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6% (age 45) and 0.8% (age 85). For men, femoral strength did not decrease until one decade later; the estimated annual percent reductions at ages 55 and 85 years were 1.1% and 1.7%, respectively, for femoral strength, over twice those for femoral neck aBMD (0.5% and 0.6%). For both sexes for each age, the prevalence of low femoral strength (15% to 20%) at the fifth decade for women and a decade later for men and then increased with age at similar gradients in both sexes, at least initially. However, unlike the rather uniform age trends for mean values of femoral strength, there was an additional increase in the prevalence of low femoral strength for women compared with men starting in the seventh decade. By the eighth decade, the prevalence of low femoral strength, almost twofold higher for women (89%) than for men (47%), was substantially greater than the prevalence of osteoporosis (27% for women, 4% for men). The prevalence of osteoporosis was similar regardless of whether the young reference value from the Lunar and the Hologic manufacturer was used. It was higher when the young reference value for the Rochester cohort itself was used but still lower than the prevalence of low femoral strength (Table 1). The prevalence of low femoral strength remained higher than the prevalence of osteoporosis (based on the manufacturers' reference values) even if it was defined as a femoral strength value less than 2000?N. Femoral neck aBMD is correlated with bone strength26 and is the preferred clinical metric for assessing both fracture risk3 and the prevalence of osteoporosis.23 However, our results demonstrate that femoral strength is reduced to a much greater extent during adulthood than would be suggested by reductions in femoral neck bone density and that this effect is accentuated in elderly women. We also found that the prevalence of low femoral strength, as defined in this study ( in this cohort than was the prevalence of osteoporosis. Our prevalence threshold for femoral strength was based on our observation that all men in the MrOS prospective fracture surveillance study who had BCT-derived femoral strength values of less than 2900?N reported a new hip fracture during follow-up.17 Additionally, the hazard ratio for hip fracture per standard deviation decrease in femoral strength in that study was large (13.1, 95% CI 3.9�C43.5). The MrOS study did not include women, and no similar studies for women have yet been reported.