Journal of Clinical Densitometry : the Official Journal of the International Society for Clinical Densitometry, 17(2), 295-300, 2014
Choice of lumbar spine bone density reference database for fracture prediction in men and women: a population-based analysis
William D Leslie, Lisa Langsetmo, Wei Zhou
David Goltzman, Christopher S Kovacs, Jerilynn C Prior, W P Olszynski, Tassos Anastassiades, Tanveer Towheed, S M Kaiser, Brian Lentle , Nancy Kreiger , CaMos Research Group , David A Hanley, K Shawn Davison, Robert G Josse, Stephanie M Kaiser
The diagnosis of osteoporosis in men is controversial, although most studies demonstrate similar fracture rates for men and women with the same level of hip bone mineral density (BMD). Whether this applies to the lumbar spine is currently uncertain and has important implications with respect to choice of reference population for T-score calculation and osteoporosis diagnosis. This question was specifically addressed in the population-based Canadian Multicentre Osteoporosis Study cohort of 4745 women and 1887 men ages 50+ yr at the time of baseline lumbar spine dual energy x-ray absorptiometry. In up to 10 yr of observation, incident clinical major osteoporotic fractures occurred in 110 men (5.8%) vs 543 women (11.4%) (p < 0.001). Mean lumbar spine BMD in men was greater than in women, both among those with and those without incident major osteoporotic fracture (p < 0.001). Men were at slightly lower risk for incident major osteoporotic fracture than women for an equivalent lumbar spine BMD (ageand BMD-adjusted rate ratio 0.75, 95% confidence interval 0.60-0.93, p = 0.008) with similar findings after adjustment for the World Health Organization fracture risk assessment clinical risk factors or competing mortality. No significant sex difference in the BMD relationship was seen for vertebral fractures (clinical or radiographic) or for all fractures. In summary, this large population-based longitudinal cohort study found similar or lower fracture risk for men vs women after adjustment for absolute lumbar spine BMD and additional covariates. The least complicated model for describing fracture risk is therefore to use the same reference lumbar spine data for generating T-scores in men and women.
lumbar spine bone mineral density reference database, fracture prediction men women BMD, osteoporosis diagnosis reference population, T-score fracture risk lumbar spine, bone density measurement standardization, Canadian Multicentre Osteoporosis Study BMD, sex-specific fracture prediction model, femoral neck versus lumbar spine BMD, densitometry reference database selection
PMID 24613388 24613388 DOI 10.1016/j.jocd.2013.09.003 10.1016/j.jocd.2013.09.003
Cite this article
Leslie, W. D., Langsetmo, L., Zhou, W., Goltzman, D., Kovacs, C. S., Prior, J., Josse, R., Olszynski, W. P., Davison, K. S., Anastassiades, T., Towheed, T., Hanley, D. A., Kaiser, S. M., Lentle, B., Kreiger, N., & CaMos Research Group (2014). Choice of lumbar spine bone density reference database for fracture prediction in men and women: a population-based analysis. Journal of clinical densitometry : the official journal of the International Society for Clinical Densitometry, 17(2), 295-300. https://doi.org/10.1016/j.jocd.2013.09.003
Leslie WD, Langsetmo L, Zhou W, Goltzman D, Kovacs CS, Prior J, et al. Choice of lumbar spine bone density reference database for fracture prediction in men and women: a population-based analysis. J Clin Densitom. 2014;17(2):295-300. doi:10.1016/j.jocd.2013.09.003
Leslie, W. D., et al. "Choice of lumbar spine bone density reference database for fracture prediction in men and women: a population-based analysis." Journal of clinical densitometry : the official journal of the International Society for Clinical Densitometry, vol. 17, no. 2, 2014, pp. 295-300.
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