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Which Fractures Are Associated with Low Appendicular Bone Mass in Elderly Women?

Dana G. Seeley, MS; Warren S. Browner, MD, MPH; Michael C. Nevitt, PhD; Harry K. Genant, MD; Jean C. Scott, RN, MPH; Steven R. Cummings, MD, Study of Osteoporotic Fractures Research Group*
[+] Article and Author Information

Grant Support: By Public Health Service grants AG05394, AG05407, AR35582, AR35583, and AR35584.

Requests for Reprints: Dana G. Seeley, MS, Department of Epidemiology and Biostatistics, University of California, 74 New Montgomery, Suite 600, San Francisco, CA 94105.

Current Author Addresses: Ms. Seeley and Drs. Browner, Cummings, and Nevitt: Department of Epidemiology and Biostatistics, University of California, 74 New Montgomery, Suite 600, San Francisco, CA 94105.

Ms. Scott: University of Maryland, Department of Epidemiology and Preventive Medicine, 660 West Redwood Street, Howard Hall, Room 140, Baltimore, MD 21201.

Dr. Genant: Department of Radiology, University of California, Box 0628. San Francisco, CA 94143.


From the University of California, San Francisco, California; and the University of Maryland, Baltimore, Maryland. For current author addresses, see end of text.*For members of the Study of Osteoporotic Fractures Research Group, see the Appendix.


© 1991 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1991;115(11):837-842. doi:10.7326/0003-4819-115-11-837
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Objective: To determine which types of fractures have an increased incidence in elderly women with low appendicular bone mass.

Design: Prospective cohort study.

Setting: Four clinical centers in the United States (Baltimore, Maryland; Minneapolis, Minnesota; Portland, Oregon; Monangehela Valley, Pennsylvania); and one coordinating center in San Francisco, California.

Subjects: Ambulatory, nonblack women (9704) aged 65 years or more who were recruited from population-based listings.

Measurements: We measured bone mass at the distal and proximal radius and calcaneus using single-photon absorptiometry. Fractures were verified radiographically. Associations were calculated as age-adjusted hazard ratios (with 95% CIs) per standard deviation decrease in bone mass.

Main Results: During a mean follow-up of 2.23 years, 841 nonspinal fractures occurred in 753 women. The risks for fractures of the wrist, foot, humerus, hip, rib, toe, leg, pelvis, hand, and clavicle were significantly related to reduced bone mass (P < 0.05). These fractures represented 74% of nonspinal fractures. The overall hazard ratio for the occurrence of one or more of these fractures was 1.65 (Cl, 1.49 to 1.82) at the distal radius. In a subsample of the cohort, vertebral fractures were also related to low bone mass. Fractures of the ankle, elbow, finger, and face, however, were not associated with bone mass at any measurement site; the overall hazard ratio for these fractures was 1.12 (Cl, 0.96 to 1.30) at the distal radius.

Conclusion: Most types of fractures have an increased incidence in elderly women with low bone mass.

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