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Letters
April 2, 2008

Bone Mineral Density and High-Trauma Fractures—Reply

JAMA. 2008;299(13):1542-1543. doi:10.1001/jama.299.13.1543-a

In Reply: In response to Drs Kumar and Verma, our results indicate that the force applied to the bone during a fracture cannot be judged by conventional low- and high-trauma classifications, such as falls from standing height. Therefore, such classifications are not useful for determining whether a fracture is related to bone mineral density or future fracture risk.

Very few men sustained subsequent fracture during follow-up in the MrOS. Among the 8022 women in the SOF, 1082 sustained a subsequent fracture following a first-incident low-trauma fracture, and 96 sustained a subsequent fracture following a first-incident high-trauma fracture. Of those who sustained a subsequent fracture following a first-incident low-trauma fracture, 1025 (95%) had low-trauma and 57 (5%) had high-trauma subsequent fractures. Similarly, among SOF women who sustained a subsequent fracture following a first-incident high-trauma fracture, 91 (95%) had low-trauma and 5 (5%) had high-trauma subsequent fractures. However, because the intensity of trauma cannot be judged by conventional low- and high-trauma classifications, such classifications should not be used to draw inference about underlying osteoporosis.

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