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Femoral neck BMD is a strong predictor of hip fracture susceptibility in elderly men and women because it detects cortical bone instability / F. Rivadeneira in Journal of bone and mineral research, 22(2007)11 ([11/01/2007])
[article] Femoral neck BMD is a strong predictor of hip fracture susceptibility in elderly men and women because it detects cortical bone instability : the Rotterdam Study [printed text] / F. Rivadeneira, Author ; M.C. Zillikens, Author ; Chris De Laet , Author ; A. Hofman, Author ; A.G. Uitterlinden, Author ; T.J. Beck, Author ; H.A. Pols, Author . - 2007 . - 1781-90.
Languages : English (eng)
in Journal of bone and mineral research > 22(2007)11 [11/01/2007] . - 1781-90
W 1 Serials. Periodicals
Aged ; Bone Density ; Epidemiology ; Female ; Femur Neck ; Hip Fractures ; Humans ; Incidence ; Journal Article ; Male ; Netherlands ; Peer Review ; Prognosis ; Risk ; United States
Abstract: We studied HSA measurements in relation to hip fracture risk in 4,806 individuals (2,740 women). Hip fractures (n = 147) occurred at the same absolute levels of bone instability in both sexes. Cortical instability (propensity of thinner cortices in wide diameters to buckle) explains why hip fracture risk at different BMD levels is the same across sexes.
INTRODUCTION: Despite the sexual dimorphism of bone, hip fracture risk is very similar in men and women at the same absolute BMD. We aimed to elucidate the main structural properties of bone that underlie the measured BMD and that ultimately determines the risk of hip fracture in elderly men and women.
MATERIALS AND METHODS: This study is part of the Rotterdam Study (a large prospective population-based cohort) and included 147 incident hip fracture cases in 4,806 participants with DXA-derived hip structural analysis (mean follow-up, 8.6 yr). Indices compared in relation to fracture included neck width, cortical thickness, section modulus (an index of bending strength), and buckling ratio (an index of cortical bone instability). We used a mathematical model to calculate the hip fracture distribution by femoral neck BMD, BMC, bone area, and hip structure analysis (HSA) parameters (cortical thickness, section modulus narrow neck width, and buckling ratio) and compared it with prospective data from the Rotterdam Study.
RESULTS: In the prospective data, hip fracture cases in both sexes had lower BMD, thinner cortices, greater bone width, lower strength, and higher instability at baseline. In fractured individuals, men had an average BMD that was 0.09 g/cm(2) higher than women (p < 0.00001), whereas no significant difference in buckling ratios was seen. Modeled fracture distribution by BMD and buckling ratio levels were in concordance to the prospective data and showed that hip fractures seem to occur at the same absolute levels of bone instability (buckling ratio) in both men and women. No significant differences were observed between the areas under the ROC curves of BMD (0.8146 in women and 0.8048 in men) and the buckling ratio (0.8161 in women and 0.7759 in men).
CONCLUSIONS: The buckling ratio (an index of bone instability) portrays in both sexes the critical balance between cortical thickness and bone width. Our findings suggest that extreme thinning of cortices in expanded bones plays a key role on local susceptibility to fracture. Even though the buckling ratio does not offer additional predictive value, these findings improve our understanding of why low BMD is a good predictor of fragility fractures.
Link for e-copy: http://onlinelibrary.wiley.com/doi/10.1359/jbmr.070712/pdf Format of e-copy: PDF [Open Access] (Embargo: 1 year) (1986 to present) Record link: https://kce.docressources.info/index.php?lvl=notice_display&id=2147[article]The use of clinical risk factors enhances the performance of BMD in the prediction of hip and osteoporotic fractures in men and women / John A. Kanis, in Osteoporosis international, 19(2008)4 ([04/01/2008])
[article] The use of clinical risk factors enhances the performance of BMD in the prediction of hip and osteoporotic fractures in men and women [printed text] / John A. Kanis,, Author ; A. Oden, Author ; H. Johansson, Author ; Chris De Laet , Author ; J. Brown, Author . - 2008 . - 1033-46.
Languages : English (eng)
in Osteoporosis international > 19(2008)4 [04/01/2008] . - 1033-46
W 1 Serials. Periodicals
Age Factors ; Aged ; Area Under Curve ; Bone Density ; Female ; Fractures, Spontaneous ; Germany ; Hip Fractures ; Journal Article ; Male ; Middle Aged ; Osteoporosis ; Peer Review ; Risk Assessment ; Risk Factors
Abstract: BMD and clinical risk factors predict hip and other osteoporotic fractures. The combination of clinical risk factors and BMD provide higher specificity and sensitivity than either alone. INTRODUCTION AND
HYPOTHESES: To develop a risk assessment tool based on clinical risk factors (CRFs) with and without BMD.
METHODS: Nine population-based studies were studied in which BMD and CRFs were documented at baseline. Poisson regression models were developed for hip fracture and other osteoporotic fractures, with and without hip BMD. Fracture risk was expressed as gradient of risk (GR, risk ratio/SD change in risk score).
RESULTS: CRFs alone predicted hip fracture with a GR of 2.1/SD at the age of 50 years and decreased with age. The use of BMD alone provided a higher GR (3.7/SD), and was improved further with the combined use of CRFs and BMD (4.2/SD). For other osteoporotic fractures, the GRs were lower than for hip fracture. The GR with CRFs alone was 1.4/SD at the age of 50 years, similar to that provided by BMD (GR = 1.4/SD) and was not markedly increased by the combination (GR = 1.4/SD). The performance characteristics of clinical risk factors with and without BMD were validated in eleven independent population-based cohorts.
CONCLUSIONS: The models developed provide the basis for the integrated use of validated clinical risk factors in men and women to aid in fracture risk prediction.
Link for e-copy: http://vdic.idm.oclc.org/login?url=http://www.springerlink.com/content/a1454272j [...] Format of e-copy: VDIC IP recognition Record link: https://kce.docressources.info/index.php?lvl=notice_display&id=2149[article]