title: Fracture risk assessment without race/ethnicity information.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  This was a prospective cohort study.
  
  
  METHODS
  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.
  
  
  METHODS
  Self-reported, nondigital, noncraniofacial fractures were measured.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Geriatric Medicine, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655 Japan. ishiis-tky@umin.ac.jp
authors.forename: Shinya
authors.initials: S
authors.lastname: Ishii
authors.forename: Gail A
authors.initials: GA
authors.lastname: Greendale
authors.forename: Jane A
authors.initials: JA
authors.lastname: Cauley
authors.forename: Carolyn J
authors.initials: CJ
authors.lastname: Crandall
authors.forename: Mei-Hua
authors.initials: MH
authors.lastname: Huang
authors.forename: Michelle E
authors.initials: ME
authors.lastname: Danielson
authors.forename: Arun S
authors.initials: AS
authors.lastname: Karlamangla
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D001213:Asian / Q000706:statistics & numerical data; D049628:Body Size; D015519:Bone Density / Q000502:physiology*; D016208:Databases, Factual / Q000706:statistics & numerical data; D005260:Female; D005272:Femur Neck / Q000502:physiology*; D050723:Fractures, Bone / Q000453:epidemiology* / Q000503:physiopathology*; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D008954:Models, Biological; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data