Accelerated bone loss, but not low periosteal expansion, is associated with higher all-cause mortality in older men – prospective MINOS study

Abstract

Background Low bone mineral density (BMD), high bone resorption, fragility fractures and, possibly, accelerated bone loss are associated with higher mortality. However, it is not known if the higher mortality is related to lower volumetric BMD or lower bone width, to faster bone loss on endosteal surfaces (inside bone) or to slower periosteal apposition (formation of bone on the outer bone surface). Methods We assessed the association of 10-year mortality with bone width and bone loss in 782 men aged 50–85 years. Results Low bone width and slow periosteal apposition at the femoral neck, distal radius and distal ulna were not associated with higher mortality. Accelerated apparent bone loss (decrease in BMD), net bone loss (decrease in bone mineral content) and estimated endosteal bone loss were associated with a higher 10-year all-cause mortality after adjustment for age and other confounders. Accelerated apparent bone loss at the total hip (lowest quartile) was associated with a two-fold higher mortality (Hazard Ratio (HR)=1.96, 95% Confidence interval (CI): 1.33, 2.89, p<0.001). Conclusion Lack of association between bone size and mortality shows that periosteal expansion is not an artifact induced by the selective mortality of men with narrow bones. We confirmed that poor bone status reflects poor health. These data should be interpreted with caution because of the study limitations, especially the lack of representativity of the cohort and dropout of older and sick men. However, they suggest that older men with low BMD or accelerated bone loss should obtain detailed diagnostic assessment to establish general factors that can contribute to their poor bone status.