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