APPENDIX B

NATIONAL OSTEOPOROSIS FOUNDATION
1996 AND 2015 OSTEOPOROSIS PREVALENCE FIGURES:
STATE-BY-STATE REPORT

METHODOLOGY

Prevalence data extrapolations used in the NOF report were derived from research summaries provided by the National Health and Nutrition Examination Survey III (NHANES III) conducted from October 1988 through October 1994 in two phases (12). Each phase of the survey comprised a national probability sample. Phase I took place from October 18, 1988, through October 24, 1991, at 44 different locations; Phase II was conducted from September 20, 1991, through October 15, 1994, at 45 locations. A total of 33,994 persons were interviewed in their homes over the six-year period. The interviews included a physical examination in a mobile examination center (MEC); 30,818 such examinations were conducted.

In the MEC, bone densitometry of the proximal femur was conducted on all men and women aged 20+. (Examinees who were or possibly could be pregnant, as well as those who had previously broken both hips and those with hip pins or artificial hips were excluded.) Using dual energy x-ray absorptiometry (DXA), five bone density measurements were made: the femur neck, trochanter, intertrochanter, Ward's Triangle, and total region. Rigorous quality control was maintained throughout the survey, including the monitoring of each DXA instrument and the review of each individual scan by the Mayo Clinic before its inclusion in the NHANES III database.

Because the bone density tests were conducted in the MEC, the sample was biased in favor of those able to participate in such an examination. The sample was therefore weighted before data analysis was performed. For more information on the NHANES III sample weights, the reader is referred to the NHANES III Analytic and Reporting Guidelines (U.S. DHHS, 1996b).

The NHANES III measurements derived for the femoral neck, trochanter, and intertrochanter were used by the NOF to calculate the following percentages of women with osteoporosis and low bone mass by race:

• 21% of non-Hispanic white and Asian women aged 50+ have osteoporosis.
• 16% of American-Indian and Hispanic women aged 50+ have osteoporosis.
• 10% of African-American women aged 50+ have osteoporosis.
• 39% of non-Hispanic white and Asian women aged 50+ have low bone mass.
• 36% of American-Indian and Hispanic women aged 50+ have low bone mass.
• 29% of African-American women have low bone mass.

Estimated rates of osteoporosis and low bone mass among men were based on the observations of leading researchers and were calculated as followed:

• 5% of white, Asian, Hispanic, and American-Indian men aged 50-79 have osteoporosis.
• 3.5% of African-American men aged 50-79 have osteoporosis.
• 24% of white men aged 80+ have osteoporosis.
• 17% of African-American men aged 80+ have osteoporosis.
• 5% of Asian, Hispanic, and American-Indian men aged 80+ have osteoporosis.

The percentage of men having low bone mass was estimated at 1.5 times the rate of osteoporosis for each group. (In women, the rate of low bone mass is approximately 1.9 times the rate of osteoporosis.)

These percentages were then applied to state-specific population estimates obtained from the Census Bureau for 1995 and 2015 (extrapolated from 1993 census data) to obtain the estimated number of men and women in each state with osteoporosis and low bone mass.

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