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Change in hip bone mineral density and risk of subsequent fractures in older men.
J Bone Miner Res 2012; 27(10):2179-88JB

Abstract

Low bone mineral density (BMD) increases fracture risk; how changes in BMD influence fracture risk in older men is uncertain. BMD was assessed at two to three time points over 4.6 years using dual-energy X-ray absorptiometry (DXA) for 4470 men aged ≥65 years in the Osteoporotic Fractures in Men (MrOS) Study. Change in femoral neck BMD was estimated using mixed effects linear regression models. BMD change was categorized as "accelerated" (≤-0.034 g/cm(2)), "expected" (between 0 and -0.034 g/cm(2)), or "maintained" (≥0 g/cm(2)). Fractures were adjudicated by central medical record review. Multivariate proportional hazards models estimated the risk of hip, nonspine/nonhip, and nonspine fracture over 4.5 years after the final BMD measure, during which time 371 (8.3%) men experienced at least one nonspine fracture, including 78 (1.7%) hip fractures. Men with accelerated femoral neck BMD loss had an increased risk of nonspine (hazard ratio [HR] = 2.0; 95% confidence interval [CI] 1.4-2.8); nonspine/nonhip (HR = 1.6; 95% CI 1.1-2.3); and hip fracture (HR = 6.3; 95% CI 2.7-14.8) compared with men who maintained BMD over time. No difference in risk was seen for men with expected loss. Adjustment for the initial BMD measure did not alter the results. Adjustment for the final BMD measure attenuated the change in BMD-nonspine fracture and the change in BMD-nonspine/nonhip relationships such that they were no longer significant, whereas the change in the BMD-hip fracture relationship was attenuated (HR = 2.6; 95% CI 1.1-6.4). Total hip BMD change produced similar results. Accelerated decrease in BMD is a strong, independent risk factor for hip and other nonspine fractures in men.

Authors+Show Affiliations

Research Institute, California Pacific Medical Center, San Francisco, CA, USA. pcawthon@sfcc-cpmc.netNo affiliation info availableNo affiliation info availableNo 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)

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

Language

eng

PubMed ID

22648990

Citation

Cawthon, Peggy M., et al. "Change in Hip Bone Mineral Density and Risk of Subsequent Fractures in Older Men." Journal of Bone and Mineral Research : the Official Journal of the American Society for Bone and Mineral Research, vol. 27, no. 10, 2012, pp. 2179-88.
Cawthon PM, Ewing SK, Mackey DC, et al. Change in hip bone mineral density and risk of subsequent fractures in older men. J Bone Miner Res. 2012;27(10):2179-88.
Cawthon, P. M., Ewing, S. K., Mackey, D. C., Fink, H. A., Cummings, S. R., Ensrud, K. E., ... Orwoll, E. S. (2012). Change in hip bone mineral density and risk of subsequent fractures in older men. Journal of Bone and Mineral Research : the Official Journal of the American Society for Bone and Mineral Research, 27(10), pp. 2179-88. doi:10.1002/jbmr.1671.
Cawthon PM, et al. Change in Hip Bone Mineral Density and Risk of Subsequent Fractures in Older Men. J Bone Miner Res. 2012;27(10):2179-88. PubMed PMID: 22648990.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Change in hip bone mineral density and risk of subsequent fractures in older men. AU - Cawthon,Peggy M, AU - Ewing,Susan K, AU - Mackey,Dawn C, AU - Fink,Howard A, AU - Cummings,Steven R, AU - Ensrud,Kristine E, AU - Stefanick,Marcia L, AU - Bauer,Doug C, AU - Cauley,Jane A, AU - Orwoll,Eric S, AU - ,, PY - 2012/6/1/entrez PY - 2012/6/1/pubmed PY - 2013/2/5/medline SP - 2179 EP - 88 JF - Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research JO - J. Bone Miner. Res. VL - 27 IS - 10 N2 - Low bone mineral density (BMD) increases fracture risk; how changes in BMD influence fracture risk in older men is uncertain. BMD was assessed at two to three time points over 4.6 years using dual-energy X-ray absorptiometry (DXA) for 4470 men aged ≥65 years in the Osteoporotic Fractures in Men (MrOS) Study. Change in femoral neck BMD was estimated using mixed effects linear regression models. BMD change was categorized as "accelerated" (≤-0.034 g/cm(2)), "expected" (between 0 and -0.034 g/cm(2)), or "maintained" (≥0 g/cm(2)). Fractures were adjudicated by central medical record review. Multivariate proportional hazards models estimated the risk of hip, nonspine/nonhip, and nonspine fracture over 4.5 years after the final BMD measure, during which time 371 (8.3%) men experienced at least one nonspine fracture, including 78 (1.7%) hip fractures. Men with accelerated femoral neck BMD loss had an increased risk of nonspine (hazard ratio [HR] = 2.0; 95% confidence interval [CI] 1.4-2.8); nonspine/nonhip (HR = 1.6; 95% CI 1.1-2.3); and hip fracture (HR = 6.3; 95% CI 2.7-14.8) compared with men who maintained BMD over time. No difference in risk was seen for men with expected loss. Adjustment for the initial BMD measure did not alter the results. Adjustment for the final BMD measure attenuated the change in BMD-nonspine fracture and the change in BMD-nonspine/nonhip relationships such that they were no longer significant, whereas the change in the BMD-hip fracture relationship was attenuated (HR = 2.6; 95% CI 1.1-6.4). Total hip BMD change produced similar results. Accelerated decrease in BMD is a strong, independent risk factor for hip and other nonspine fractures in men. SN - 1523-4681 UR - https://www.unboundmedicine.com/medline/citation/22648990/Change_in_hip_bone_mineral_density_and_risk_of_subsequent_fractures_in_older_men_ L2 - https://doi.org/10.1002/jbmr.1671 DB - PRIME DP - Unbound Medicine ER -