors for fractures and falls in older women with type 2 diabetes mellitus. Calcif Tissue Int 82:87–91PubMedCrossRefGoogle Scholar
  36. 36.
    Stone KL, Seeley DG, Lui LY, Cauley JA, Ensrud K, Browner W, Nevitt M, Cummings SR (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 18:1947–1954PubMedCrossRefGoogle Scholar
  37. 37.
    Sweeney AT, Malabanan AO, Blake MA, Weinberg J, Yurner A, Ray P, Holick MF (2002) Bone mineral density assessment: comparison of dual-energy X-ray absorptiometry measurements at the calcaneus, spine, and hip. J Clin Densitom 5:57–62PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Yoo Mee Kim
    • 1
    • 2
  • Noo-Rie Hyun
    • 3
  • Ho-Sang Shon
    • 4
  • Hae-Soon Kim
    • 5
  • So-Young Park
    • 6
  • Il-Hyung Park
    • 7
  • Yoon-Sok Chung
    • 8
  • Hong-Geun Jung
    • 9
  • Do-Hee Kim
    • 10
  • Sung-Kil Lim
    • 2
    • 11
    • 12
    Email author
  1. 1.Division of Endocrinology, Department of Internal MedicineNHIC Ilsan HospitalGoyangSouth Korea
  2. 2.Division of Endocrinology, Department of Internal MedicineYonsei University College of MedicineSeoulSouth Korea
  3. 3.Sanofi-Aventis KoreaSeoulSouth Korea
  4. 4.Division of Endocrinology, Department of Internal MedicineCatholic University of Daegu School of MedicineDaeguSouth Korea
  5. 5.Division of Endocrinology, Department of Internal MedicineKeimyung University Dongsan Medical CenterDaeguSouth Korea
  6. 6.Division of Endocrinology, Department of Internal Medicine Cheil General Hospital, Kwandong University College of MedicineSeoulSouth Korea
  7. 7.Department of Orthopaedic SurgeryKyungpook National University HospitalDaeguSouth Korea
  8. 8.Division of Endocrinology, Department of Internal MedicineAjou University School of MedicineSuwonSouth Korea
  9. 9.Department of Orthopaedic SurgeryKonkuk University HospitalSeoulSouth Korea
  10. 10.Division of Endocrinology, Department of Internal MedicineDankook University HospitalSeoulSouth Korea
  11. 11.BK21 Project for Medical ScienceYonsei University College of MedicineSeoulSouth Korea
  12. 12.Institute of Endocrine ResearchYonsei University College of MedicineSeoulSouth Korea

Personalised recommendations