Karen L. Margolis, MD, MPH; Kristine E. Ensrud, MD, MPH
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Margolis K., Ensrud K.; Body Size and Vertebral Fractures. Ann Intern Med. 2001;134:796. doi: 10.7326/0003-4819-134-9_Part_1-200105010-00022
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Published: Ann Intern Med. 2001;134(9_Part_1):796.
Dr. Blank notes that DXA is not a volumetric measurement of BMD. He cites evidence that BMD of the lumbar vertebrae as measured by DXA is correlated with height and weight, whereas volumetric BMD measurements are not (1). He suggests that this may explain our finding that the associations between larger body size and risks for hip, pelvis, and rib fractures are eliminated by adjustment for hip BMD since DXA measurement captures bone size as well as BMD.
To test this hypothesis, we did additional proportional hazards analyses of the associations between total body weight and risks for hip, pelvis, and rib fractures. By using the same approach as reported in Table 2 of our paper, we tested one set of models by adding height at visit 2 to the existing adjustments for age, smoking status, physical activity, history of falls, estrogen use, and health status. We then tested a second set of models that included an additional adjustment for total-hip BMD. The adjustment for height as a proxy for bone size did not affect our results or conclusions. After adjustment for height, age, smoking status, physical activity, history of falls, estrogen use, and health status, women in the lowest quartile of weight (<57.8 kg) compared with those in the upper quartile (>73.3 kg) had an increased risk for hip fracture (odds ratio [OR], 2.1 [95% CI, 1.5 to 3.0]), pelvis fracture (OR, 2.7 [CI, 1.3 to 5.6]), and rib fracture (OR, 2.0 [CI, 1.2 to 3.2]). After further adjustment for BMD, the point estimates of risk were reduced and no longer reached statistical significance (OR for hip fracture, 0.9 [CI, 0.6 to 1.3]; OR for pelvis fracture, 1.5 [CI, 0.7 to 3.3]; OR for rib fracture, 1.3 [CI, 0.7 to 2.2]).
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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