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Cited by 54Bone health and osteoporosis researchHip and Femur FracturesNutrition and Health in Aging

Areal and volumetric bone mineral density and risk of multiple types of fracture in older men

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Chalhoub, Didier, Orwoll, Eric S., Cawthon, Peggy M., Ensrud, Kristine E., Boudreau, Robert, Greenspan, Susan, Newman, Anne B., Zmuda, Joseph +3 more·2016·Bone
DOI 10.1016/j.bone.2016.08.014PMC PMC5056840
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Abstract

Although many studies have examined the association between low bone mineral density (BMD) and fracture risk in older men, none have simultaneously studied the relationship between multiple BMD sites and risk of different types of fractures. Using data from the Osteoporotic Fractures in Men study, we evaluated the association between areal BMD (aBMD) by dual-energy X-ray absorptiometry (DXA) and volumetric BMD (vBMD) by quantitative computed tomography (QCT) measurements, and different types of fractures during an average of 9.7years of follow-up. Men answered questionnaires about fractures every 4months (>97% completions). Fractures were confirmed by centralized review of radiographic reports; pathological fractures were excluded. Risk of fractures was assessed at the hip, spine, wrist, shoulder, rib/chest/sternum, ankle/foot/toe, arm, hand/finger, leg, pelvis/coccyx, skull/face and any non-spine fracture. Age and race adjusted Cox proportional-hazards modeling was used to assess the risk of fracture in 3301 older men with both aBMD (at the femoral neck (FN) and lumbar spine) and vBMD (at the trabecular spine and FN, and cortical FN) measurements, with hazard ratios (HRs) expressed per standard deviation (SD) decrease. Lower FN and spine aBMD were associated with an increased risk of fracture at the hip, spine, wrist, shoulder, rib/chest/sternum, arm, and any non-spine fracture (statistically significant HRs per SD decrease ranged from 1.24-3.57). Lower trabecular spine and FN vBMD were associated with increased risk of most fractures with statistically significant HRs ranging between 1.27 and 3.69. There was a statistically significant association between FN cortical vBMD and fracture risk at the hip (HR=1.55) and spine sites (HR=1.26), but no association at other fracture sites. In summary, both lower aBMD and vBMD were associated with increased fracture risk. The stronger associations observed for trabecular vBMD than cortical vBMD may reflect the greater metabolic activity of the trabecular compartment.

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  • Compared to a study of incident vertebral fractures in the MrOS cohort, the AUCs reported here are higher for trabecular vBMD (0.885 vs 0.79) but lower for DXA-based aBMD (0.668 vs 0.72).

    “Compared to a study of incident vertebral fractures in the Osteoporotic Fractures in Men (MrOS) Study cohort of elderly men, the AUCs we report seem considerably higher for trabecular vBMD (AUC = 0.885 vs. 0.79), but lower for DXA-based aBMD (AUC = 0.668 vs. 0.72) [28].”

    From Automatic opportunistic osteoporosis screening in routine CT: improved prediction of patients with prevalent vertebral fractures compared to DXA (2021) · cites this paper as [28]

    The Discussion (page unavailable) identifies this as a MrOS study and reports that trabecular spine vBMD predicted spine fractures better than DXA-based spine aBMD. The cited paper passages do not give the specific AUCs of 0.79 and 0.72, so those numerical comparisons are not verified by our copy. (LLM, conf=0.78)

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Authors
Chalhoub, D., Orwoll, E. S., Cawthon, P. M., Ensrud, K. E., Boudreau, R., Greenspan, S., Newman, A. B., Zmuda, J., Bauer, D., Cummings, S., & Cauley, J. A.
Affiliations
  • National Institutes of Health (US)
  • Oregon Health & Science University (US)
  • California Pacific Medical Center (US)
  • University of Minnesota (US)
  • University of Pittsburgh (US)
  • University of California, San Francisco (US)
Corresponding author
Cauley, Jane A.
ORCID
Venue
Bone
Publisher
Elsevier BV
Published
2016-11
Volume
92
Pages
100-106
ISSN
  • 1873-2763 (ISSN-L)
  • 8756-3282
DOI
10.1016/j.bone.2016.08.014
PMC
PMC5056840
OpenAlex
W2518064184
Cited by
54
References
1
Citations by year
2026: 4 · 2025: 6 · 2024: 3 · 2023: 11 · 2022: 4 · 2021: 4 · 2020: 10 · 2019: 8 · 2018: 4
FWCI
4.87
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Bone (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
Funders
  • National Institutes of Health (UL1TR000128)
  • National Institute on Aging (U01AG042145, U01AG042168, U01AG042143, U01AG027810, U01AG042139, U01AG042124, U01AG042140, P30AG024827)
  • National Institute of Arthritis and Musculoskeletal and Skin Diseases (U01AR066160)
  • National Center for Advancing Translational Sciences
Topics
  • Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
  • Health Sciences › Medicine › Surgery › Hip and Femur Fractures
  • Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
Keywords
bone mineral density, volumetric bone mineral density, areal bone mineral density, fracture risk, older men, hip fracture, spinal fractures, wrist fractures, femoral neck, trabecular bone, cortical bone, osteoporosis, Osteoporotic Fractures in Men Study
MeSH terms
Aged, Aged, 80 and over, Female, Hip Fractures, Humans, Male, Prospective Studies, Risk Factors, Tomography, X-Ray Computed, Cohort Studies, Bone Density, Spinal Fractures, Osteoporotic Fractures

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