1. Identification and fracture outcomes of undiagnosed low bone mineral density in postmenopausal women: results from the National Osteoporosis Risk Assessment
- Author
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Louis M. Sherwood, Ethel S. Siris, Elizabeth Barrett-Connor, Kenneth G. Faulkner, Thomas A. Abbott, Arthur C. Santora, Paul D. Miller, Lois E. Wehren, and Marc L. Berger
- Subjects
Pediatrics ,medicine.medical_specialty ,Bone density ,Pathologic fracture ,Population ,Osteoporosis ,Rate ratio ,Lower risk ,Risk Assessment ,Fractures, Bone ,Absorptiometry, Photon ,Bone Density ,Risk Factors ,Internal medicine ,medicine ,Humans ,Longitudinal Studies ,Risk factor ,education ,Osteoporosis, Postmenopausal ,Aged ,Proportional Hazards Models ,Ultrasonography ,Aged, 80 and over ,Hip fracture ,education.field_of_study ,business.industry ,Obstetrics and Gynecology ,General Medicine ,Odds ratio ,Middle Aged ,medicine.disease ,United States ,Menopause ,Osteopenia ,Postmenopause ,Bone Diseases, Metabolic ,Physical therapy ,Female ,Risk assessment ,business - Abstract
Osteoporotic fractures are a prominent cause of disability, and hip fracture produces 20% excess mortality in the ensuing year. The expanding population of elderly is expected to raise both direct and indirect costs of fractures in the United States and elsewhere in the world. Risk factors for low bone mineral density (BMD) and the incidence of fractures during 12 months of follow-up were studied in 200,160 ambulatory postmenopausal women aged 50 years or older, none of whom had been diagnosed as osteoporotic. Follow-up data were available for 82% of the group, whose mean age was 64.5 years. Nearly 90% of the study population were white. BMD was measured variably in the forearm, finger, or heel. Nearly 4 in 10 of the women tested (39.6%) had osteopenia at one or more of the measurement sites, and another 7.2% had osteoporosis. Advancing age was the outstanding risk factor; the odds ratio for osteoporosis rose from 1.79 in women 55 to 59 years of age to 22.6 for those aged 80 and older. The risk also increased with the years since menopause (independently of age), but only for those at least 30 years postmenopausal. Poor self-rated health, a history of fracture, and a maternal history of either fracture after age 45 or osteoporosis all made osteoporosis significantly more likely. Asian and Hispanic women were more at risk than whites, whereas African American women had just over half the risk level of white women. Increasing body mass index correlated with a lower risk of osteoporosis, as did either the former or especially current use of estrogen postmenopausally. Current exercise also lowered the risk, as did consuming one to six alcoholic beverages per week. On follow-up, analysis using T-score categories showed that osteoporosis increased the risk of fracture 4-fold compared with normal BMD, and women with osteopenia had a 1.8-fold higher fracture rate. In a Cox proportional hazards model, osteoporosis and osteopenia increased the risk of fracture within 12 months by 2.74- and 1.73-fold, respectively. There seems no doubt that a large population of women expected to live well into the present century will be at risk of fracture. The risk exists at the time low BMD is recognized at peripheral skeletal sites.
- Published
- 2001