Bone Test Predicts Spine Fracture

Low Bone-Mineral Density Predicts Later Spine Fracture in Women

Medically Reviewed by Louise Chang, MD on December 18, 2007

Dec. 18, 2007 -- Postmenopausal women who seem healthy but have low bone-mineral density are at risk of spinal fracture later in life.

The finding comes from a 15-year study of nearly 2,700 women who were an average 69 years old at the start of the study.

Spinal fracture is the most common kind of fracture in women with osteoporosis, notes study researcher Jane A. Cauley, DrPH, of the University of Pittsburgh. It is also among the most feared consequences of aging, causing chronic pain, limited daily activities, and reduced quality of life.

"The idea is to prevent these fractures in the first place," Cauley tells WebMD. "People used to think osteoporosis was an inevitable part of aging. It is not inevitable. If you have a risk factor for osteoporosis, have a BMD test and talk to a doctor about your various treatment options."

Cauley's team also found that women who have a "silent," symptom-free spinal fracture are four times more likely to suffer a spinal fracture than women with no fracture and normal bone-mineral density (BMD).

If women have both low BMD and a previous spinal fracture, they have a very high risk of another spinal fracture. More than half of these women will have a new fracture, Cauley says.

A woman's overall risk of spinal fracture isn't small. The study showed that 18% of 69-year-old women had a spinal fracture within 15 years. The effect of doubling or quadrupling this risk is very large indeed.

"About a third of women with low BMD had a fracture, compared to only 9% among women with normal BMD," Cauley says. "For women with a low BMD and existing spinal fracture, about 56% had a new fracture. So clearly the two things to focus on are BMD and whether a fracture exists."

Cauley advises women at higher risk of osteoporosis to have their BMD checked before they reach their 60s.

"The current recommendation is all women 65 and older should have a BMD test. We think we should go a step further for some women younger than that," she says. "If you have a risk such as a mother who had a hip fracture, you're a current smoker, or if you fell recently and broke your wrist, then you should talk to a doctor and see about having a BMD test."

That sounds like sensible advice to Scott D. Boden, MD, professor of orthopaedic surgery and director of the Emory University Spine Center in Atlanta.

"Many factors go into risk of spinal fracture -- not only BMD but bone architecture, genetics, exercise level, hormonal status, lots of different things," Boden tells WebMD. "But if you have risk factors, it does not hurt to get your BMD screened. Because if your bone mass is low you should preserve it before you lose it. Now with these new treatments for osteoporosis, there are options worth considering for younger women."

Cauley and colleagues report their findings in the Dec. 19 issue of The Journal of the American Medical Association.

Show Sources

SOURCES: Cauley, J.A. The Journal of the American Medical Association, Dec.19, 2007; vol 298: pp 2761-2767. Jane A. Cauley, DrPH, professor and vice chairwoman for research, Graduate School of Public Health, University of Pittsburgh. Scott D. Boden, MD, professor of orthopaedic surgery and director, Emory Orthopaedics and Spine Center, Atlanta.

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