Wiley, Journal of Bone and Mineral Research, 9(21), p. 1489-1495, 2006
DOI: 10.1359/jbmr.060601
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In terms of possible weaknesses of this study, 15.3% of the study population was lost over the 2-year follow-up period, which may have introduced bias because there was a preferential dropout of children from families of lower socio-economic status (results not shown). In addition, although 87% of subjects in whom we were able to obtain X-ray reports were confirmed as having a fracture, we were not able to verify reported fractures in all cases, and it is inevitable that a small number of children were erroneously classified as having had a fracture. However, any such misclassification of our outcome is likely to have underestimated the association between DXA measures and fracture risk, rather than to have produced a spurious association. We were not able to exclude children who fractured because of high levels of trauma such as road traffic injury, where fracture is likely to be inevitable and not dependent on bone mass, and this may also attenuate the size of the association. Finally, although we interpreted our findings as indicating a difference between vBMD between children with and without fractures, in the absence of other measures such as pQCT, it is not possible to determine whether these differences are as a consequence of altered cortical thickness, trabecular bone content, or level of bone tissue mineralization.