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Evaluating the value of repeat bone mineral density measurement and prediction of fractures in older women: the study of osteoporotic fractures.
Arch Intern Med 2007; 167(2):155-60AI

Abstract

BACKGROUND

Whether repeat bone mineral density (BMD) measurement adds benefit beyond the initial BMD measurement in predicting fractures in older women is unknown.

METHODS

We prospectively measured total hip BMD in 4124 older women (mean +/- SD age, 72 +/- 4 years) from 1989 to 1990 and again 8 years later. Incident nontraumatic hip and nonspine fractures were validated by radiology reports (>95% follow-up). In addition, spine fractures were defined morphometrically in 2129 of these women by lateral spine x-ray films from 1991 to 1992 and then again 11.4 years later. Prediction of fracture risk was assessed with proportional hazards models and receiver operating characteristic curves for BMD measures.

RESULTS

Over a mean of 5 years after the repeat BMD measure, 877 women experienced an incident nontraumatic nonspine fracture (275 hip fractures). In addition, 340 women developed a spine fracture. After adjustment for age and weight change, initial and repeat BMD measurements were similarly associated with fracture risk (per unit standard deviation lower in BMD) for nonspine (hazard ratio, 1.6), spine (odds ratio, 1.8-1.9), and hip (hazard ratio, 2.0-2.2) fractures (P<.001 for all models). Areas under the receiver operating characteristic curves (AUC) revealed no significant differences to discriminate nonspine (AUC, 0.65), spine (AUC, 0.67-0.68), or hip (AUC, 0.73-0.74) fractures between models with initial BMD, repeat BMD, or initial BMD plus change in BMD. Stratification by initial BMD t scores (normal, osteopenic, or osteoporotic), high bone loss, or hormone therapy did not alter results.

CONCLUSION

In healthy, older, postmenopausal women, repeating a measurement of BMD up to 8 years later provides little additional value besides the initial BMD measurement for predicting incident fractures.

Authors+Show Affiliations

Center for Health Research, Kaiser Permanente Northwest/Hawaii, Portland, OR 97227, USA. Teresa.Hillier@kp.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Evaluation Studies
Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

17242316

Citation

Hillier, Teresa A., et al. "Evaluating the Value of Repeat Bone Mineral Density Measurement and Prediction of Fractures in Older Women: the Study of Osteoporotic Fractures." Archives of Internal Medicine, vol. 167, no. 2, 2007, pp. 155-60.
Hillier TA, Stone KL, Bauer DC, et al. Evaluating the value of repeat bone mineral density measurement and prediction of fractures in older women: the study of osteoporotic fractures. Arch Intern Med. 2007;167(2):155-60.
Hillier, T. A., Stone, K. L., Bauer, D. C., Rizzo, J. H., Pedula, K. L., Cauley, J. A., ... Cummings, S. R. (2007). Evaluating the value of repeat bone mineral density measurement and prediction of fractures in older women: the study of osteoporotic fractures. Archives of Internal Medicine, 167(2), pp. 155-60.
Hillier TA, et al. Evaluating the Value of Repeat Bone Mineral Density Measurement and Prediction of Fractures in Older Women: the Study of Osteoporotic Fractures. Arch Intern Med. 2007 Jan 22;167(2):155-60. PubMed PMID: 17242316.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Evaluating the value of repeat bone mineral density measurement and prediction of fractures in older women: the study of osteoporotic fractures. AU - Hillier,Teresa A, AU - Stone,Katie L, AU - Bauer,Doug C, AU - Rizzo,Joanne H, AU - Pedula,Kathryn L, AU - Cauley,Jane A, AU - Ensrud,Kristine E, AU - Hochberg,Marc C, AU - Cummings,Steve R, PY - 2007/1/24/pubmed PY - 2007/2/17/medline PY - 2007/1/24/entrez SP - 155 EP - 60 JF - Archives of internal medicine JO - Arch. Intern. Med. VL - 167 IS - 2 N2 - BACKGROUND: Whether repeat bone mineral density (BMD) measurement adds benefit beyond the initial BMD measurement in predicting fractures in older women is unknown. METHODS: We prospectively measured total hip BMD in 4124 older women (mean +/- SD age, 72 +/- 4 years) from 1989 to 1990 and again 8 years later. Incident nontraumatic hip and nonspine fractures were validated by radiology reports (>95% follow-up). In addition, spine fractures were defined morphometrically in 2129 of these women by lateral spine x-ray films from 1991 to 1992 and then again 11.4 years later. Prediction of fracture risk was assessed with proportional hazards models and receiver operating characteristic curves for BMD measures. RESULTS: Over a mean of 5 years after the repeat BMD measure, 877 women experienced an incident nontraumatic nonspine fracture (275 hip fractures). In addition, 340 women developed a spine fracture. After adjustment for age and weight change, initial and repeat BMD measurements were similarly associated with fracture risk (per unit standard deviation lower in BMD) for nonspine (hazard ratio, 1.6), spine (odds ratio, 1.8-1.9), and hip (hazard ratio, 2.0-2.2) fractures (P<.001 for all models). Areas under the receiver operating characteristic curves (AUC) revealed no significant differences to discriminate nonspine (AUC, 0.65), spine (AUC, 0.67-0.68), or hip (AUC, 0.73-0.74) fractures between models with initial BMD, repeat BMD, or initial BMD plus change in BMD. Stratification by initial BMD t scores (normal, osteopenic, or osteoporotic), high bone loss, or hormone therapy did not alter results. CONCLUSION: In healthy, older, postmenopausal women, repeating a measurement of BMD up to 8 years later provides little additional value besides the initial BMD measurement for predicting incident fractures. SN - 0003-9926 UR - https://www.unboundmedicine.com/medline/citation/17242316/Evaluating_the_value_of_repeat_bone_mineral_density_measurement_and_prediction_of_fractures_in_older_women:_the_study_of_osteoporotic_fractures_ L2 - https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/10.1001/archinte.167.2.155 DB - PRIME DP - Unbound Medicine ER -