Bone Mineral Density and the Risk of Incident Nonspinal Fractures in Black and White Women

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Abstract
The recently released US surgeon general’s report on bone health and osteoporosis noted that 1 in 2 individuals older than 50 years will be at risk for fractures from osteoporosis.1 Although fracture rates are lower among black women,2 the report emphasizes that osteoporosis is a real risk for any aging man or woman. The identification of individuals at risk for osteoporotic fracture is essential for prevention. Low bone mineral density (BMD) has been shown to be an important predictor of increased fracture risk.3-6 However, these data are primarily based on studies of North American and European white women. Two case-control studies of fracture in black women reported a higher risk of fracture with low body mass index (BMI), low physical activity, and poor neuromuscular function,7,8 but neither of these studies measured BMD. Low heel, forearm, or finger BMD was associated with an increased 1-year risk of fracture in black women.9 It is not known whether BMD in the axial skeleton, which is the criterion standard for assessing risk of osteoporosis, is related to fractures in older black women.