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

THE RECENTLY RELEASED US SUR-geon general’s report on bonehealth and osteoporosis notedthat 1 in 2 individuals older than 50 years will be at risk for frac-tures from osteoporosis.1 Although frac-ture rates are lower among black wom-en,2 the report emphasizes that osteoporosis is a real risk for any ag-ing 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 stud-ies of North American and European white women. Two case-control stud-ies of fracture in black women re-ported a higher risk of fracture with low body mass index (BMI), low physical activity, and poor neuromuscular func-tion,7,8 but neither of these studies mea-sured BMD. Low heel, forearm, or fin-ger 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 cri-terion standard for assessing risk of os-teoporosis, is related to fractures in older black women. In the current study, we examined the relationship between BMD mea-sured by dual-energy x-ray absorpti-ometry (DXA) and incident nonspinal fractures in 636 black and 7334 white women enrolled in the Study of Osteo