Advertisement
ADVANCED SEARCH

This Article Figures Only Full Text Full Text (PDF) Résumé Submit a response View responses Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Cranney, A. Articles by Leslie, W. D. Search for Related Content PubMed PubMed Citation Articles by Cranney, A., MD MSc Articles by Leslie, W. D., MD MSc Related Collections Français Osteoporosis Menopause (including HRT) Related Articles

Low bone mineral density and fracture burden in postmenopausal women

From the Ottawa Health Research Institute (Cranney), Ottawa, Ont.; the Department of Medicine, Division of Endocrinology and Metabolism (Jamal, Josse), St. Michael's Hospital, University of Toronto, Toronto, Ont.; and the Faculty of Medicine (Tsang, Leslie), University of Manitoba, Winnipeg, Man.

Correspondence to: Dr. Ann Cranney, Clinical Epidemiology Program, Ottawa Health Research Institute, Rm. ASB 1-009, 1053 Carling Ave., Ottawa ON K1Y 4E9; ancranney{at}ohri.ca

Background: The study objectives were to determine fracture rates in relation to bone mineral density at various central skeletal sites, using the World Health Organization definition for osteoporosis (T-score –2.5 or less), and to contrast fracture patterns among women 50 to 64 years of age with those among women 65 years of age and older.

Methods: Historical cohort study with a mean observation period of 3.2 (standard deviation [SD] 1.5) years. The study group (16 505 women 50 years of age or older) was drawn from the Manitoba Bone Density Program database, which includes all bone mineral density results for Manitoba. Baseline density measurements for the lumbar spine and hip were performed with dual-energy x-ray absorptiometry. Outcomes included the percentage of osteoporotic fractures and the rates of fracture and excess fracture (per 1000 person-years) among postmenopausal women with osteopenia and osteoporosis relative to those with normal bone mineral density (according to the classification of the World Health Organization).

Results: The mean age was 65 (SD 9) years, and the mean T-scores for all sites fell within the osteopenic category. There were 765 incident fractures (fracture rate 14.5 [95% confidence interval, CI, 13.5–15.6 [per 1000 person-years). Fracture rates were significantly higher among women 65 years of age or older than among women 50–64 years of age (21.6 [95% CI 19.7–23.4] v. 8.6 [95% CI 7.5–9.7] per 1000 person-years, p < 0.001). Although fracture rates were significantly higher among women with osteoporotic T-scores, most fractures occurred in women with nonosteoporotic values (min–max: 59.7%–67.8%).

Interpretation: In this study, most of the postmenopausal women with osteoporotic fractures had nonosteoporotic bone mineral density values. This finding highlights the importance of considering key clinical risk factors that operate independently of bone mineral density (such as age) when assessing fracture risk.

This article has been cited by other articles:

				A. B. Hodsman, W. D. Leslie, J. F. Tsang, and G. D. Gamble 10-Year Probability of Recurrent Fractures Following Wrist and Other Osteoporotic Fractures in a Large Clinical Cohort: An Analysis From the Manitoba Bone Density Program Arch Intern Med, November 10, 2008; 168(20): 2261 - 2267. [Abstract] [Full Text] [PDF]

				H. Kumar K. V. S. and A. Verma Bone Mineral Density and High-Trauma Fractures JAMA, April 2, 2008; 299(13): 1542 - 1543. [Full Text] [PDF]

				L. Mascitelli MD and F. Pezzetta MD Diabetes and osteoporotic fractures Can. Med. Assoc. J., November 20, 2007; 177(11): 1391 - 1392. [Full Text] [PDF]

eLetters:

HOME	CURRENT ISSUE	PAST ISSUES	COLLECTIONS	HELP	SEARCH
Copyright 1995-2007, Canadian Medical Association. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p) All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.