This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (53)  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in JAMA  Topic Collections  • Rheumatology  • Osteoporosis  • Women's Health  • Women's Health, Other  • Alert me on articles by topic  Social Bookmarking   What's this?

Jane A. Cauley, DrPH; Li-Yung Lui, MA, MS; Kristine E. Ensrud, MD, MPH; Joseph M. Zmuda, PhD; Katie L. Stone, PhD; Marc C. Hochberg, MD; Steven R. Cummings, MD

JAMA. 2005;293:2102-2108.

Context  Black women have a lower rate of fracture than white women, but whether bone mineral density (BMD) predicts fracture risk as well in black women as it does in white women is not established.

Objective  To examine the association between BMD and incident nonspinal fractures in older black and white women.

Design, Setting, and Participants  Prospective cohort study of baseline data collected from 1986 through 1990 (7334 white women aged 67-99 years) and from 1996 through 1998 (636 black women aged 65-94 years) at 4 US clinical centers in the Study of Osteoporotic Fractures; mean (SD) follow-up of 6.1 (1.5) years until October 1, 2004.

Main Outcome Measures  Incident nonspinal fractures were confirmed by radiograpic report. Total hip and femoral neck BMD and bone mineral content were measured by dual energy x-ray absorptiometry.

Results  A total of 58 black women had a combined total of 61 fractures and 1606 white women had a combined total of 1712 fractures. In age-adjusted proportional hazard models, a 1-SD decrease in femoral neck BMD was associated with a 37% increased risk of fracture in black women (relative risk [RR], 1.37; 95% confidence interval [CI], 1.08-1.74) and a 49% increase in fracture in white women (RR, 1.49; 95% CI, 1.40-1.58). Adjustment for body weight and other risk factors for fracture weakened the association between BMD and fracture, especially among black women (multivariable adjusted RR per 1-SD decrease in femoral neck BMD for black vs white women: RR, 1.20 [95% CI, 0.93-1.55] vs RR, 1.42 [95% CI, 1.32-1.52]). The absolute incidence of fracture across the pooled BMD distribution was 30% to 40% lower among black women at every BMD tertile. The lower risk of fracture among black compared with white women was independent of BMD and other risk factors (RR, 0.48; 95% CI, 0.36-0.64).

Conclusions  Decreased total hip and femoral neck BMD is associated with an increased risk of fracture in both older black and white women, but this relationship was largely explained by other risk factors in black women. Black women have a lower fracture risk than white women at every level of BMD. Race-specific normative databases may be appropriate for the densitometric definition of osteoporosis.

Author Affiliations: Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pa (Drs Cauley and Zmuda); Department of Medicine, Univeristy of California, San Francisco (Ms Lui and Dr Stone); VA Medical Center and Department of Medicine and Epidemiology, University of Minnesota, Minneapolis (Dr Ensrud); Departments of Medicine, Epidemiology, and Preventive Medicine, University of Maryland, Baltimore (Dr Hochberg); and California Pacific Medical Center, San Francisco (Dr Cummings).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati     What's this?

RELATED ARTICLE

Bone Density and the Risk of Fractures: Should Treatment Thresholds Vary by Race?
Louise S. Acheson
JAMA. 2005;293(17):2151-2154.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Differences in vitamin D status as a possible contributor to the racial disparity in peripheral arterial disease
Reis et al.
Am. J. Clin. Nutr. 2008;88:1469-1477.
ABSTRACT | FULL TEXT  

Gene Encoding Duffy Antigen/Receptor for Chemokines Is Associated with Asthma and IgE in Three Populations
Vergara et al.
Am. J. Respir. Crit. Care Med. 2008;178:1017-1022.
ABSTRACT | FULL TEXT  

The bare bones of race.
Fausto-Sterling
Social Studies of Science 2008;38:657-694.
ABSTRACT  

African Americans, 25-hydroxyvitamin D, and osteoporosis: a paradox
Aloia
Am. J. Clin. Nutr. 2008;88:545S-550S.
ABSTRACT | FULL TEXT  

Bone Mineral Density Changes during the Menopause Transition in a Multiethnic Cohort of Women
Finkelstein et al.
J. Clin. Endocrinol. Metab. 2008;93:861-868.
ABSTRACT | FULL TEXT  

Epilepsy-associated bone mineral density loss should be prevented
Trevathan
Neurology 2008;70:166-167.
FULL TEXT  

Body Mass Index and Mortality among Older Breast Cancer Survivors in the Study of Osteoporotic Fractures
Reeves et al.
Cancer Epidemiol. Biomarkers Prev. 2007;16:1468-1473.
ABSTRACT | FULL TEXT  

Identification of mouse Duffy Antigen Receptor for Chemokines (Darc) as a BMD QTL gene
Edderkaoui et al.
Genome Res 2007;17:577-585.
ABSTRACT | FULL TEXT  

The Risk of Hip Fractures in Older Individuals With Diabetes: A population-based study
Lipscombe et al.
Diabetes Care 2007;30:835-841.
ABSTRACT | FULL TEXT  

Osteoporosis Redux
Lentle and Worsley
JNM 2006;47:1945-1959.
FULL TEXT  

Optimal vitamin D status and serum parathyroid hormone concentrations in African American women.
Aloia et al.
Am. J. Clin. Nutr. 2006;84:602-609.
ABSTRACT | FULL TEXT  

Genetic Susceptibility Contributes to Renal and Cardiovascular Complications of Type 2 Diabetes Mellitus
Freedman et al.
Hypertension 2006;48:8-13.
FULL TEXT  

High Prevalence of Vitamin D Inadequacy and Implications for Health
Holick
Mayo Clin Proc. 2006;81:353-373.
ABSTRACT | FULL TEXT  

Bone Density and the Risk of Fractures: Should Treatment Thresholds Vary by Race?
Acheson
JAMA 2005;293:2151-2154.
FULL TEXT