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Study: Height loss screen ultimately could reduce hip fractures

30.04.2004

Seth Kantor

The loss of 2 or more inches in height during adulthood serves as a powerful predictor of osteoporosis in the hip, and thus the risk for hip fractures, in elderly women, according to a new study at The Ohio State University Medical Center. The finding has led researchers to recommend that primary care physicians routinely screen aging patients for height loss.

“May is National Osteoporosis Month, and in 2004, an osteoporotic or fragility fracture of the hip should be preventable,” said Dr. Seth Kantor, a rheumatologist at OSU Medical Center and lead author of the study, published in a recent issue of the Journal of Clinical Densitometry. “Our findings suggest that a very simple test for all patients – current height compared to peak adult height – can predict the need for a bone mineral density scan to check for osteoporosis.”

New medications that help build and stabilize bone make effective treatment for osteoporosis possible, he noted. In patients with osteoporosis, the natural cycle of losing and adding minerals in healthy bone falls out of balance and the loss outpaces the gain, leading to low bone mass, structural deterioration of bone tissue, fragility and an increased susceptibility to fractures of the hip, spine and wrist. An estimated 30 million American women either have or are at risk for osteoporosis, which is responsible for about 300,000 hip fractures annually. Men account for 25 percent of the hip fractures nationally.

Kantor considers osteoporosis a major public health threat and calls it a “silent disease” because patients with the disorder feel no symptoms until a fracture occurs. Broken hips can be catastrophic for elderly patients – nearly 50 percent of sufferers never return to normal function, 25 percent require nursing home care and 20 percent die of infection, blood clots or other complications within six months after the fractures, he said.

For the study, Ohio State researchers conducted a statistical analysis of bone density scans on more than 2,100 women. The results showed that height loss of between 2 inches and 3 inches increased more than fourfold the chances the women had osteoporosis of the hip. Odds of osteoporosis in the hip were nearly 10 times greater in women with 3 or more inches of height loss compared to women with less than an inch of loss. The average age of the women was 60. Odds were adjusted for variables of age, weight and maximum adult height.

“We didn’t necessarily try to define the best model for predicting hip osteoporosis. Instead, we wanted to illuminate the relationship between height loss and osteoporosis by ruling out other factors that might affect this relationship,” Kantor said. “The clear relationship we found implies that a simple evaluation of height can help physicians in an outpatient setting decide whether a patient should undergo a bone density scan.”

The analysis indicated that height loss of up to 1 inch did not predict osteoporosis of the hip. Kantor also noted that it’s possible to have severe osteoporosis and not lose any height.

Kantor said that in an ideal world, a bone density scan – known as a DXA scan – would become as routine as a mammogram for women who have reached menopause, when the lack of estrogen production can lead to dramatic bone loss. Aging men should be screened as well, Kantor asserted.

Kantor co-authored the study with Stanley Lemeshow, dean of the Ohio State School of Public Health; Stacy Hoshaw-Woodard, formerly of Ohio State’s Center for Biostatistics; and former OSU medical student Kristen Ossa.

Contact: Emily Caldwell, Medical Center Communications, 614-293-3737 or caldwell.151@osu.edu