American Journal of Epidemiology Vol. 151, No. 7: 689-692
Copyright © 2000 by The Johns Hopkins University School of Hygiene and Public Health
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Elderly Cohort Study Subjects Unable to Return for Follow-up Have Lower Bone Mass than Those Who Can Return
1Hebrw Rehabilitation Center for Aged, Research and Training Institute Boston, MA
2Division on Aging, Harrard Medical School Boston, MA
3Department of Epidemiology and Biostatistics, Boston University School of Public Health Boston, MA
4Orthopaedic Biomechanics Laboratory, Beth Israel Deaconess Medical Center Boston, MA
5Section of General Internal Medicine, Boston Untversrty School of Medicine Boston, MA
6Section of Preventive Mediane, Boston University school of Medicine Boston, MA
Reprint requests to Dr. Douglas P. Kiel, HRCA Research and Training Institute, 1200 Centre Street, Boston, MA 02131-1097
Longitudinal studies of osteoporosis in older persons may underestimate bone loss because of a lack of follow-up measurements on subjects too frail to return. The authors addressed this possible bias as part of the population-based Framingham Study; in 1996–1997, they used quantitative ultrasound to assess the bone status of elderly subjects regardless of their ability to return to the clinic. Broadband ultrasound attenuation (BUA) and speed of sound of the calcaneus (heel) were measured in 433 subjects at the Framingham, Massachusetts, clinic and in 167 subjects at their homes or nursing homes. All ultrasound parameters were measured with intramachine coefficients of variation of <6.0%. The mean BUA for those subjects evaluated at the clinic was higher than for those measured at home (9.2% higher for men, p = 0.081 ; 8.6% higher for women, p = 0.034). After adjustment for age and weight, the differences in BUA were no longer significant. Among the elderly subjects participating in this longitudinal cohort study, those who were unable to return for follow-up were older, weighed less, and had a lower BUA than those who did return, suggesting that longitudinal studies of changes in bone mass with aging may underestimate the true population values. Am J Epidemiol 2000; 151:689–92.
bias (epidemiology); bone density; osteporosis; ultrasonography
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