Definition of a spine fracture threshold based upon prospective fracture risk

Assessment of fracture threshold (FT) could have important clinical application in determining which individuals should be treated preventively, and what level of therapy to prescribe, if suitable treatment regimens can be developed. We propose that FT be defined as the bone mineral content (BMC) at which the risk of fracture doubles, relative to premenopausal women, as determined by logistic regression analysis of spine fracture incidence in a prospective study of 408 postmenopausal women. The observed values for the FT agree well with those reported by others, based upon more arbitrary definitions. More than 90% of individuals with new nonviolent spine fractures have BMC below the fracture threshold, while fewer than 10% of younger women (age 30-45) are below this value. Although not all women with BMC below the FT have had fractures, they are at increased risk of fracture. Women with BMC equivalent to the FT have at least a 5% chance of fracture over a 10-year period, and the probability of fracture rises rapidly as BMC decreases. BMC appears to be a much stronger predictor of fracture risk than age or body size (height or weight). Thus, use of a BMC fracture threshold to categorize individual risk could provide a more objective basis for clinical decision making.