title: Bone loss and the risk of non-vertebral fractures in women and men: the Tromsø study.
abstract: CONCLUSIONS
  We assessed the association between the rate of forearm bone loss and non-vertebral fracture. Bone loss at the distal forearm predicted fractures, independently of baseline BMD, but not independently of follow-up BMD in women. The BMD level where an individual ends up is the significant predictor of fracture risk.
  
  
  BACKGROUND
  Bone loss may predict fracture risk independently of baseline BMD. The influence of follow-up BMD on this prediction is unknown. The aim of this study was to assess the association between bone loss and fracture risk in both sexes in a prospective population-based study.
  
  
  METHODS
  We included 1,208 postmenopausal women (50 to 74 years), and 1,336 men (55 to 74 years) from the Tromsø Study, who had repeated distal and ultra-distal forearm BMD measurements. Non-vertebral fractures were registered from 2001 to 2005.
  
  
  RESULTS
  A total of 100 women and 46 men sustained fractures during the follow-up time. Independent of baseline BMD, the RR associated with distal site bone loss of 1 SD %/year was 1.23 (1.01-1.50) for low-trauma fractures (excluding hand, foot, skull & high-trauma) and 1.32 (1.07-1.62) for osteoporotic fractures (hip, wrist and shoulder). However, bone loss did not predict fracture after adjusting for follow-up BMD. The BMD level where an individual ends up became the significant predictor of fracture risk and not the rate of bone loss. Follow-up BMD at ultra-distal site was associated with low-trauma fractures in both sexes. While ultra-distal site BMD changes were not associated with fracture risk in both sexes.
  
  
  CONCLUSIONS
  Bone loss at the distal forearm predicted non-vertebral fractures, independently of baseline BMD, but not independently of follow-up BMD, in women. The BMD level where an individual ends up is the significant predictor of fracture risk and not the rate of bone loss.
authors: Institute of community medicine, University of Tromsø, 9037 Tromsø, Norway. luai.ahmed@uit.no
authors: L A
authors: LA
authors: Ahmed
authors: N
authors: N
authors: Emaus
authors: G K
authors: GK
authors: Berntsen
authors: A
authors: A
authors: Bjørnerem
authors: V
authors: V
authors: Fønnebø
authors: L
authors: L
authors: Jørgensen
authors: H
authors: H
authors: Schirmer
authors: J
authors: J
authors: Størmer
authors: R M
authors: RM
authors: Joakimsen
mesh_terms: D000368:Aged; D015519:Bone Density / Q000502:physiology; D018450:Disease Progression; D004812:Epidemiologic Methods; D005260:Female; D005542:Forearm / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D010024:Osteoporosis / Q000453:epidemiology* / Q000503:physiopathology; D015663:Osteoporosis, Postmenopausal / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology; D058866:Osteoporotic Fractures / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D012737:Sex Factors