Anatomic Sites of Measurement
 While there is some debate among experts
on the optimal site of BMD measurement, it should
not obscure the underlying premise that any measurement
of BMD is preferred over no measurement at all. The
future risk of hip fracture may be best measured by
BMD of the hip. One study reported on 8,134 women
65 years of age or older whose BMD was measured with
several different techniques; during a mean follow-up
of 1.8 years, 65 patients suffered a hip fracture.46 Each 1 SD decrease in BMD of the hip was associated
with an increase in the age-adjusted relative risk
of hip fracture of 2.6. In contrast, the relative
risks based on measurements of the wrist or heel were
significantly lower—1.6 and 2.0, respectively. This
study, in conjunction with the morbidity related to
hip fractures, and the intuitive appeal of measuring
the site of greatest clinical interest, has contributed
to the popularity of DXA scanning. Additionally, DXA
can measure vertebral BMD during the same study.
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