Differences in Site-Specific Fracture Risk Among Older Women with Discordant Results for Osteoporosis at Hip and Spine: Study of Osteoporotic Fractures

Fink, Howard A.; Harrison, Stephanie L.; Taylor, Brent C.; Cummings, Steven R.; Schousboe, John T.; Kuskowski, Michael A.; Stone, Katie L.; Ensrud, Kristine E.; for the Study of Osteoporotic Fractures (SOF) Group,

doi:10.1016/j.jocd.2007.12.018

« Previous Next »Journal of Clinical Densitometry
Volume 11, Issue 2 , Pages 250-259, April 2008

Differences in Site-Specific Fracture Risk Among Older Women with Discordant Results for Osteoporosis at Hip and Spine: Study of Osteoporotic Fractures

Howard A. Fink
- Geriatric Research Education & Clinical Center, Minneapolis, MN, USA
- Center for Chronic Disease Outcomes Research, VA Medical Center, Minneapolis, MN, USA
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
- Address correspondence to: Howard A. Fink, MD, MPH, VA Medical Center, Geriatric Research, Education & Clinical Center, One Veterans Drive, Box 11G, Minneapolis, MN 55417.
Stephanie L. Harrison
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, CA, USA
Brent C. Taylor
- Center for Chronic Disease Outcomes Research, VA Medical Center, Minneapolis, MN, USA
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
Steven R. Cummings
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, CA, USA
- University of California, San Francisco, CA, USA
John T. Schousboe
- Park Nicollet Clinic, Minneapolis, MN, USA
- Division of Health Services Research and Policy, School of Public Health, University of Minnesota, Minneapolis, MN, USA
Michael A. Kuskowski
- Geriatric Research Education & Clinical Center, Minneapolis, MN, USA
Katie L. Stone
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, CA, USA
Kristine E. Ensrud
- Center for Chronic Disease Outcomes Research, VA Medical Center, Minneapolis, MN, USA
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
for the Study of Osteoporotic Fractures (SOF) Group

Received 10 August 2007; received in revised form 20 December 2007; accepted 20 December 2007. published online 27 February 2008.

Abstract

To examine the fracture pattern in older women whose bone mineral density (BMD) T-score criteria for osteoporosis at hip and spine disagree, hip and spine BMD were measured in Study of Osteoporotic Fractures participants using dual energy X-ray absorptiometry (DXA). Hip osteoporosis was defined as T-score ≤−2.5 at femoral neck or total hip, and spine osteoporosis as T-score ≤−2.5 at lumbar spine. Incident clinical fractures were self-reported and centrally adjudicated. Incident radiographic spine fractures were defined morphometrically. Compared to women with osteoporosis at neither hip nor spine, those osteoporotic only at hip had a 3.0-fold age- and weight-adjusted increased risk for hip fracture (95% confidence interval [CI]: 2.4–3.6), and smaller increases in risk of nonhip nonspine (hazard ratios [HR]=1.6), clinical spine (odds ratio [OR]=2.2), and radiographic spine fractures (OR=1.5). Women osteoporotic only at spine had a 2.8-fold increased odds of radiographic spine fracture (95% CI: 2.1–3.8), and smaller increases in risk of clinical spine (OR=1.4), nonhip nonspine (HR=1.6), and hip fractures (HR=1.2). Discordant BMD results predict different fracture patterns. DXA fracture risk estimation in these patients should be site specific. Women osteoporotic only at spine would not have been identified from hip BMD measurement alone, and may have a sufficiently high fracture risk to warrant preventive treatment.