{"doi":"10.1007/s00198-025-07663-2","title":"The association of bone density and hip fracture risk among Asian women","abstract":"Asian women have lower bone density than White women, but their hip fracture risk similarly increased two-fold or more for each unit decline in bone density T-score. Adjusting for age, T-score, and treatment, hip fracture risk remained lower for Asian compared to White women, with some attenuation after stature adjustment. BACKGROUND: Few studies have examined the relationship of bone mineral density (BMD) and hip fracture risk among US Asian women. METHODS: Incident hip fractures were examined among Asian/Pacific Islander (PI) and non-Hispanic White (NHW) women aged 60-89 years who had femoral neck-(FN)-BMD measured in 2000-2019 without prior osteoporosis treatment. The BMD-T-score risk gradient for hip fracture was examined using Cox proportional hazard models, adjusting for age and time-updated osteoporosis therapy. Hip fracture risk for Asian versus NHW women was also examined (overall and by low T-score category), adjusting for age, T-score, and osteoporosis therapy. RESULTS: Among 54,294 Asian/PI and 219,585 NHW women, 14.3% of NHW and 23.5% of Asian/PI women had FN-T-score ≤ -2.5 (osteoporosis) that ranged 12.6% (Native Hawaiian/PI), 17.4% (South Asian), 22-23% (Chinese, Filipina, Korean), 26.7% (Japanese), and 30.5% (Vietnamese). During five-year follow-up, hip fracture incidence was 1.03 (Asian/PI) and 3.39 (NHW) per 1000 person-years. Each unit T-score reduction was associated with adjusted hazards ratio (aHR) for hip fracture of 2.11 [2.03-2.20] NHW, 2.84 [2.11-3.82] Chinese, 2.69 [2.01-3.60] Japanese, 2.22 [1.67-2.97] Filipina, and 2.18 [1.19-3.99] South Asian. Comparing Asian to NHW women, aHRs for hip fracture were 0.2-0.3 (Chinese, Filipina) and 0.4-0.6 (Japanese, South Asian), with some attenuation after height adjustment. CONCLUSION: Among Asian and NHW women, each unit reduction in FN-T-score was associated with ≥ two-fold higher risk of hip fracture that varied by ethnicity. Accounting for T-score differences, Asian women had lower hip fracture risk than NHW women. These findings have implications for fracture risk assessment in these populations.","journal":"Osteoporosis International","year":2025,"id":520206,"datarank":0.31191623125197543,"base_score":2.0794415416798357,"endowment":2.0794415416798357,"self_citation_contribution":0.31191623125197543,"citation_network_contribution":0.0,"self_endowment_contribution":0.31191623125197543,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":7,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9604,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":371484,"name":"Malini Chandra","orcid":"0000-0003-4817-9540","position":1,"is_corresponding":false},{"id":249495,"name":"Wei Yang","orcid":"0000-0003-2575-3570","position":2,"is_corresponding":false},{"id":765795,"name":"Jeanne Darbinian","orcid":"0000-0002-4390-1445","position":3,"is_corresponding":false},{"id":520813,"name":"Amber L. Wheeler","orcid":"0000-0002-9926-1301","position":4,"is_corresponding":false},{"id":967433,"name":"Nancy P. Gordon","orcid":"0000-0003-3692-112X","position":5,"is_corresponding":false},{"id":313721,"name":"Catherine Lee","orcid":"0000-0003-0008-9052","position":6,"is_corresponding":false},{"id":371481,"name":"Joan C. Lo","orcid":"0000-0002-7159-0648","position":0,"is_corresponding":true}],"reference_count":37,"raw_metadata":{"citation_network_status":"fetched"},"created_at":"2026-07-19T02:49:28.470782Z","pmid":"41123632","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}