Elsevier

Annals of Epidemiology

Volume 13, Issue 10, November 2003, Pages 692-697
Annals of Epidemiology

Bone mineral density and mortality in women and men: the NHANES I epidemiologic follow-up study

https://doi.org/10.1016/S1047-2797(03)00062-0Get rights and content

Abstract

Purpose

We sought to assess the long-term association of bone mineral density with total, cardiovascular, and non-cardiovascular mortality.

Methods

The First National Health and Nutrition Examination Survey data were obtained from a nationally representative sample of non-institutionalized civilians. A cohort aged 45 through 74 years at baseline (1971–1975) was observed through 1992. Subjects were followed for a maximum of 22 years. Included in the analyses were 3501 white and black subjects. Death certificates were used to identify a total of 1530 deaths.

Results

Results were evaluated to determine the relative risk for death per 1 SD lower bone mineral density, after controlling for age at baseline, smoking status, alcohol consumption, history of diabetes, history of heart disease, education, body mass index, recreational physical activity, and blood pressure medication. Bone mineral density showed a significant inverse relationship to mortality in white men and blacks, but did not reach significance in white women. Based on 1 SD lower bone mineral density, the relative risk for white men was 1.16 (95% confidence interval (CI), 1.07–1.26, p<.01), while for white women the relative risk was 1.10 (95% CI, 0.99–1.23, p = .07), and in blacks the relative risk was 1.22 (95% CI, 1.05–1.42, p<.01). Bone mineral density was also associated with non-cardiovascular mortality in all three race-gender groups. An association between bone mineral density and cardiovascular mortality was found only in white men.

Conclusions

Bone mineral density is a significant predictor of death from all causes (white men, blacks), cardiovascular (white men only) and other causes combined, in whites and blacks.

Introduction

Bone mineral density (BMD) is accepted as a predictor of fractures 1., 2.. Low BMD has also been associated with increased mortality in prospective studies of the elderly 3., 4., 5.. Increased mortality has also been reported among men and women who have had an osteoporotic fracture 6., 7.. The majority of studies thus far have focused on white women; a lesser number have included white men. To date we are not aware of any longitudinal studies that have investigated BMD and mortality in blacks. Data from the Epidemiologic Follow-up to the First National Health and Nutrition Examination Survey (NHANES I) provided a unique opportunity to assess the long-term predictive usefulness of phalangeal BMD with total, cardiovascular, and non-cardiovascular mortality in a cohort of white and black men and women.

Section snippets

Methods

The NHANES I Epidemiologic Follow-up Study (NHEFS) is a longitudinal study of participants in NHANES I who were 25 to 74 years of age at the time of the survey in 1971 through 1975 8., 9., 10., 11., 12., 13.. The personal interviews and physical and laboratory examinations of NHANES I provided the baseline data for the NHEFS 8., 9.. This analysis was based on four waves of follow-up data collection during 1982–84, 1986, 1987, and 1992. Data collected consisted of four interview surveys, health

Results

Table 1 shows the number of deaths from all causes by BMD quartile. Age-adjusted mortality rates were highest in the first BMD quartile for white men, white women, and blacks. Age-adjusted cardiovascular and non-cardiovascular mortality rates per 1000 person-years are shown in Table 2. Cardiovascular death rates were highest in the first BMD quartile among all three race-gender groups. Results were similar for non-cardiovascular disease. Baseline characteristics of subjects by BMD quartile are

Discussion

This article reports one of the few longitudinal analyses of BMD and total and cause-specific mortality as well as the first in a biracial cohort of women and men. Phalangeal BMD was associated with subsequent death from all causes (white men, blacks), cardiovascular (white men only) and non-cardiovascular death (all groups) after controlling for baseline age, and other potential confounding factors. Despite having higher baseline BMD, blacks showed age-adjusted associations of BMD and

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