An approach to identifying osteopenic women at increased short-term risk of fracture

Arch Intern Med. 2004 May 24;164(10):1113-20. doi: 10.1001/archinte.164.10.1113.


Background: Identification and management of women to reduce fractures is often limited to T scores less than -2.5, although many fractures occur with higher T scores. We developed a classification algorithm that identifies women with osteopenia (T scores of -2.5 to -1.0) who are at increased risk of fracture within 12 months of peripheral bone density testing.

Methods: A total of 57 421 postmenopausal white women with baseline peripheral T scores of -2.5 to -1.0 and 1-year information on new fractures were included. Thirty-two risk factors for fracture were entered into a classification and regression tree analysis to build an algorithm that best predicted future fracture events.

Results: A total of 1130 women had new fractures in 1 year. Previous fracture, T score at a peripheral site of -1.8 or less, self-rated poor health status, and poor mobility were identified as the most important determinants of short-term fracture. Fifty-five percent of the women were identified as being at increased fracture risk. Women with previous fracture, regardless of T score, had a risk of 4.1%, followed by 2.2% in women with T scores of -1.8 or less or with poor health status, and 1.9% for women with poor mobility. The algorithm correctly classified 74% of the women who experienced a fracture.

Conclusions: This classification tool accurately identified postmenopausal women with peripheral T scores of -2.5 to -1.0 who are at increased risk of fracture within 12 months. It can be used in clinical practice to guide assessment and treatment decisions.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Distribution
  • Aged
  • Aged, 80 and over
  • Algorithms
  • Bone Density / physiology*
  • Cohort Studies
  • Densitometry
  • Female
  • Follow-Up Studies
  • Fractures, Spontaneous / diagnosis
  • Fractures, Spontaneous / epidemiology*
  • Fractures, Spontaneous / etiology*
  • Humans
  • Incidence
  • Middle Aged
  • Osteoporosis, Postmenopausal / complications*
  • Osteoporosis, Postmenopausal / diagnosis*
  • Probability
  • Risk Assessment
  • Risk Factors
  • Severity of Illness Index
  • Time Factors