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Prior to 2000, DXA measurements were performed with a pencil-beam instrument (Lunar DPX, GE Lunar, Madison WI, USA), and after that date, a fan-beam instrument was used (Lunar Prodigy, GE Lunar). Densitometers showed stable long-term performance [coefficient of variation (CV) http://www.selleckchem.com/products/dabrafenib-gsk2118436.html Each subject's longitudinal health service record was assessed from April 1, 1987, to March 31, 2007, for the presence of International Classification of Disease-9-Clinical Modification (ICD-9-CM) fracture codes that were not associated with trauma codes. Fracture sites of interest were the spine, ribs and sternum, pelvis, trunk, clavicle, proximal humerus, forearm, proximal femur (hip), patella, tibia/fibula, and ankle. We were only able to ascertain vertebral fractures that were identified clinically. Craniofacial fractures and fractures of the hands or feet were excluded. Prevalent fractures were identified as fractures that occurred prior to the index BMD measurement and generated two or more site-specific fracture http://www.selleck.cn/products/ly2157299.html codes in any diagnosis field (eg, hospitalization, physician visit). Prevalent fractures were grouped as ��major�� fractures (eg, hip, clinical spine, forearm, and humerus) and ��minor�� fractures (eg, ribs, sternum, pelvis, trunk, clavicle, scapula, patella, tibia/fibula, and ankle). The fracture http://www.selleckchem.com/products/sch772984.html groupings were based on previously published analyses from this data set, demonstrating that fractures of the spine, humerus, forearm, and femoral neck were most strongly and consistently associated with older age, osteoporotic BMD, and incident osteoporotic fractures.23 Incident fractures of the hip, clinical spine, forearm, and humerus were identified as fractures that occurred after the index BMD measurement and generated two or more site-specific fracture codes in any diagnosis field (eg, hospitalization, physician visit). We required that hip fractures and forearm fractures be accompanied by a site-specific fracture reduction, fixation, or casting code because this enhances the diagnostic and temporal specificity for an acute fracture event. To minimize potential misclassification of prior fractures as incident fractures, we required that there be no hospitalization or physician visit(s) with the same fracture type in the 6 months preceding an incident fracture diagnosis. Using these fracture definitions, we have shown previously that BMD measurements predict fractures in our clinical cohort, as well as has been reported in large meta-analyses.