title: Contribution of Lumbar Spine BMD to Fracture Risk in Individuals With T-Score Discordance.
abstract: Fracture risk estimates are usually based on femoral neck (FN) BMD. It is unclear how to address T-score discordance, where lumbar spine (LS) T-score is lower than FN T-score. The objective of this work was to examine the impact of LS BMD on fracture risk, in individuals with lower LS T-score than FN T-score. Participants aged 60+ years from the Dubbo Osteoporosis Epidemiology Study with LS and FN BMD measured at first visit, and were followed from 1989 to 2014. Five-hundred and seventy-three (573) of 2270 women and 131 of 1373 men had lower LS than FN T-score by ≥ 0.6 standard deviation (SD) (low-LS group based on least significant change). In low-LS women, each 1 SD lower LS T-score than FN was associated with a 30% increase in fracture risk (hazard ratio [HR] 1.30; 95% CI, 1.11 to 1.45). For low-LS men there was a 20% nonsignificant increase in fracture risk for each 1 SD lower LS than FN T-score (HR 1.20; 95% CI, 0.10 to 1.67). Low-LS women had greater absolute fracture risks than the rest of the women. This increased risk was more apparent for lower levels of FN T-score and in older age groups. At an FN T-score of -2, low-LS women had a 3%, 10%, and 23% higher 5-year absolute fracture risk than non-low LS women in the 60 to 69 year, 70 to 79 year, and 80+ years age-groups, respectively. Furthermore, an osteoporotic LS T-score increased 5-year absolute fracture risk for women with normal or osteopenic FN T-score by 10% to 13%. Men in the low-LS group had very few fractures; therefore, a meaningful analyses of fracture risk could not be conducted. This study shows the significant contribution of lower LS BMD to fracture risk over and above FN BMD in women. A LS BMD lower than FN BMD should be incorporated into fracture risk calculators at least for women in older age-groups.
authors.affiliation: Osteoporosis and Bone Biology, Garvan Institute of Medical Research, Sydney, Australia.
authors.forename: Dunia
authors.initials: D
authors.lastname: Alarkawi
authors.affiliation: Osteoporosis and Bone Biology, Garvan Institute of Medical Research, Sydney, Australia.
authors.forename: Dana
authors.initials: D
authors.lastname: Bliuc
authors.affiliation: Osteoporosis and Bone Biology, Garvan Institute of Medical Research, Sydney, Australia.|Faculty of Medicine, University of New South Wales (UNSW) Australia, Sydney, Australia.
authors.forename: Tuan V
authors.initials: TV
authors.lastname: Nguyen
authors.affiliation: Osteoporosis and Bone Biology, Garvan Institute of Medical Research, Sydney, Australia.|Faculty of Medicine, University of New South Wales (UNSW) Australia, Sydney, Australia.|Clinical School, St Vincent's Hospital, Sydney, Australia.|Clinical Translation and Advanced Education, Garvan Institute of Medical Research, Sydney, Australia.|School of Medicine Sydney, University of Notre Dame Australia, Sydney, Australia.
authors.forename: John A
authors.initials: JA
authors.lastname: Eisman
authors.affiliation: Osteoporosis and Bone Biology, Garvan Institute of Medical Research, Sydney, Australia.|Faculty of Medicine, University of New South Wales (UNSW) Australia, Sydney, Australia.|Clinical School, St Vincent's Hospital, Sydney, Australia.
authors.forename: Jacqueline R
authors.initials: JR
authors.lastname: Center
mesh_terms: D000368:Aged; D015519:Bone Density; D005260:Female; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000453:epidemiology* / Q000378:metabolism*; D006801:Humans; D008159:Lumbar Vertebrae / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000453:epidemiology* / Q000378:metabolism*; D012307:Risk Factors
keywords: FRACTURE RISK ASSESSMENT; GENERAL POPULATION STUDIES; OSTEOPOROSIS