Change in hip bone mineral density and risk of subsequent fractures in older men

Peggy M. Cawthon, Susan K. Ewing, Dawn C. MacKey, Howard A. Fink, Steven R. Cummings, Kristine E. Ensrud, Marcia L. Stefanick, Doug C. Bauer, Jane A. Cauley, Eric Orwoll

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Low bone mineral density (BMD) increases fracture risk; how changes in BMD influence fracture risk in older men is uncertain. BMD was assessed at two to three time points over 4.6 years using dual-energy X-ray absorptiometry (DXA) for 4470 men aged <65 years in the Osteoporotic Fractures in Men (MrOS) Study. Change in femoral neck BMD was estimated using mixed effects linear regression models. BMD change was categorized as "accelerated" (-0.034 g/cm), (between 0 and -0.034 g/cm), or (0g/cm). Fractures were adjudicated by central medical record review. Multivariate proportional hazards models estimated the risk of hip, nonspine/nonhip, and nonspine fracture over 4.5 years after the final BMD measure, during which time 371 (8.3%) men experienced at least one nonspine fracture, including 78 (1.7%) hip fractures. Men with accelerated femoral neck BMD loss had an increased risk of nonspine (hazard ratio [HR] = 2.0; 95% confidence interval [CI] 1.4-2.8); nonspine/nonhip (HR = 1.6; 95% CI 1.1-2.3); and hip fracture (HR = 6.3; 95% CI 2.7-14.8) compared with men who maintained BMD over time. No difference in risk was seen for men with expected loss. Adjustment for the initial BMD measure did not alter the results. Adjustment for the final BMD measure attenuated the change in BMD-nonspine fracture and the change in BMD-nonspine/nonhip relationships such that they were no longer significant, whereas the change in the BMD-hip fracture relationship was attenuated (HR = 2.6; 95% CI 1.1-6.4). Total hip BMD change produced similar results. Accelerated decrease in BMD is a strong, independent risk factor for hip and other nonspine fractures in men.

Original languageEnglish (US)
Pages (from-to)2179-2188
Number of pages10
JournalJournal of Bone and Mineral Research
Volume27
Issue number10
DOIs
StatePublished - Oct 2012

Fingerprint

Pelvic Bones
Bone Density
Hip Fractures
Confidence Intervals
Femur Neck
Hip
Linear Models
Osteoporotic Fractures
Photon Absorptiometry

Keywords

  • AGING
  • BONE DENSITOMETRY
  • OSTEOPOROSIS

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Endocrinology, Diabetes and Metabolism

Cite this

Cawthon, P. M., Ewing, S. K., MacKey, D. C., Fink, H. A., Cummings, S. R., Ensrud, K. E., ... Orwoll, E. (2012). Change in hip bone mineral density and risk of subsequent fractures in older men. Journal of Bone and Mineral Research, 27(10), 2179-2188. https://doi.org/10.1002/jbmr.1671

Change in hip bone mineral density and risk of subsequent fractures in older men. / Cawthon, Peggy M.; Ewing, Susan K.; MacKey, Dawn C.; Fink, Howard A.; Cummings, Steven R.; Ensrud, Kristine E.; Stefanick, Marcia L.; Bauer, Doug C.; Cauley, Jane A.; Orwoll, Eric.

In: Journal of Bone and Mineral Research, Vol. 27, No. 10, 10.2012, p. 2179-2188.

Research output: Contribution to journalArticle

Cawthon, PM, Ewing, SK, MacKey, DC, Fink, HA, Cummings, SR, Ensrud, KE, Stefanick, ML, Bauer, DC, Cauley, JA & Orwoll, E 2012, 'Change in hip bone mineral density and risk of subsequent fractures in older men', Journal of Bone and Mineral Research, vol. 27, no. 10, pp. 2179-2188. https://doi.org/10.1002/jbmr.1671
Cawthon PM, Ewing SK, MacKey DC, Fink HA, Cummings SR, Ensrud KE et al. Change in hip bone mineral density and risk of subsequent fractures in older men. Journal of Bone and Mineral Research. 2012 Oct;27(10):2179-2188. https://doi.org/10.1002/jbmr.1671
Cawthon, Peggy M. ; Ewing, Susan K. ; MacKey, Dawn C. ; Fink, Howard A. ; Cummings, Steven R. ; Ensrud, Kristine E. ; Stefanick, Marcia L. ; Bauer, Doug C. ; Cauley, Jane A. ; Orwoll, Eric. / Change in hip bone mineral density and risk of subsequent fractures in older men. In: Journal of Bone and Mineral Research. 2012 ; Vol. 27, No. 10. pp. 2179-2188.
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