Identification and Fracture Outcomes of Undiagnosed Low Bone Mineral Density in Postmenopausal Women

are an important cause of disability. 1 Hip fracture is associated with a 20% excess mortality in the year following fracture. 2The cost of managing fractures is substantial: approximately 13. 8 billion dollars were spent in the United States in 1995 alone 3 ; estimates of current costs would almost certainly be larger. The size of the population aged 50 years or older will increase markedly during the next several decades, driven by the aging of the baby boomers and by increasing longevity. Thus, the direct as well as indirect costs of fractures are expected to increase correspondingly, both in the United States and worldwide. 4ow bone mineral density (BMD) is the single best predictor of fracture risk in asymptomatic postmenopausal women. 5, 6Dual-energy x-ray absorptiometry (DXA) of the hip and spine is currently the "gold standard" for measurement of BMD. 7 Central DXA equipment is large, expensive, and not universally available. Testing costs are not consistently covered by insurance companies, especially for women younger than 65 years. The availability of lowercost, small, portable technologies that