Skeletal Health Prognostications

Authors: E Michael Lewiecki, MD, FACP


The National Health and Nutrition Examination Survey (NHANES) is an ongoing cross-sectional population survey conducted by the National Center for Health Statistics, which is part of the Centers for Disease Control and Prevention (CDC). The objective of NHANES is to assess the health and nutrition of adults and children throughout the USA by doing in-home interviews and health examinations. The examinations are performed in a mobile examination center made of four linked trailers containing high-tech medical equipment. One of the many measurements taken is bone mineral density (BMD) testing of the proximal femur by dual-energy x-ray absorptiometry (DXA). NHANES data provide a benchmark for public health policymakers and epidemiologists to evaluate the health status of Americans. These data have been used to formulate healthcare policy, evaluate health trends, and perform extensive epidemiologic research. NHANES III (1988–1994) values have become the reference standard for calculating T-scores at the hip in the USA, and may soon be officially recognized as the international reference standard. In addition, NHANES provides an abundance of information about the association, or lack of association, of many variables with BMD.

This content is limited to qualifying members.

Existing members, please login first.

If you have an existing account please login now to access this article or view your purchase options.

Purchase only this article ($15)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.


1. Bass MA, Ford MA, Mauromoustakos A, et al. Variables for the Prediction of Femoral Bone Mineral Status in American Women. South Med J 2006;99:115–122.
2. Watts NB, Pols H, Ringe JD, et al. Detection of “unexpected” osteoporosis: insights from the “IMPACT” trial. Arthritis Rheum 2001;44:S256.
3. Physician's Guide to Prevention and Treatment of Osteoporosis. 2003. Washington DC, National Osteoporosis Foundation. 2003.
4. Pfeifer M, Begerow B, Minne HW, et al. Vitamin D status, trunk muscle strength, body sway, falls, and fractures among 237 postmenopausal women with osteoporosis. Exp Clin Endocrinol Diabetes2001;109:87–92.
5. Marshall D, Johnell O, Wedel H. Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ 1996;312:1254–1259.
6. Kanis JA, Borgstrom F, De Laet C, et al. Assessment of fracture risk. Osteoporos Int 2005;16:581–589.
7. McClung MR, Geusens P, Miller PD, et al. Effect of risedronate on the risk of hip fracture in elderly women. N Engl J Med 2001;344:333–340.
8. Kanis JA, Johnell O, Oden A, et al. Ten-year risk of osteoporotic fracture and the effect of risk factors on screening strategies. Bone 2002;30:251–258.
9. Kanis JA, Johnell O, Oden A, et al. Intervention thresholds for osteoporosis in men and women: a study based on data from Sweden. Osteoporos Int 2005;16:6–14.