• Carolyn J Crandall, Kathleen M Hovey, Christopher A Andrews, Jane A Cauley, JoAnn E Manson, Jean Wactawski-Wende, Nicole C Wright, Wenjun Li, Kristen Beavers, Jeffrey R Curtis, and Meryl S LeBoff.
• Department of Medicine (C.J.C.), David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California 90024; Department of Epidemiology and Environmental Health (K.M.H., J.W.-W.), State University of New York at Buffalo, Buffalo, New York 14260; Department of Ophthalmology and Visual Sciences (C.A.A.), University of Michigan, Ann Arbor, Michigan 48109; Department of Epidemiology (J.A.C.), Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania 15261; Division of Preventive Medicine (J.E.M.) and Department of Medicine, Endocrine, Diabetes and Hypertension Division (M.S.L.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02467; Department of Epidemiology (N.C.W.) and Division of Clinical Immunology and Rheumatology (J.R.C.), University of Alabama at Birmingham, Birmingham, Alabama 35294; Division of Preventive and Behavioral Medicine (W.L.), University of Massachusetts Medical School, Worcester, Massachusetts 01655; and Department of Health and Exercise Science (K.B.), Wake Forest University, Winston-Salem, North Carolina 27106.
• J. Clin. Endocrinol. Metab. 2015 Nov 1; 100 (11): 4315-24.

ContextWrist fractures are common among postmenopausal women. Associations of bone mineral density (BMD) and 10-year predicted risk of major osteoporotic fracture (MOF) with wrist fractures are poorly characterized.ObjectiveThe objective was to examine associations between the Fracture Risk Assessment Tool (FRAX)-predicted risk of MOF, BMD, BMD change, and wrist fracture.DesignThis was a prospective observational study with a mean follow-up of 8.5 years.SettingThis study included 40 US centers.ParticipantsA total of 11 392 participants from the Women's Health Initiative BMD Cohort aged 50-79 years at baseline were included in this study.InterventionsNone.Main OutcomeThe goal was to measure incident wrist fracture.ResultsA FRAX-predicted MOF risk ≥9.3% identified 17% of the women aged <65 years who subsequently experienced wrist fracture. Each one standard deviation lower BMD was associated with higher wrist fracture risk, with adjusted hazard ratio (95% confidence interval) of 1.66 (1.42-1.93) for femoral neck (FN) BMD and 1.45 (1.28-1.64) for lumbar spine BMD. Compared with FN BMD T score ≥ -1.0, wrist fracture adjusted hazard ratios (95% confidence interval) were: 1.51 (1.06-2.16) for a T score between -1.01 and -1.49; 1.93 (1.36-2.72) for T score between -1.50 and -1.99; 2.52 (1.77-3.60) for a T score between -2.00 and -2.49; and 2.65 (1.78-3.95) for a T score ≤ -2.5. Decrease in FN BMD between baseline and year 3 was associated with increased risk of subsequent wrist fracture; however, change in lumbar spine BMD was not.ConclusionsLumbar spine and femoral neck BMDs were associated with incident wrist fracture, but the FRAX threshold recommended to identify screening candidates did not identify the majority of women who subsequently experienced wrist fracture. Improved understanding of determinants of wrist fractures is warranted.

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