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To determine whether measurement of hip and spine bone mass by dual-energy x-ray absorptiometry DEXA predicts fractures in women and to compare the predictive value of DEXA with that of single-photon absorptiometry SPA of appendicular sites, we prospectively studied nonblack women age 65 years and older who had both DEXA and SPA measurements of bone mass.

A total of nonspine fractures, including 37 wrist fractures, occurred during the follow-up period, which averaged 0. The risk of fracture was inversely related to bone density at all measurement sites.

After adjusting for age, the relative risks per decrease of 1 standard deviation in bone density for the occurrence of any fracture was 1. Results were similar for all regions of the proximal femur as well as SPA measurements at the calcaneus, distal radius, and proximal radius.

None of these measurements was a significantly better predictor of fractures than the others. Furthermore, measurement of the distal radius was not a better predictor of wrist fracture relative risk 1. We conclude that the inverse relationship between bone mass and risk of fracture in older women is similar for absorptiometric measurements made at the hip, spine, and appendicular sites.