PREDICTION OF FRACTURE RISK USING AXIAL BONE-MINERAL DENSITY IN A PERIMENOPAUSAL POPULATION - A PROSPECTIVE-STUDY

Several prospective studies have shown that the bone mineral density ( BMD) measured in the appendicular or axial skeleton has an inverse rel ationship with the risk of subsequent fractures. However, most of thes e studies have concentrated on relatively old age groups, and the usef ulness of measuring BMD at the time of menopause has not been establis hed In the present study, BMD was measured at the lumbar spine and fem oral neck by dual X-ray absorptiometry (DXA) in a random stratified po pulation sample of 3222 perimenopausal women (mean age 53.4 years, ran ge 47-59 years). These women were followed for fractures over a period of 2 years. The fractures reported by a postal inquiry were verified from medical records. Fractures sustained in motor vehicle accidents w ere excluded from the analyses. During a mean follow-up of 2.4 years, 183 fractures occurred in 168 women. Wrist (n = 47), ankle (n = 31), a nd rib (n = 28) were the most common sites of a fracture. Women in the lowest quartile of spinal BMD had a 2.9 times greater risk of fractur e than those in the highest quartile. The respective risk increased 2. 2 times from the lowest to the highest quartile of femoral BMD, respec tively. The relative risk for suffering from any fracture per one SD d ecrease in BMD was 1.50 (95% CI; 1.27-1.76) for the spine and 1.41 (1. 21-1.64) for the femoral neck The present study demonstrates that bone mass is important in the pathogenesis of fractures even in perimenopa usal women. We conclude that the axial BMD measurement at the time of menopause can be of use in predicting subsequent fracture risk