The population burden of fractures originates in women with osteopenia, not osteoporosis

Pasco, J. A., Seeman, E., Henry, M. J., Merriman, E. N., Nicholson, G. C. and Kotowicz, M. A. (2006) The population burden of fractures originates in women with osteopenia, not osteoporosis. Osteoporosis International, 17 9: 1404-1409. doi:10.1007/s00198-006-0135-9

Author Pasco, J. A.
Seeman, E.
Henry, M. J.
Merriman, E. N.
Nicholson, G. C.
Kotowicz, M. A.
Title The population burden of fractures originates in women with osteopenia, not osteoporosis
Journal name Osteoporosis International   Check publisher's open access policy
ISSN 0937-941X
Publication date 2006-09
Sub-type Article (original research)
DOI 10.1007/s00198-006-0135-9
Volume 17
Issue 9
Start page 1404
End page 1409
Total pages 6
Place of publication Guildford, Surrey, England
Publisher Springer U K
Language eng
Formatted abstract
Introduction: Osteoporosis is associated with increased risk for fracture. However, most postmenopausal women have bone mineral density (BMD) within the normal or osteopenic range. The aim of this study was to determine the proportion of the population burden of fragility fractures arising from women at modest risk for fracture. Methods: We measured baseline BMD in a population-based random sample of 616 postmenopausal women aged 60-94 years and followed these individuals for a median of 5.6 years (IQR 3.9-6.5) to determine the incidence of fractures according to age, BMD and the presence of a prior fracture. Results: Based on WHO criteria, 37.6% of the women had normal total hip BMD, 48.0% had osteopenia and 14.5% had osteoporosis. The incidence of fracture during follow-up was highest in women with osteoporosis, but only 26.9% of all fractures arose from this group; 73.1% occurred in women without osteoporosis (56.5% in women with osteopenia, 16.6% in women with normal BMD). Decreasing BMD, increasing age and prior fracture contributed independently to increased fracture risk; in a multivariate model, the relative risk for fracture increased 65% for each SD decrease in BMD (RR=1.65, 95%CI 1.32-2.05), increased 3% for every year of age (RR=1.03, 95%CI 1.01-1.06) and doubled with prevalent fracture (RR=2.01, 95% CI 1.40-2.88). A prevalent fracture increased the risk for fractures such that women with osteopenia and prevalent fracture had the same, if not greater, risk as women with osteoporosis alone. Conclusions: Reducing the population burden of fractures requires attention to women with osteopenia, as well as osteoporosis, because over half of the fragility fractures in the population arise in these individuals, and women with osteopenia plus a prevalent fracture have the same fracture risk as women with osteoporosis. © International Osteoporosis Foundation and National Osteoporosis Foundation 2006.
Keyword Bone mineral density (BMD)
Fracture Risk
Population study
Bone-Mineral Density
Hip Fracture
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Unknown

Document type: Journal Article
Sub-type: Article (original research)
Collections: ERA 2012 Admin Only
School of Medicine Publications
Version Filter Type
Citation counts: TR Web of Science Citation Count  Cited 103 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 123 times in Scopus Article | Citations
Google Scholar Search Google Scholar
Created: Sun, 11 Sep 2011, 20:49:11 EST by System User on behalf of School of Medicine