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From the CaMos Methods Centre (Berger), McGill University, Montréal, Que.; the CaMos National Coordinating Centre (Langsetmo, Tenenhouse, Kreiger, Goltzman), McGill University, Montréal, Que.; the Department of Epidemiology and Biostatistics (Joseph), McGill University, Montréal, Que.; the Departments of Medicine and Community Health Sciences (Hanley), University of Calgary, Calgary, Alta.; the Department of Rheumatology and Immunology (Davidson), Université Laval, Québec, Que.; the Department of Medicine (Josse), University of Toronto, Toronto, Ont.; the Department of Public Health Sciences (Kreiger), University of Toronto, Toronto, Ont.; the Department of Medicine (Goltzman), McGill University, and the Calcium Research Laboratory, Royal Victoria Hospital, Montréal, Que.
Correspondence to: Dr. David Goltzman, Canadian Multicentre Osteoporosis Study, Royal Victoria Hospital, 687 Pine Ave. W, Rm. E1-59, Montréal QC H3A 1A1; david.goltzman{at}mcgill.ca
Background: Measurement of bone mineral density is the most common method of diagnosing and assessing osteoporosis. We sought to estimate the average rate of change in bone mineral density as a function of age among Canadians aged 25–85, stratified by sex and use of antiresorptive agents.
Methods: We examined a longitudinal cohort of 9423 participants. We measured the bone mineral density in the lumbar spine, total hip and femoral neck at baseline in 1995–1997, and at 3-year (participants aged 40–60 years only) and 5-year follow-up visits. We used the measurements to compute individual rates of change.
Results: Bone loss in all 3 skeletal sites began among women at age 40–44. Bone loss was particularly rapid in the total hip and was greatest among women aged 50–54 who were transitioning from premenopause to postmenopause, with a change from baseline of –6.8% (95% confidence interval [CI] –7.5% to –4.9%) over 5 years. The rate of decline, particularly in the total hip, increased again among women older than 70 years. Bone loss in all 3 skeletal sites began at an earlier age (25–39) among men than among women. The rate of decline of bone density in the total hip was nearly constant among men 35 and older and then increased among men older than 65. Use of antiresorptive agents was associated with attenuated bone loss in both sexes among participants aged 50–79.
Interpretation: The period of accelerated loss of bone mineral density in the hip bones occurring among women and men older than 65 may be an important contributor to the increased incidence of hip fracture among patients in that age group. The extent of bone loss that we observed in both sexes indicates that, in the absence of additional risk factors or therapy, repeat testing of bone mineral density to diagnose osteoporosis could be delayed to every 5 years.
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