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The Study of Osteoporotic Fractures

Teresa A. Hillier, MD, MS; Katie L. Stone, PhD; Doug C. Bauer, MD; Joanne H. Rizzo, MS; Kathryn L. Pedula, MS; Jane A. Cauley, DrPH; Kristine E. Ensrud, MD, MPH; Marc C. Hochberg, MD; Steve R. Cummings, MD

Arch Intern Med. 2007;167(2):155-160.

Background  Whether repeat bone mineral density (BMD) measurement adds benefit beyond the initial BMD measurement in predicting fractures in older women is unknown.

Methods  We prospectively measured total hip BMD in 4124 older women (mean ± SD age, 72 ± 4 years) from 1989 to 1990 and again 8 years later. Incident nontraumatic hip and nonspine fractures were validated by radiology reports (>95% follow-up). In addition, spine fractures were defined morphometrically in 2129 of these women by lateral spine x-ray films from 1991 to 1992 and then again 11.4 years later. Prediction of fracture risk was assessed with proportional hazards models and receiver operating characteristic curves for BMD measures.

Results  Over a mean of 5 years after the repeat BMD measure, 877 women experienced an incident nontraumatic nonspine fracture (275 hip fractures). In addition, 340 women developed a spine fracture. After adjustment for age and weight change, initial and repeat BMD measurements were similarly associated with fracture risk (per unit standard deviation lower in BMD) for nonspine (hazard ratio, 1.6), spine (odds ratio, 1.8-1.9), and hip (hazard ratio, 2.0-2.2) fractures (P<.001 for all models). Areas under the receiver operating characteristic curves (AUC) revealed no significant differences to discriminate nonspine (AUC, 0.65), spine (AUC, 0.67-0.68), or hip (AUC, 0.73-0.74) fractures between models with initial BMD, repeat BMD, or initial BMD plus change in BMD. Stratification by initial BMD t scores (normal, osteopenic, or osteoporotic), high bone loss, or hormone therapy did not alter results.

Conclusion  In healthy, older, postmenopausal women, repeating a measurement of BMD up to 8 years later provides little additional value besides the initial BMD measurement for predicting incident fractures.

Author Affiliations: Center for Health Research, Kaiser Permanente Northwest/Hawaii, Portland, Ore (Dr Hillier and Mss Rizzo and Pedula); San Francisco Coordinating Center, California Pacific Medical Center, and Department of Medicine, University of California, San Francisco (Drs Stone, Bauer, and Cummings); Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pa (Dr Cauley); Department of Medicine, Minneapolis VA Medical Center and University of Minnesota, Minneapolis (Dr Ensrud); and Department of Medicine, University of Maryland, Baltimore (Dr Hochberg).

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