SPINAL TRABECULAR BONE LOSS AND FRACTURE IN AMERICAN AND JAPANESE WOMEN

This study examined trabecular bone mineral density (BMD) in Japanese women with and without spinal fracture, and compared the results to Am erican women with and without fracture. The quantitative computed tomo graphy (QCT) systems used at the University of California, San Francis co (UCSF) and at Nagasaki University were cross-calibrated. Normative BMD was assessed with the K2HPO4 liquid phantom in 538 Americans aged 20-85 years, and with the B-MAS200 phantom in 577 Japanese aged 20-83 years. These BMD were adjusted for use with the Image Analysis solid p hantom using the result of cross-calibration, The trabecular BMD in 11 1 postmenopausal American women (55 with fracture), and in 185 postmen opausal Japanese women (67 with fracture) were compared for investigat ion of the difference in BMD values relative to fracture status. The a bsolute BMD values in Japanese were lower than those in Americans, and the differences were greater with advancing age. The magnitude of the BMD difference was 8.6, 20.5, 38.1 mg/cm(3) in women aged 20-24 years , 40-44 years, 60-64 years, respectively. In premenopausal women, BMD began to decrease at the age of 20 in Japanese, whereas the peak bone mass was maintained until the age of 35 in the American women. In imme diate postmenopausal women, BMD significantly decreased in both popula tions. In later postmenopausal women, BMD significantly decreased with age in the Japanese women but decreased less rapidly in the American women. The aging decrease of BMD was 1.4% and 2.2% per year in the lat er postmenopausal American and Japanese women, respectively. The fract ure threshold is considered to be lower in Japanese women. However, th e BMD difference between American and Japanese women with fracture was similar to that without fracture. The Z-scores of fracture subjects v ersus controls were 2.9 in American and 1.8 in Japanese women. In conc lusion, Japanese women were found to have a lower BMD and lower fractu re threshold than American women. The significant decrease of spinal t rabecular BMD in late postmenopause is potentially responsible for the higher prevalence of spinal fracture in Japanese women.