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Bone mineral density as a predictor of subsequent wrist fractures: findings from the Women’s Health Initiative Study

Crandall CJ, Hovey KM, Andrews CA, Cauley JA, Manson JE, Wactawski-Wende J, Wright NC, Li W, Beavers K, Curtis JR, LeBoff MS. Bone mineral density as a predictor of subsequent wrist fractures: findings from the Women’s Health Initiative Study. J Clin Endocrinol Metab. 2015 Sep 14:jc20152568. [Epub ahead of print]

 

Abstract

CONTEXT:

Wrist fractures are common among postmenopausal women. Associations of bone mineral density (BMD) and 10-year predicted risk of major osteoporotic fracture (MOF) with wrist fractures are poorly characterized.

OBJECTIVE:

To examine associations between the Fracture Risk Assessment Tool (FRAX)-predicted risk of MOF, BMD, BMD change, and wrist fracture.

DESIGN:

Prospective observational study; mean follow-up 8.5 years.

SETTING:

Forty U.S. centers.

PARTICIPANTS:

11,392 participants of the Women's Health Initiative BMD Cohort aged 50-79 years at baseline.

INTERVENTIONS:

None.

MAIN OUTCOME:

Incident wrist fracture Results: A FRAX-predicted MOF risk ≥ 9.3% identified 17% of the women aged < 65 years who subsequently experienced wrist fracture. Each one standard deviation lower BMD was associated with higher wrist fracture risk, with adjusted hazard ratio (aHR) (95% confidence interval [CI]) of 1.66 (1.42-1.93) for femoral neck (FN) BMD and 1.45 (1.28-1.64) for lumbar spine (LS) BMD. Compared with FN BMD T-score ≥-1.0, wrist fracture aHR (95% CI) were: 1.51 (1.06-2.16) for T-score between -1.01 and -1.49; 1.93 (1.36-2.72) for T-score between -1.50 and -1.99; 2.52 (1.77-3.60) for T-score between -2.00 and -2.49; and 2.65 (1.78-3.95) for T-score ≤-2.5. Decrease in FN BMD between baseline and year 3 was associated with increased risk of subsequent wrist fracture; however, change in LS BMD was not.

CONCLUSIONS:

Lumbar spine and femoral neck BMD were associated with incident wrist fracture, but the FRAX threshold recommended to identify screening candidates did not identify the majority of women who subsequently experienced wrist fracture. Improved understanding of determinants of wrist fractures is warranted.