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- Title
Fracture risk assessment without race/ethnicity information.
- Authors
Ishii S; Greendale GA; Cauley JA; Crandall CJ; Huang MH; Danielson ME; Karlamangla AS; Ishii, Shinya; Greendale, Gail A; Cauley, Jane A; Crandall, Carolyn J; Huang, Mei-Hua; Danielson, Michelle E; Karlamangla, Arun S
- Abstract
<bold>Context: </bold>Dual-energy x-ray absorptiometry-derived bone mineral density (BMD) does not explain interracial differences in fracture risk; thus, BMD-based fracture risk assessment requires patient race/ethnicity information and ethnicity-specific BMD reference databases.<bold>Objective: </bold>The objective of the study was to investigate whether composite femoral neck strength indices, which integrate dual-energy x-ray absorptiometry-derived femoral neck size, femoral neck BMD, and body size, will allow fracture risk assessment without requiring race/ethnicity information.<bold>Design: </bold>This was a prospective cohort study.<bold>Setting and Participants: </bold>A total of 1940 community-dwelling women aged 42-53 yr from four race/ethnicity groups (968 Caucasian, 512 African-American, 239 Japanese, and 221 Chinese) were followed up for 9 yr.<bold>Outcome Measurements: </bold>Self-reported, nondigital, noncraniofacial fractures were measured.<bold>Results: </bold>Two hundred and two women (10.4%) sustained fractures and 82 (4.3%) had minimum-trauma fractures. Each sd increment in any of the strength indices was associated with a 34-41% reduction in fracture hazard over 9 yr (each P<0.001). Race/ethnicity predicted fracture hazard independent of BMD (P=0.02) but did not predict fracture hazard independent of any of the composite indices (P=0.11-0.22). Addition of race/ethnicity did not improve risk discrimination ability of the strength indices, but did significantly improve the discrimination ability of BMD. The discrimination ability of BMD with race/ethnicity was not statistically different from that of any of the strength indices without race/ethnicity.<bold>Conclusions: </bold>Composite strength indices of the femoral neck can predict fracture risk without race/ethnicity information as accurately as bone mineral density does in combination with race/ethnicity information and therefore would allow risk prediction in people of mixed race/ethnicity and in groups without a BMD reference database.
- Publication
Journal of Clinical Endocrinology & Metabolism, 2012, Vol 97, Issue 10, p3593
- ISSN
0021-972X
- Publication type
journal article
- DOI
10.1210/jc.2012-1997