Fracture incidence and association with bone mineral density in elderly men and women: the Rotterdam Study
Abstract
The incidence of all non-vertebral fractures, as well as the relation to bone mineral density (BMD), was quantified in 7806 men and women from the Rotterdam Study, a prospective, population-based cohort study of men and women aged 55 years and older. In addition, the sensitivity of using a T-score at or below -2.5 for identifying subjects at risk for fractures was assessed. At baseline, between 1990 and 1993, femoral neck BMD was measured by dual energy X-ray absorptiometry (DXA). Subsequently, gender-specific T-scores were calculated using the NHANES reference population. During a mean follow-up of 6.8 years, information on incident non-vertebral fractures was gathered. In general, hip, wrist and upper humerus fractures are the most frequent fractures in both men and women. Femoral neck BMD appears to be an equally important risk factor in both genders, and is especially related to hip fractures. For all non-vertebral fractures, the age-adjusted hazard ratio (95% confidence interval) per standard deviation decrease in femoral neck BMD was 1.5 (1.4-1.6) for women and 1.4 (1.2-1.6) for men. For hip fractures, the hazard ratios were 2.1 (1.7-2.5) for women and 2.3 (1.6-3.3) for men. Only 44% of all non-vertebral fractures occurred in women with a T-score below -2.5; in men, this percentage was even lower (21%). Thus, there is a clear need for the development of more sensitive risk assessment tools, using not only BMD, but also other clinical predictors of fractures.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Osteopenic and normal DXA T-scores were prevalent among patients with vertebral fractures in our study and in others.
“Osteopenic and normal DXA T-scores were prevalent among patients with vertebral fractures in our study and in others (22, 23)”
From Opportunistic screening for osteoporosis using abdominal computed tomography scans obtained for other indications (2013) · cites this paper as [23]
Prior studies document that many patients without osteoporosis diagnosed by DXA will sustain fragility fractures.
“Our observations are consistent with prior studies documenting that many patients without osteoporosis diagnosed by DXA will sustain fragility fractures (22, 23)”
From Opportunistic screening for osteoporosis using abdominal computed tomography scans obtained for other indications (2013) · cites this paper as [23]
Less than half of women (44%) and even fewer men (21%) with osteoporotic fractures exhibited low aBMD in a large observational study.
“First, less than half of women (44%) and even fewer men (21%) with osteoporotic fractures exhibited low aBMD in a large observational study [12]”
From Automatic opportunistic osteoporosis screening in routine CT: improved prediction of patients with prevalent vertebral fractures compared to DXA (2021) · cites this paper as [12]
Cites
Updated Data on Proximal Femur Bone Mineral Levels of US Adults
Looker, A. C., Wahner, H. W., Dunn, W. L., Calvo, M. S., Harris, T. B., Heyse, S. P., Johnston Jr, C. C., & Lindsay, R. (1998) · Osteoporosis International · doi:10.1007/s001980050093 · Cited by 1,121 · cited 1× · see citing works
“Gender-specific T-scores were calculated from the femoral neck BMD using the NHANES reference population [8] of Caucasian males and females aged 20 to 29 years.”
Method
Flagged first, then by citations
Cited by
Sorted by citations
Compston, J. E., McClung, M. R., & Leslie, W. D. (2019) · The Lancet · doi:10.1016/s0140-6736(18)32112-3 · Cited by 2,449 · see citing works
The clinician's guide to prevention and treatment of osteoporosis
LeBoff, M. S., Greenspan, S. L., Insogna, K. L., Lewiecki, E. M., Saag, K. G., Singer, A. J., & Siris, E. S. (2022) · Osteoporosis International · doi:10.1007/s00198-021-05900-y · Cited by 1,487 · see citing works
Pickhardt, P. J., Pooler, B. D., Lauder, T., del Rio, A. M., Bruce, R. J., & Binkley, N. (2013) · Annals of Internal Medicine · doi:10.7326/0003-4819-158-8-201304160-00003 · Cited by 954 · see citing works
Osteoporosis in Men: An Endocrine Society Clinical Practice Guideline
Watts, N. B., Adler, R. A., Bilezikian, J. P., Drake, M. T., Eastell, R., Orwoll, E. S., & Finkelstein, J. S. (2012) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2011-3045 · Cited by 611 · see citing works
Gender Disparities in Osteoporosis
Alswat, K. A. (2017) · Journal of Clinical Medicine Research · doi:10.14740/jocmr2970w · Cited by 596 · see citing works
UK clinical guideline for the prevention and treatment of osteoporosis
Gregson, C. L., Armstrong, D. J., Bowden, J., Cooper, C., Edwards, J., Gittoes, N. J. L., Harvey, N., Kanis, J., Leyland, S., Low, R., et al. (2022) · Archives of Osteoporosis · doi:10.1007/s11657-022-01061-5 · Cited by 593 · see citing works
Derstine, B. A., Holcombe, S. A., Ross, B. E., Wang, N. C., Su, G. L., & Wang, S. C. (2018) · Scientific Reports · doi:10.1038/s41598-018-29825-5 · Cited by 507 · see citing works
Sornay-Rendu, E., Boutroy, S., Munoz, F., & Delmas, P. D. (2007) · Journal of Bone and Mineral Research · doi:10.1359/jbmr.061206 · Cited by 454 · see citing works
The clinical utility of bone marker measurements in osteoporosis
Wheater, G., Elshahaly, M., Tuck, S. P., Datta, H. K., & van Laar, J. M. (2013) · Journal of Translational Medicine · doi:10.1186/1479-5876-11-201 · Cited by 322 · see citing works
Chronic kidney disease and bone fracture: A growing concern
Nickolas, T. L., Leonard, M. B., & Shane, E. (2008) · Kidney International · doi:10.1038/ki.2008.264 · Cited by 300 · see citing works
Clinical Applications of Vertebral Fracture Assessment by Dual-Energy X-Ray Absorptiometry
Lewiecki, E. M., & Laster, A. J. (2006) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2006-1178 · Cited by 201 · see citing works
Risk factors for incident vertebral fractures in men and women: the Rotterdam Study
van der Klift, M., de Laet, C. E., McCloskey, E. V., Johnell, O., Kanis, J. A., Hofman, A., & Pols, H. A. (2004) · Journal of Bone and Mineral Research · doi:10.1359/jbmr.040215 · Cited by 197 · see citing works
Self-citationDole, N. S., Mazur, C. M., Acevedo, C., Lopez, J. P., Monteiro, D. A., Fowler, T. W., Gludovatz, B., Walsh, F., Regan, J. N., Messina, S., et al. (2017) · Cell Reports · doi:10.1016/j.celrep.2017.10.115 · Cited by 173 · see citing works
Mazziotti, G., Frara, S., & Giustina, A. (2018) · Endocrine Reviews · doi:10.1210/er.2018-00005 · Cited by 181 · see citing works
Current status and prospects of metal-organic frameworks for bone therapy and bone repair
Li, M., Yin, S., Lin, M., Chen, X., Pan, Y., Peng, Y., Sun, J., Kumar, A., & Liu, J. (2022) · Journal of Materials Chemistry B · doi:10.1039/d2tb00742h · Cited by 156 · see citing works
Subclinical Thyroid Dysfunction and Incident Hip Fracture in Older Adults
Lee, J. S., Bůžková, P., Fink, H. A., Vu, J., Carbone, L., Chen, Z., Cauley, J., Bauer, D. C., Cappola, A. R., & Robbins, J. (2010) · Archives of Internal Medicine · doi:10.1001/archinternmed.2010.424 · Cited by 134 · see citing works
Bone mass and architecture determination: state of the art
Griffith, J. F., & Genant, H. K. (2008) · Best Practice & Research Clinical Endocrinology & Metabolism · doi:10.1016/j.beem.2008.07.003 · Cited by 126 · see citing works
Löffler, M. T., Jacob, A., Scharr, A., Sollmann, N., Burian, E., El Husseini, M., Sekuboyina, A., Tetteh, G., Zimmer, C., Gempt, J., et al. (2021) · European Radiology · doi:10.1007/s00330-020-07655-2 · Cited by 120 · see citing works
“First, less than half of women (44%) and even fewer men (21%) with osteoporotic fractures exhibited low aBMD in a large observational study [12], emphasiz-”
BackgroundCoupling factors involved in preserving bone balance
Kim, B.-J., & Koh, J.-M. (2019) · Cellular and Molecular Life Sciences · doi:10.1007/s00018-018-2981-y · Cited by 111 · see citing works
SIRT2 regulates extracellular vesicle-mediated liver-bone communication
Lin, L., Guo, Z., He, E., Long, X., Wang, D., Zhang, Y., Guo, W., Wei, Q., He, W., Wu, W., et al. (2023) · Nature Metabolism · doi:10.1038/s42255-023-00803-0 · Cited by 88 · see citing works
Sundh, D., Rudäng, R., Zoulakis, M., Nilsson, A. G., Darelid, A., & Lorentzon, M. (2016) · Journal of Bone and Mineral Research · doi:10.1002/jbmr.2747 · Cited by 76 · see citing works
Guss, J. D., Taylor, E., Rouse, Z., Roubert, S., Higgins, C. H., Thomas, C. J., Baker, S. P., Vashishth, D., Donnelly, E., Shea, M. K., et al. (2019) · Bone · doi:10.1016/j.bone.2019.06.010 · Cited by 77 · see citing works
Mo, D., Fleseriu, M., Qi, R., Jia, N., Child, C. J., Bouillon, R., & Hardin, D. S. (2015) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(15)00098-4 · Cited by 64 · see citing works
Is Osteoporosis Disease Management Cost Effective?
Dell, R., & Greene, D. (2010) · Current Osteoporosis Reports · doi:10.1007/s11914-010-0009-0 · Cited by 54 · see citing works
Evaluating osteoporosis in chronic kidney disease: Both bone quantity and quality matter
Lloret, M. J., Fusaro, M., Jørgensen, H. S., Haarhaus, M., Gifre, L., Alfieri, C. M., Massó, E., D’Marco, L., Evenepoel, P., & Bover, J. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13041010 · Cited by 32 · see citing works
- Authors
- Schuit, S. C. E., van der Klift, M., Weel, A. E. A. M., de Laet, C. E. D. H., Burger, H., Seeman, E., Hofman, A., Uitterlinden, A. G., van Leeuwen, J. P. T. M., & Pols, H. A. P.
- Affiliations
- Erasmus MC (NL)
- University Medical Center Utrecht (NL)
- The University of Melbourne (AU)
- Corresponding author
- Pols, H.A.P
- Venue
- Bone
- Publisher
- Elsevier BV
- Published
- 2004-01
- Volume
- 34
- Issue
- 1
- Pages
- 195-202
- ISSN
- 1873-2763 (ISSN-L)
- 8756-3282
- OpenAlex
- W2068947159
- Cited by
- 1,651
- References
- 1
- Citations by year
- 2026: 51 · 2025: 68 · 2024: 71 · 2023: 84 · 2022: 95 · 2021: 86 · 2020: 109 · 2019: 66 · 2018: 96 · 2017: 85 · 2016: 100 · 2015: 74 · 2014: 58 · 2013: 86 · 2012: 75
- FWCI
- 30.97
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Bone (publishedVersion)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
- Funders
- Nederlandse Organisatie voor Wetenschappelijk Onderzoek
- Topics
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
- Health Sciences › Medicine › Surgery › Hip and Femur Fractures
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Balance, Gait, and Falls Prevention
- Keywords
- fracture incidence, non-vertebral fractures, bone mineral density, femoral neck BMD, hip fracture, wrist fractures, T-score, fracture risk assessment, elderly men and women, sex differences
- MeSH terms
- Aged, Aged, 80 and over, Bone and Bones, Bone Diseases, Metabolic, Female, Humans, Male, Middle Aged, Osteoporosis, Risk Factors, Sex Characteristics, Cohort Studies, Bone Density, Incidence, Proportional Hazards Models, Risk Assessment, Fractures, Bone
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
