Abstract
Summary
This study aimed to determine whether low bone mineral density (BMD) at the femoral neck independently predicts all-cause mortality in elderly Japanese women. A prospective cohort study of 271 women aged 67–89 years was conducted. A Cox proportional hazard model was used to examine independent associations between BMD and total mortality. During a 12-year follow-up period, the mortality risk (as measured by hazard ratio [HR]) was significantly increased in the three categories of baseline BMD (diagnostic criteria of osteoporosis, tertile of BMD, and quartile of BMD). After adjusting for major potential confounding variables for mortality, significantly increased mortality risks were found in subjects with osteoporosis (HR = 2.17, p = 0.032), in subjects in the lowest tertile (HR = 2.57, p = 0.007), and in subjects in the lowest quartile (HR = 3.13, p = 0.014], respectively. Our findings suggest that preventive strategies should be considered to increase and maintain high BMD at the femoral neck in the elderly women not only to prevent hip fractures but also probably to reduce mortality risk.
Introduction
Several longitudinal studies with Caucasian subjects have suggested that osteoporosis is associated with increased mortality. This study aimed to determine whether low bone mineral density (BMD) at the femoral neck independently predicts all-cause mortality in elderly Japanese community-dwelling women.
Method
A prospective cohort study of 271 women aged 67–89 years was conducted. A Cox proportional hazard model was used to examine independent associations between BMD at both the femoral neck and the trochanter and total mortality.
Results
During a 12-year follow-up period, 81 of 271 women (29.9%) died. An independent and significant relationship was found between baseline BMD at the femoral neck and mortality risk. The mortality risk (as measured by HR) was increased by 2.80-fold (95% confidence interval [CI] 1.55–5.06; p < 0.01) in the subjects with osteoporosis or by 2.94-fold (95% CI 1.64–5.26; p < 0.001) in subjects in the lowest tertile or by 3.61-fold (95% CI 1.77–7.41; p < 0.001) in subjects in the lowest quartile of BMD, respectively. After adjusting for major potential confounding factors for mortality such as age, body mass index, blood pressure, blood variables, medical history, alcohol drinking, and smoking status, those in the subjects with osteoporosis (HR = 2.17 [95% CI 1.07–4.41], p = 0.032), in the lowest tertile (HR = 2.57 [95% CI 1.29–5.15], p = 0.007), or in the lowest quartile (HR = 3.13 [95% CI 1.26–7.73], p = 0.014] had a significantly increased risk of mortality. BMD measurement at the trochanter showed similar but weaker results.
Conclusions
Our findings suggest that preventive strategies should be considered to increase and maintain high BMD at the femoral neck in elderly subjects not only to prevent osteoporosis and its associated fractures but also probably to reduce mortality risk.
Similar content being viewed by others
References
Melton LJ III (1995) Epidemiology of fractures. In: Riggs BL, Melton LJ III (eds) Osteoporosis : etiology, diagnosis and management, 2nd edn. Lippincott-Raven, Philadelphia, pp 225–247
Fisher ES, Baron JA, Malenka DJ, Barrett JA, Kniffin WD, Whaley FS, Bubolz TA (1991) Hip fracture incidence and mortality in New England. Epidemiology 2:116–122
Magaziner J, Simonsick EM, Kashner TM, Hebel JR, Kenzora JE (1989) Survival experience of aged hip fracture patients. Am J Public Health 79:274–278
Pitto RP (1994) The mortality and social prognosis of hip fractures. A prospective multifactorial study. Int Orthop 18:109–113
Muraki S, Yamamoto S, Ishibashi H, Nakamura K (2006) Factors associated with mortality following hip fracture in Japan. J Bone Miner Metab 24:100–104
Johansson C, Black D, Jonell O, Oden A, Mellstrom D (1998) Bone mineral density is a predictor of survival. Calcif Tissue Int 63:190–196
Kado DM, Browner WS, Palemo L, Nevitt MC, Genant HK, Cummings SR (1999) Vertebral fractures and mortality in older women. Arch Int Med 159:1215–1220
Ensruud KE, Thompson DE, Cauley JA, Nevitt MC, Kado DM, Hochoberg MC, Santora AC, Black DM (2000) Prevalent vertebral deformities predict mortality and hospitalization in older women with low bone mass. J Am Geriat Soc 48:241–249
Trivedi DP, Khaw KT (2001) Bone mineral density at the hip predicts mortality in elderly men. Osteoporos Int 12:259–265
Nguyen ND, Center JR, Eisman JA, Nguyen TV (2007) Bone loss, weight loss, and weight fluctuation predict mortality risk in elderly men and women. J Bone Miner Res 22:1147–1154
Browner WS, Seeley DG, Vogt TM, Cummings SR (1991) Non-trauma mortality in elderly women with low bone mineral density. Study of Osteoporotic Fracture Research Group. Lancet 338:355–358
Lu-Yao GL, Baron JA, Barrett JA, Fisher ES (1994) Treatment and survival among elderly Americans with hip fractures: a population-based study. Am J Public Health 84:1287–1291
Browher WS, Pressman AR, Nevitt MC, Cummings SR (1996) Mortality following fractures in older women: the study of osteoporotic fractures. Arch Intern Med 156:1521–1525
Forsen L, Sogaard AJ, Meyer HE, Enda TH, Kopjar B (1999) Survival after hip fracture: short-and long-term excess mortality according to age and gender. Osteoporos Int 10:73–78
Kin K, Lee JH, Kushida K, Sartoris DJ, Ohmura A, Clopton PL, Inoue T (1993) Bone density and body composition on the Pacific Rim: a comparison between Japanese-born and U.S.-born Japanese–American women. J Bone Miner Res 8:861–869
Ross PD, Orimo H, Wasnich RD, Vogel C, MacLean JW, Nomura DA (1989) Methodologic issues in comparing genetic and environmental influence on bone mass. Bone Miner 7:67–77
Gallagher JC, Melton LJ III, Riggs BL, Bergstrath E (1980) Epidemiology of fractures of the proximal femur in Rochester, Minnesota. Clin Orthop 150:163–171
Johnell O, Gullberg B, Allender E, Kanis JA, the MEDOS Study Group (1992) The apparent incidence of hip fracture in Europe: a study of national register source. Osteoporos Int 2:298–302
Suzuki T, Yoshida H, Hashimoto T, Yoshimura N, Fujiwara S, Fukunaga M, Nakamura T, Yoh K, Inoue T, Hosoi T, Orimo H (1997) Case–control study of risk factors for hip fractures in the Japanese elderly by a MEDOS questionnaire. Bone 21:461–467
Jonell O, Kanis JA, Oden A, Johansson H, Laet De, Delmas P, Eisman JA, Fujiwara S, Kroger H, Mellstrom D, Meunier PJ, Melton LJ III, O’Neil T, Pols H, Reeve J, Silman A, Tenenhause A (2005) Predictive value of BMD for hip and other fractures. J Bone Miner Res 20:1185–1194
Rivadeneira F, Zillikens MC, De Laet CEDH, Hofman A, Uitterlinden AG, Beck TJ, Pols HAP (2007) Femoral neck BMD is a strong predictor of hip fracture susceptibility in elderly men and women because it detects cortical bone instability: the Rotterdam Study. J Bone Miner Res 22:1781–1790
Suzuki T, Shibata H (2003) An introduction of the Tokyo Metropolitan Institute of Gerontology Longitudinal Interdisciplinary Study on Aging (TMIG-LISA, 1991–2001). Geriatr Gerontol Int 3:S1–S4
Shibata H, Suzuki T, Shimonaka Y (1997) Overview of a new longitudinal interdisciplinary study on aging (TMIG-LISA, 1991–2001). In: Guez D et al (eds) Facts, research and intervention in geriatrics. Springer, New York, pp 7–20
Suzuki T, Haga H, Yasumura S, Nagai H, Shibata H (1994) Vertebral bone mineral density of the elderly in the urban community by mobile DXA. J Bone Miner Metab 12:9–16
Laskey MA, Flaxman ME, Barber RW, Trattord S, Hayball MP, Lyttle KD (1991) Comparative performance in vitro and in vivo of Lunar DPX and Hologic QDR-1000 dual energy X-ray absorptiometers. Br J Radiol 64:1023–1029
von der Recke P, Hansen MA, Hassager C (1999) The association between low bone mass at the menopause and cardiovascular mortality. Am J Med 106:273–278
Van der Klift M, Polas HAP, Geleijnse JM, Van der Kuip DAM, De HA, Laet CEDH (2002) Bone mineral density and mortality in elderly men and women: the Rotterdam Study. Bone 30:643–648
Tanko’ LB, Christiansen C, Cox DA, Geiger MJ, McNabb MA, Cummings SR (2005) Relationship between osteoporosis and cardiovascular disease in postmenopausal women. J Bone Miner Res 20:1912–1920
Demer LL, Tintut Y (2003) Mineral exploration: search for the mechanism of vascular calcification and beyond: the 2003 Jeffrey M. Hoeg Award lecture. Arterioscler Thromb Vasc Biol 23:1739–1743
Kammerer CM, Dualan AA, Samollow PB, Perisse AR, Bauer RL, MacCluer JW, O’Leary DH, Mitchell BD (2004) Bone mineral density, carotid artery intimal medial thickness, and the vitamin D receptor Bsm I polymorphism in Mexican American women. Calcif Tissue Int 75:297–298
Towler DA, Shao J-S, Cheng S-L, Pingsterhaus JM, Loewy AP (2006) Osteogenic regulation of vascular calcification. Ann NY Acad Sci 1068:327–333
Hofbauer LC, Brueck CC, Shanahan CM, Schoppet M, Dobnig H (2007) Vascular calcification and osteoporosis—from clinical observation towards molecular understanding. Osteoporos Int 18:251–259
Samelson EJ, Cupples LA, Broe KE, Hannan MI, O’Donnell CJ, Kiel DP (2007) Vascular calcification in middle age and long-term risk of hip fracture: the Frammingham Study. J Bone Miner Res 22:1449–1454
Iribarren C, Sidney S, Sternfeld B, Browner WS (2000) Calcification of the aortic arch: Risk factors and association with coronary heart disease, stroke, and peripheral vascular disease. JAMA 283:2810–2815
Wilson PW, Kauppila LI, O’Donnell CJ, Kiel DP, Hannan M, Polak JM, Cupples LA (2001) Abdominal aortic calcitic deposits are an important predictor of vascular morbidity and mortality. Circulation 103:1529–1534
Browne WS, Pressman AR, Nevitt MC, Cauley JA, Cummings SR (1993) Association between low bone density and stroke in elderly women. The study of osteoporotic fractures. Stroke 24:940–946
Sambrook PN, Chen CJS, March L, Cameron JD, Cumming RG, Lord SR, Simpson JM, Seibel MJ (2006) High bone turnover is an independent predictor of mortality in the frail elderly. J Bone Miner Res 21:549–555
Cauley JA, Lucas FLL, Kuller LH, Vogt MI, Browner WS, Cummings SR (1996) Bone mineral density and risk of breast cancer in older women. The Study of Osteoporosis Fractures. JAMA 276:1404–1408
Zang Y, Kiel DP, Kreger BE, Cupples LA, Ellison RC, Dorgan JF (1997) Bone mass and the risk of breast cancer among postmenopausal women. N Engl J Med 336:611–617
Shepherd JA, Cheng XL, Lu Y (2002) Universal standardization of forearm bone densitometry. J Bone Miner Res 17:734–745
Stone KL, Seeley DG, Lui LY (2003) BMD at multiple sites and risk of fracture of multiple types: long-term results from the study of osteoporotic fractures. J Bone Miner Res 18:1947–1954
Marshall D, Johnell O, Wedel H (1996) Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ 312:1254–1259
Cummings SR, Bates D, Black DM (2002) Clinical use of bone densitometry: scientific review. JAMA 288:1889–1897
Fujiwara S, Kasagi F, Masunari N, Naito K, Suzuki G, Fukunaga M (2003) Fracture prediction from bone mineral density in Japanese men and women. J Bone Miner Res 18:1547–1553
Acknowledgements
The authors gratefully acknowledge Hiroshi Shibata MD, Ph.D., Graduate School of International Studies, Obirin University, and Mr. Hisakazu Moriki and Mr. Yoshinori Nagai, Toyo Medic Co. Ltd., for their research support and assistances in the DXA scanning and analysis. We would also like to thank the subjects whose participation made this investigation possible.
Funding sources
This work was supported in part by a Grant-in-Aid for Scientific Research on the Tokyo Metropolitan Institute of Gerontology, Longitudinal and Interdisciplinary Study on Aging (TMIG-LISA) from the Tokyo Metropolitan Government
Conflicts of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Suzuki, T., Yoshida, H. Low bone mineral density at femoral neck is a predictor of increased mortality in elderly Japanese women. Osteoporos Int 21, 71–79 (2010). https://doi.org/10.1007/s00198-009-0970-6
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00198-009-0970-6