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Bone mineral density and the risk of incident nonspinal fractures in black and white women.
JAMA 2005; 293(17):2102-8JAMA

Abstract

CONTEXT

Black women have a lower rate of fracture than white women, but whether bone mineral density (BMD) predicts fracture risk as well in black women as it does in white women is not established.

OBJECTIVE

To examine the association between BMD and incident nonspinal fractures in older black and white women.

DESIGN, SETTING, AND PARTICIPANTS

Prospective cohort study of baseline data collected from 1986 through 1990 (7334 white women aged 67-99 years) and from 1996 through 1998 (636 black women aged 65-94 years) at 4 US clinical centers in the Study of Osteoporotic Fractures; mean (SD) follow-up of 6.1 (1.5) years until October 1, 2004.

MAIN OUTCOME MEASURES

Incident nonspinal fractures were confirmed by radiograpic report. Total hip and femoral neck BMD and bone mineral content were measured by dual energy x-ray absorptiometry.

RESULTS

A total of 58 black women had a combined total of 61 fractures and 1606 white women had a combined total of 1712 fractures. In age-adjusted proportional hazard models, a 1-SD decrease in femoral neck BMD was associated with a 37% increased risk of fracture in black women (relative risk [RR], 1.37; 95% confidence interval [CI], 1.08-1.74) and a 49% increase in fracture in white women (RR, 1.49; 95% CI, 1.40-1.58). Adjustment for body weight and other risk factors for fracture weakened the association between BMD and fracture, especially among black women (multivariable adjusted RR per 1-SD decrease in femoral neck BMD for black vs white women: RR, 1.20 [95% CI, 0.93-1.55] vs RR, 1.42 [95% CI, 1.32-1.52]). The absolute incidence of fracture across the pooled BMD distribution was 30% to 40% lower among black women at every BMD tertile. The lower risk of fracture among black compared with white women was independent of BMD and other risk factors (RR, 0.48; 95% CI, 0.36-0.64).

CONCLUSIONS

Decreased total hip and femoral neck BMD is associated with an increased risk of fracture in both older black and white women, but this relationship was largely explained by other risk factors in black women. Black women have a lower fracture risk than white women at every level of BMD. Race-specific normative databases may be appropriate for the densitometric definition of osteoporosis.

Authors+Show Affiliations

Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pa 15261, USA. jcauley@pitt.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

15870413

Citation

Cauley, Jane A., et al. "Bone Mineral Density and the Risk of Incident Nonspinal Fractures in Black and White Women." JAMA, vol. 293, no. 17, 2005, pp. 2102-8.
Cauley JA, Lui LY, Ensrud KE, et al. Bone mineral density and the risk of incident nonspinal fractures in black and white women. JAMA. 2005;293(17):2102-8.
Cauley, J. A., Lui, L. Y., Ensrud, K. E., Zmuda, J. M., Stone, K. L., Hochberg, M. C., & Cummings, S. R. (2005). Bone mineral density and the risk of incident nonspinal fractures in black and white women. JAMA, 293(17), pp. 2102-8.
Cauley JA, et al. Bone Mineral Density and the Risk of Incident Nonspinal Fractures in Black and White Women. JAMA. 2005 May 4;293(17):2102-8. PubMed PMID: 15870413.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Bone mineral density and the risk of incident nonspinal fractures in black and white women. AU - Cauley,Jane A, AU - Lui,Li-Yung, AU - Ensrud,Kristine E, AU - Zmuda,Joseph M, AU - Stone,Katie L, AU - Hochberg,Marc C, AU - Cummings,Steven R, PY - 2005/5/5/pubmed PY - 2005/5/10/medline PY - 2005/5/5/entrez SP - 2102 EP - 8 JF - JAMA JO - JAMA VL - 293 IS - 17 N2 - CONTEXT: Black women have a lower rate of fracture than white women, but whether bone mineral density (BMD) predicts fracture risk as well in black women as it does in white women is not established. OBJECTIVE: To examine the association between BMD and incident nonspinal fractures in older black and white women. DESIGN, SETTING, AND PARTICIPANTS: Prospective cohort study of baseline data collected from 1986 through 1990 (7334 white women aged 67-99 years) and from 1996 through 1998 (636 black women aged 65-94 years) at 4 US clinical centers in the Study of Osteoporotic Fractures; mean (SD) follow-up of 6.1 (1.5) years until October 1, 2004. MAIN OUTCOME MEASURES: Incident nonspinal fractures were confirmed by radiograpic report. Total hip and femoral neck BMD and bone mineral content were measured by dual energy x-ray absorptiometry. RESULTS: A total of 58 black women had a combined total of 61 fractures and 1606 white women had a combined total of 1712 fractures. In age-adjusted proportional hazard models, a 1-SD decrease in femoral neck BMD was associated with a 37% increased risk of fracture in black women (relative risk [RR], 1.37; 95% confidence interval [CI], 1.08-1.74) and a 49% increase in fracture in white women (RR, 1.49; 95% CI, 1.40-1.58). Adjustment for body weight and other risk factors for fracture weakened the association between BMD and fracture, especially among black women (multivariable adjusted RR per 1-SD decrease in femoral neck BMD for black vs white women: RR, 1.20 [95% CI, 0.93-1.55] vs RR, 1.42 [95% CI, 1.32-1.52]). The absolute incidence of fracture across the pooled BMD distribution was 30% to 40% lower among black women at every BMD tertile. The lower risk of fracture among black compared with white women was independent of BMD and other risk factors (RR, 0.48; 95% CI, 0.36-0.64). CONCLUSIONS: Decreased total hip and femoral neck BMD is associated with an increased risk of fracture in both older black and white women, but this relationship was largely explained by other risk factors in black women. Black women have a lower fracture risk than white women at every level of BMD. Race-specific normative databases may be appropriate for the densitometric definition of osteoporosis. SN - 1538-3598 UR - https://www.unboundmedicine.com/medline/citation/15870413/Bone_mineral_density_and_the_risk_of_incident_nonspinal_fractures_in_black_and_white_women_ L2 - https://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.293.17.2102 DB - PRIME DP - Unbound Medicine ER -