Screening for height loss could prevent hip fractures

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Rheumawire

May 7, 2004

Screening for height loss could prevent hip fractures

Columbus, OH - Height loss in an elderly woman is a powerful predictor

of osteoporosis at the hip and thus highlights those at an increased

risk of hip fracture. Targeting this population with screening and

treatment would reduce the risk of and could prevent hip fractures,

which can be catastrophic in the elderly, says rheumatologist Dr Seth

Kantor (Ohio State University Medical Center, Columbus).

Kantor headed a study that examined data on 2108 women to explore the

relationship between height loss and osteoporosis at the hip, published

in the Spring 2004 issue of the Journal of Clinical Densitometry [1].

" Our findings suggest that a very simple test for all patientscurrent

height compared with peak adult heightcan predict the need for a

bone-mineral-density (BMD) scan to check for osteoporosis. "

As a result, the researchers recommend that all physicians routinely

screen for height loss in aging patients. Noting that May is National

Osteoporosis Month in the US, Kantor says: " In 2004, an osteoporotic or

fragility fracture of the hip should be preventable. "

The finding was intuitive, Kantor et al commentelderly women who have

lost height because of fragility fractures in the vertebrae would be

expected also to have fragile bones elsewhere in the body. But the size

of the resulting odds ratio " was striking. "

Women who had lost >2 inches but <3 inches in height had a 4.4-fold

increase (95% CI 2.6-7.4) in the odds of having osteoporosis at the hip

compared with women who had less than 1 inch of height loss. In women

who had lost more than 3 inches in height, the odds increased by 9.6

(95% CI 4.8-19.2).

A height loss of less than 1 inch did not predict osteoporosis of the

hip, but Kantor notes that it is possible to have severe osteoporosis

and not lose any height.

The odds ratios were adjusted for variables of age, weight, and maximum

height. The women in this study had an average age of 60 years. Nearly

10% of the sample had osteoporosis at the hip, as defined by total

femoral BMD measured by dual-energy x-ray absorptiometry (DEXA). In

addition, nearly half of the women (47%) had abnormally low bone mass,

either osteopenia or osteoporosis, at the hip.

" Taken in total, these findings demonstrate that any stature loss of 2

inches or more is suggestive of diminished bone density at the hip, "

Kantor et al conclude.

" This outcome implies that a simple and reliable clinical measure,

height loss, may suggest underlying low femoral bone density and so an

increased risk of hip fracture, " they comment. " Because the final

regression model controlled for confounding variables, our study result

applies regardless of age, weight, or maximum adult height. "

In their study, the researchers asked women to recall how tall they were

when they were 21 years old. They comment that there is evidence from

other studies that recalled maximum height is a valid proxy for actual

maximum height when records are not available. " Thus, stature loss

calculated from recalled maximum height and current measured height is

likely to be an accurate estimate of actual height loss in a patients,

regardless of age. "

Zosia Chustecka

Source

1. Kantor SM, Ossa KS, Hoshaw-Woodard SL, Lemeshow S. Height loss and

osteoporosis of the hip. J Clin Densitom 2004 Spring; 7(1):65-70.

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org