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J Clin Densitom. 2014 Apr-Jun;17(2):295-300. doi: 10.1016/j.jocd.2013.09.003. Epub 2014 Mar 7.

Choice of lumbar spine bone density reference database for fracture prediction in men and women: a population-based analysis.

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  • 1Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada. Electronic address:
  • 2Department of Medicine, McGill University, Montreal, QC, Canada.
  • 3Department of Medicine, Memorial University, St. John's, NL, Canada.
  • 4Department of Medicine, University British Columbia, Vancouver, BC, Canada.
  • 5Department of Medicine, University of Toronto, Toronto, ON, Canada.
  • 6Department of Medicine, University of Saskatchewan, Saskatoon, SK, Canada.
  • 7Department of Medicine, Queen's University, Kingston, ON, Canada.
  • 8Departments of Medicine, Oncology, and Community Health Sciences, University of Calgary, Calgary, AB, Canada.
  • 9Division of Endocrinology and Metabolism, Dalhousie University, Halifax, NS, Canada.
  • 10Department of Radiology, University British Columbia, Vancouver, BC, Canada.
  • 11Department of Medicine, University of Toronto, Toronto, ON, Canada; Cancer Care Ontario, Toronto, ON, Canada.


The diagnosis of osteoporosis in men is controversial, although most studies demonstrate similar fracture rates for men and women with the same level of hip bone mineral density (BMD). Whether this applies to the lumbar spine is currently uncertain and has important implications with respect to choice of reference population for T-score calculation and osteoporosis diagnosis. This question was specifically addressed in the population-based Canadian Multicentre Osteoporosis Study cohort of 4745 women and 1887 men ages 50+ yr at the time of baseline lumbar spine dual energy x-ray absorptiometry. In up to 10 yr of observation, incident clinical major osteoporotic fractures occurred in 110 men (5.8%) vs 543 women (11.4%) (p < 0.001). Mean lumbar spine BMD in men was greater than in women, both among those with and those without incident major osteoporotic fracture (p < 0.001). Men were at slightly lower risk for incident major osteoporotic fracture than women for an equivalent lumbar spine BMD (age- and BMD-adjusted rate ratio 0.75, 95% confidence interval 0.60-0.93, p = 0.008) with similar findings after adjustment for the World Health Organization fracture risk assessment clinical risk factors or competing mortality. No significant sex difference in the BMD relationship was seen for vertebral fractures (clinical or radiographic) or for all fractures. In summary, this large population-based longitudinal cohort study found similar or lower fracture risk for men vs women after adjustment for absolute lumbar spine BMD and additional covariates. The least complicated model for describing fracture risk is therefore to use the same reference lumbar spine data for generating T-scores in men and women.

Copyright © 2014 The International Society for Clinical Densitometry. Published by Elsevier Inc. All rights reserved.


Bone mineral density; dual energy x-ray absorptiometry; fractures; lumbar spine; sex

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