Skip to main content

Advertisement

SpringerLink
Log in

Femur neck bone mineral density and fracture risk by age, sex, and race or Hispanic origin in older US adults from NHANES III

  • Original Article
  • Published:
Archives of Osteoporosis Aims and scope Submit manuscript

Abstract

Summary

Differences in the relationship between femur neck bone mineral density (FNBMD) and fracture risk were examined by age, sex, and race/ethnicity in the third National Health and Nutrition Examination Survey (NHANES III) cohort. FNBMD had similar, significant predictive utility for fracture in the different subgroups, but it did not completely account for subgroup differences in risk.

Purpose

Few previous studies of FNBMD and fracture risk examined the relationship by age, sex, and race within the same cohort. The present study examined the relationship between FNBMD and risk of incident major osteoporotic fracture (hip, spine, radius, and humerus) in older US adults from NHANES III (1988–1994).

Methods

Incident fractures were identified using linked mortality and Medicare records obtained through 2007 for 2,743 men and women ages 65 years and older. FNBMD was measured by dual-energy X-ray absorptiometry. Cox proportional hazards models were used to estimate the hazards ratio (HR) of fracture for FNBMD and femur neck T score and risk of major osteoporotic fracture.

Results

The sample included 380 incident major osteoporotic fractures. Fracture risk approximately doubled for each SD decrease in FNBMD. HR’s for FNBMD were similar within age, sex, or race/Hispanic origin subgroups, and also for T scores calculated with either white female or sex- and race/ethnic-specific reference data. Adding FNBMD to Cox models slightly attenuated HR for age, sex, or race/Hispanic origin, but all three variables remained significant predictors of fracture risk.

Conclusions

FNBMD had similar, significant predictive utility within age, sex, and race/Hispanic origin subgroups. However, FNBMD did not appear to completely account for fracture risk differences in these subgroups. Similarity of HR’s for T scores calculated with two different reference databases support use of a uniform reference database to calculate these scores.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Notes

  1. 1 SD = 0.14 gm/cm2

References

  1. Nevitt MC, Johnell O, Black DM, Ensrud K, Genant HK, Cummings SR (1994) Bone-mineral density predicts non-spine fractures in very elderly women. Osteoporos Int 4:325–331

    Article  CAS  PubMed  Google Scholar 

  2. Schott AM, Cormier C, Hans D et al (1998) How hip and whole-body bone mineral density predict hip fracture in elderly women: the EPIDOS prospective study. Osteoporos Int 8:247–254

    Article  CAS  PubMed  Google Scholar 

  3. Fujiwara S, Kasagi F, Masunari N, Naito K, Suzuki G, Fukunaga M (2003) Fracture prediction from bone mineral density in Japanese men and women. J Bone Miner Res 18:1547–1553

    Article  PubMed  Google Scholar 

  4. Schuit SCE, van der Klift M, Weel AEAM, de Laet CEDH, Burger H, Seeman E, Hofman A, Uitterlinden AG, van Leeuwen JPTM, Pols HAP (2004) Fracture incidence and association with bone mineral density in elderly men and women: the Rotterdam Study. Bone 34:195–202

    Article  CAS  PubMed  Google Scholar 

  5. Nguyen ND, Pongchaiyakul C, Center JR, Eisman JA, Nguyen TV (2005) Identification of high-risk individuals for hip fracture: a 14-year prospective study. J Bone Miner Res 20:1921–1928

    Article  PubMed  Google Scholar 

  6. Cauley JA, Lui LY, Ensrud KE, Zmuda JM, Stone KL, Hochberg MC, Cummings SR (2005) Bone mineral density and the risk of incident nonspinal fractures in black and white women. Jama-J Am Med Assoc 293:2102–2108

    Article  CAS  Google Scholar 

  7. Barrett-Connor E, Siris ES, Wehren LE, Miller PD, Abbott TA, Berger ML, Santora AC, Sherwood LM (2005) Osteoporosis and fracture risk in women of different ethnic groups. J Bone Miner Res 20:185–194

    Article  PubMed  Google Scholar 

  8. Johnell O, Kanis JA, Oden A et al (2005) Predictive value of BMD for hip and other fractures. J Bone Miner Res 20:1185–1194

    Article  PubMed  Google Scholar 

  9. Siris ES, Brenneman SK, Barrett-Connor E, Miller PD, Sajjan S, Berger ML, Chen YT (2006) The effect of age and bone mineral density on the absolute, excess, and relative risk of fracture in postmenopausal women aged 50–99: results from the National Osteoporosis Risk Assessment (NORA). Osteoporos Int 17:565–574

    Article  CAS  PubMed  Google Scholar 

  10. Cummings SR, Cawthon PM, Ensrud KE, Cauley JA, Fink HA, Orwoll ES, Grp MR (2006) BMD and risk of hip and nonvertebral fractures in older men: a prospective study and comparison with older women. J Bone Miner Res 21:1550–1556

    Article  PubMed  Google Scholar 

  11. Rivadeneira F, Zillikens MC, De Laet CE, Hofman A, Uitterlinden AG, Beck TJ, Pols HAP (2007) Femoral neck BMD is a strong predictor of hip fracture susceptibility in elderly men and women because it detects cortical bone instability: the Rotterdam study. J Bone Miner Res 22:1781–1790

    Article  PubMed  Google Scholar 

  12. Cauley JA, Wu LL, Wampler NS, Barnhart JM, Allison M, Chen Z, Jackson R, Robbins J (2007) Clinical risk factors for fractures in multi-ethnic women: the women’s health initiative. J Bone Miner Res 22:1816–1826

    Article  PubMed  Google Scholar 

  13. Mackey DC, Eby JG, Harris F, Taaffe DR, Cauley JA, Tylavsky FA, Harris TB, Lang TF, Cummings SR (2007) Prediction of clinical non-spine fractures in older black and white men and women with volumetric BMD of the spine and areal BMD of the hip: the health, aging, and body composition study. J Bone Miner Res 22:1862–1868

    Article  PubMed  Google Scholar 

  14. Langsetmo L, Leslie WD, Zhou W et al (2010) Using the same bone density reference database for men and women provides a simpler estimation of fracture risk. J Bone Miner Res 25:2108–2114

    Article  PubMed  Google Scholar 

  15. Cauley JA, Palermo L, Voot M, Ensrud KE, Ewing S, Hochberg M, Nevitt MC, Black DM (2008) Prevalent vertebral fractures in black women and white women. J Bone Miner Res 23:1458–1467

    Article  PubMed  Google Scholar 

  16. Kanis JA, WHO Scientific Group on Assessment of Osteoporosis at the Primary Health-care Level (2007) Assessment of osteoporosis at the primary health-care level. World Health Organization, Geneva

    Google Scholar 

  17. Centers for Disease Control and Prevention National Center for Health Statistics (1994) Plan and Operation of the Third National Health and Nutrition Examination Survey, 1988–94. In: Department of Health and Human Services (ed) Series 1: Programs and collection procedures. Centers for Disease Control and Prevention, National Center for Health Statistics, Hyattsville, pp 1–407

    Google Scholar 

  18. Centers for Disease Control and Prevention National Center for Health Statistics (2012) NHANES Questionnaires, datasets and related documentation. Centers for Disease Control and Prevention, National Center for Health Statistics. http://www.cdc.nchs.gov/nchs/nhanes/nhanes_questionnaires.htm. Accessed 19 May 2013

  19. Centers for Disease Control and Prevention National Center for Health Statistics (2012) NCHS data linked to mortality files. Centers for Disease Control and Prevention, National Center for Health Statistics. http://www.cdc.gov/nchs/data_access/data_linkage/mortality.htm. Accessed 19 May 2013

  20. Centers for Disease Control and Prevention National Center for Health Statistics (2012) NCHS Data linked to CMS Medicare enrollment and claims files. Centers for Disease Control and Prevention, National Center for Health Statistics. http://www.cdc.gov/nchs/data_access/data_linkage/CMS_Medicare.htm. Accessed 19 May 2013

  21. Moon M (1996) What Medicare has meant to older Americans. Health Care Financ R 18:49–59

    CAS  Google Scholar 

  22. Ray WA, Griffin MR, Fought RL, Adams ML (1992) Identification of fractures from computerized Medicare files. J Clin Epidemiol 45:703–714

    Article  CAS  PubMed  Google Scholar 

  23. Taylor AJ, Gary LC, Arora T et al (2011) Clinical and demographic factors associated with fractures among older Americans. Osteoporos Int 22:1263–1274

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  24. Curtis JR, Mudano AS, Solomon DH, Xi J, Melton E, Saag KG (2009) Identification and validation of vertebral compression fractures using administrative claims data. Med Care 47:69–72

    Article  PubMed Central  PubMed  Google Scholar 

  25. Association AM (2010) CPT (Current Procedural Terminology) Assistant Archives 1990–2009. American Medical Association, Chicago IL

    Google Scholar 

  26. National Center for Health Statistics (2010) Conversion Table of New ICD-9-CM Codes. National Center for Health Statistics, http://www.cdc.gov/nchs/data/icd9/icdcnvFY11.pdf. Accessed 19 May 2013

  27. Baron JA BJ, Berger M, NCCDPHP (1996) Incidence and cost to Medicare of fractures among Medicare beneficiaries aged ≥65 years: United States July 1991–June 1992. MMWR 45:877–883

    Google Scholar 

  28. Wahner HW, Looker A, Dunn WL, Walters LC, Hauser MF, Novak C (1994) Quality control of bone densitometry in a national health survey (NHANES III) using three mobile examination centers. J Bone Miner Res 9:951–960

    Article  CAS  PubMed  Google Scholar 

  29. Kanis JA, McCloskey EV, Johansson H, Oden A, Melton LJ 3rd, Khaltaev N (2008) A reference standard for the description of osteoporosis. Bone 42:467–475

    Article  CAS  PubMed  Google Scholar 

  30. Research Triangle Institute (2008) SUDAAN Language Manual, Release 10.0. Research Triangle Institute, Research Triangle Park, NC

  31. Walters SJ (2001) What is a Cox model? Hayward Medical Communications, p 8

  32. Looker AC, Wahner HW, Dunn WL, Calvo MS, Harris TB, Heyse SP, Johnston CC Jr, Lindsay R (1998) Updated data on proximal femur bone mineral levels of US adults. Osteoporos Int 8:468–489

    Article  CAS  PubMed  Google Scholar 

  33. National Center for Health Statistics Office of Analysis and Epidemiology (2011) Use of survey weights for linked data—preliminary guidance. National Center for Health Statistics, Hyattsville

    Google Scholar 

  34. Baim S, Binkley N, Bilezikian JR, Kendler DL, Hans DB, Lewiecki EM, Silverman S (2008) Official positions of the International Society for Clinical Densitometry and executive summary of the 2007 ISCD Position Development Conference. J Clin Densitom 11:75–91

    Article  PubMed  Google Scholar 

  35. Looker AC, Sempos CT, Liu KA, Johnson CL, Gunter EW (1990) Within-person variance in biochemical indicators of iron status: effects on prevalence estimates. Am J Clin Nutr 52:541–547

    CAS  PubMed  Google Scholar 

  36. Kanis JA, Johnell O, Oden A, Borgstrom F, Zethraeus N, De Laet C, Jonsson B (2004) The risk and burden of vertebral fractures in Sweden. Osteoporos Int 15:20–26

    Article  CAS  PubMed  Google Scholar 

  37. Stone KL, Seeley DG, Lui LY, Cauley JA, Ensrud K, Browner W, Nevitt MC, Cummings SR, Osteoporotic Fractures R (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 18:1947–1954

    Article  PubMed  Google Scholar 

  38. Looker AC (2013) Serum 25-hydroxyvitamin D and risk of major osteoporotic fracture in older US adults. J Bone Miner Res 28;997–1006

    Google Scholar 

Download references

Conflicts of interest

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.

Author information

Authors and Affiliations

  1. National Center for Health Statistics, Centers for Disease Control and Prevention, Room 4310 3311 Toledo Rd, Hyattsville, MD, 2078, USA

    Anne C. Looker

Authors
  1. Anne C. Looker
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Anne C. Looker.

Electronic supplementary material

Below is the link to the electronic supplementary material.

ESM 1

(DOCX 20 kb)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Looker, A.C. Femur neck bone mineral density and fracture risk by age, sex, and race or Hispanic origin in older US adults from NHANES III. Arch Osteoporos 8, 141 (2013). https://doi.org/10.1007/s11657-013-0141-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s11657-013-0141-4

Keywords

Search

Navigation