To determine which types of fractures have an increased incidence in elderly women with low appen... more To determine which types of fractures have an increased incidence in elderly women with low appendicular bone mass. Prospective cohort study. Four clinical centers in the United States (Baltimore, Maryland; Minneapolis, Minnesota; Portland, Oregon; Monangehela Valley, Pennsylvania); and one coordinating center in San Francisco, California. Ambulatory, nonblack women (9704) aged 65 years or more who were recruited from population-based listings. We measured bone mass at the distal and proximal radius and calcaneus using single-photon absorptiometry. Fractures were verified radiographically. Associations were calculated as age-adjusted hazard ratios (with 95% Cls) per standard deviation decrease in bone mass. During a mean follow-up of 2.23 years, 841 nonspinal fractures occurred in 753 women. The risks for fractures of the wrist, foot, humerus, hip, rib, toe, leg, pelvis, hand, and clavicle were significantly related to reduced bone mass (P less than 0.05). These fractures represented 74% of nonspinal fractures. The overall hazard ratio for the occurrence of one or more of these fractures was 1.65 (Cl, 1.49 to 1.82) at the distal radius. In a subsample of the cohort, vertebral fractures were also related to low bone mass. Fractures of the ankle, elbow, finger, and face, however, were not associated with bone mass at any measurement site; the overall hazard ratio for these fractures was 1.12 (Cl, 0.96 to 1.30) at the distal radius. Most types of fractures have an increased incidence in elderly women with low bone mass.
The assessment of vertebral fracture by conventional radiography has been refined and improved us... more The assessment of vertebral fracture by conventional radiography has been refined and improved using either semiquantitative or quantitative criteria. The inter- and intraobserver variability was determined for a semiquantitative visual approach that we routinely use in clinical studies for assessing prevalent and incident vertebral fractures. In addition, the semiquantitative approach was compared with a quantitative morpho-metric approach. The incidence and prevalence of vertebral fractures were determined in 57 postmenopausal women (age 65–75 years) by three independent observers. The radiographic basis for fracture definitions and the source of interpretative errors are illustrated. The results show excellent intraobserver agreement and good interobserver agreement for the semiquantitative technique. We conclude that the semiquantitative approach can be applied reliably in vertebral fracture assessment when performed using well-defined criteria.
A precise method of measuring vertebral mineral content by computed tomography has been developed... more A precise method of measuring vertebral mineral content by computed tomography has been developed. Calibration phantoms scanned with patients are used to provide corrections for machine drifts. Advanced software manipulation of the display images is used to reposition precisely to the midportion of each vertebral body. A long-term precision of 2.8% for mineral content has been obtained in excised vertebrae in a phantom simulating the human torso.
Based on engineering principles, geometric measurements of femoral size should be related to femo... more Based on engineering principles, geometric measurements of femoral size should be related to femoral strength and the risk for hip fracture. To evaluate whether a simple measurement of femoral geometry is associated with hip fracture risk, we obtained dual x-ray absorptiometry scans of the proximal femur on 8074 white women age 67 or older. During an average of 1.6 years of follow-up, 64 participants suffered hip fractures. In all fracture cases and in a random sample of 134 women who did not subsequently suffer a hip fracture, we measured hip axis length (the distance from greater trochanter to inner pelvic brim), neck width, and the neck/shaft angle on the scan printout, with the observer blinded to subsequent fracture status of the participant. Results were analyzed using multiple logistic models, and odds ratios were determined. After adjustment for age, each standard deviation decrease in femoral neck bone mineral density increased hip fracture risk 2.7-fold (95% confidence interval 1.7, 4.3), and each standard deviation increase in hip axis length nearly doubled the risk of hip fracture (odds ratio = 1.8; 95% CI 1.3, 2.5). The relationship between hip axis length and fracture risk persisted even after adjustment for age, femoral neck density, height, and weight. A longer hip axis length was associated with an increased risk of both femoral neck (OR = 1.9; 95% CI 1.3, 3.0) and trochanteric fractures (1.6; 1.0, 2.4). We found no significant association between the neck width (1.1; 0.8, 1.5) or the neck/shaft angle (1.4; 0.9, 2.2) and risk of hip fracture. In a combined analysis of the control group with an additional population of younger volunteers, no significant relationship was found between the hip axis length and age (r = 0.04, P = 0.60) or femoral neck density (r = 0.01, P = 0.84) in 225 women from 41 to 92 years of age. We conclude that hip axis length predicts hip fractures independently of age and bone mineral density in elderly women. If verified by additional studies, this simple measurement can improve the assessment of hip fracture risk compared to a measurement of femoral neck bone density alone.
In the past decade, considerable progress has been made in the development of methods for assessi... more In the past decade, considerable progress has been made in the development of methods for assessing the skeleton noninvasively so that osteoporosis can be detected early, its progression and response to therapy carefully monitored, or the risk of fracture effectively ...
To determine which types of fractures have an increased incidence in elderly women with low appen... more To determine which types of fractures have an increased incidence in elderly women with low appendicular bone mass. Prospective cohort study. Four clinical centers in the United States (Baltimore, Maryland; Minneapolis, Minnesota; Portland, Oregon; Monangehela Valley, Pennsylvania); and one coordinating center in San Francisco, California. Ambulatory, nonblack women (9704) aged 65 years or more who were recruited from population-based listings. We measured bone mass at the distal and proximal radius and calcaneus using single-photon absorptiometry. Fractures were verified radiographically. Associations were calculated as age-adjusted hazard ratios (with 95% Cls) per standard deviation decrease in bone mass. During a mean follow-up of 2.23 years, 841 nonspinal fractures occurred in 753 women. The risks for fractures of the wrist, foot, humerus, hip, rib, toe, leg, pelvis, hand, and clavicle were significantly related to reduced bone mass (P less than 0.05). These fractures represented 74% of nonspinal fractures. The overall hazard ratio for the occurrence of one or more of these fractures was 1.65 (Cl, 1.49 to 1.82) at the distal radius. In a subsample of the cohort, vertebral fractures were also related to low bone mass. Fractures of the ankle, elbow, finger, and face, however, were not associated with bone mass at any measurement site; the overall hazard ratio for these fractures was 1.12 (Cl, 0.96 to 1.30) at the distal radius. Most types of fractures have an increased incidence in elderly women with low bone mass.
The assessment of vertebral fracture by conventional radiography has been refined and improved us... more The assessment of vertebral fracture by conventional radiography has been refined and improved using either semiquantitative or quantitative criteria. The inter- and intraobserver variability was determined for a semiquantitative visual approach that we routinely use in clinical studies for assessing prevalent and incident vertebral fractures. In addition, the semiquantitative approach was compared with a quantitative morpho-metric approach. The incidence and prevalence of vertebral fractures were determined in 57 postmenopausal women (age 65–75 years) by three independent observers. The radiographic basis for fracture definitions and the source of interpretative errors are illustrated. The results show excellent intraobserver agreement and good interobserver agreement for the semiquantitative technique. We conclude that the semiquantitative approach can be applied reliably in vertebral fracture assessment when performed using well-defined criteria.
A precise method of measuring vertebral mineral content by computed tomography has been developed... more A precise method of measuring vertebral mineral content by computed tomography has been developed. Calibration phantoms scanned with patients are used to provide corrections for machine drifts. Advanced software manipulation of the display images is used to reposition precisely to the midportion of each vertebral body. A long-term precision of 2.8% for mineral content has been obtained in excised vertebrae in a phantom simulating the human torso.
Based on engineering principles, geometric measurements of femoral size should be related to femo... more Based on engineering principles, geometric measurements of femoral size should be related to femoral strength and the risk for hip fracture. To evaluate whether a simple measurement of femoral geometry is associated with hip fracture risk, we obtained dual x-ray absorptiometry scans of the proximal femur on 8074 white women age 67 or older. During an average of 1.6 years of follow-up, 64 participants suffered hip fractures. In all fracture cases and in a random sample of 134 women who did not subsequently suffer a hip fracture, we measured hip axis length (the distance from greater trochanter to inner pelvic brim), neck width, and the neck/shaft angle on the scan printout, with the observer blinded to subsequent fracture status of the participant. Results were analyzed using multiple logistic models, and odds ratios were determined. After adjustment for age, each standard deviation decrease in femoral neck bone mineral density increased hip fracture risk 2.7-fold (95% confidence interval 1.7, 4.3), and each standard deviation increase in hip axis length nearly doubled the risk of hip fracture (odds ratio = 1.8; 95% CI 1.3, 2.5). The relationship between hip axis length and fracture risk persisted even after adjustment for age, femoral neck density, height, and weight. A longer hip axis length was associated with an increased risk of both femoral neck (OR = 1.9; 95% CI 1.3, 3.0) and trochanteric fractures (1.6; 1.0, 2.4). We found no significant association between the neck width (1.1; 0.8, 1.5) or the neck/shaft angle (1.4; 0.9, 2.2) and risk of hip fracture. In a combined analysis of the control group with an additional population of younger volunteers, no significant relationship was found between the hip axis length and age (r = 0.04, P = 0.60) or femoral neck density (r = 0.01, P = 0.84) in 225 women from 41 to 92 years of age. We conclude that hip axis length predicts hip fractures independently of age and bone mineral density in elderly women. If verified by additional studies, this simple measurement can improve the assessment of hip fracture risk compared to a measurement of femoral neck bone density alone.
In the past decade, considerable progress has been made in the development of methods for assessi... more In the past decade, considerable progress has been made in the development of methods for assessing the skeleton noninvasively so that osteoporosis can be detected early, its progression and response to therapy carefully monitored, or the risk of fracture effectively ...
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