03) 0.97 (0.89, 1.06)  2003 0.91 (0.89, 0.94) 1.07 (1.04, 1.11) 1.01 (0.97, 1.06) 1.00 (0.95, 1.05) 1.02 (0.96, 1.08) 0.89 (0.81, 0.97)  2004 0.89 (0.87, 0.92) 1.11

(1.08, 1.15) 0.97 (0.93, 1.02) 0.97 (0.92, 1.01) 0.99 (0.94, 1.05) 0.97 (0.89, 1.06)  2005 0.86 (0.84, 0.89) 1.10 (1.06, 1.13) 0.95 (0.91, 1.00) 0.97 (0.92, 1.02) 1.01 (0.95, 1.07) 0.97 (0.89, 1.06) Urban/Rural  Urban Core 1.00 1.00 1.00 1.00 1.00 1.00  Not Urban core 0.99 (0.97, 1.01) 0.99 (0.97, 1.01) 0.93 (0.91, 0.96) 0.89 (0.86, 0.92) 0.99 (0.96, 1.03) 0.96 (0.91, 1.01) Geographic region  Northeast 1.00 1.00 1.00 1.00 1.00 1.00  Midwest 1.03 (1.01, 1.06) 1.11 (1.08, 1.14) 0.98 (0.94, 1.01) 0.90 (0.87, 0.94) 0.96 (0.92, 1.01) 0.98 (0.91, 1.05)  West 1.01 (0.98, 1.04) 1.14 (1.11, 1.18) 0.70 (0.67, 0.73) 0.72 (0.68, 0.76) 0.68 (0.64, 0.72) Autophagy Compound Library clinical trial Epigenetics 0.72 (0.66, 0.79)  South 1.16 (1.13, 1.18) 1.22 (1.18, 1.25) 0.99 (0.96, 1.02) 0.94 (0.90, 0.97) 0.91 (0.87, 0.96) 0.91 (0.85, 0.98) Median income  0–<30,000 1.00 1.00 1.00 1.00 1.00 1.00  30,000–<45,000 0.94 (0.92, 0.96) 0.97 (0.95, 1.00) 0.99 (0.96, 1.03) 0.95 (0.92, 0.99) 1.00 (0.95, 1.04) 0.94 (0.88, 1.00)  45,000–<60,000 0.91 (0.89, 0.93) 0.94 (0.92, 0.97) 1.00 ( 0.96, 1.04) 0.94 (0.90, 0.99) 0.98 (0.92, 1.03) 0.88 (0.82, 0.95)  60,000–<75,000 0.88 (0.85, 0.91) 0.90 (0.87,

0.94) 0.93 (0.89, 0.98) 0.94 (0.89, 0.99) 0.93 (0.87, 1.00) 0.82 (0.74, 0.90)  75,000+ 0.84 (0.81, 0.87) 0.89 (0.85, 0.93) 0.92 (0.87, 0.97) 0.86 (0.81, 0.92) 0.89 (0.82, 0.96) 0.82 (0.73, 0.91) aAdjusted for all variables in this table b N number of beneficiaries included in the analysis of each of the six

incident fracture sites c PY person-years of follow-up d IR crude incidence rate for the particular incident fracture site per 1,000 PY”
“Introduction The vertebral fracture status is a powerful and independent risk factor STK38 for all new fractures, which is a major health care problem in the aging population of the western world [1–3]. Although the concept of risk factors is gaining ground, the current clinical practice of osteoporosis assessment is still largely based on bone mineral density (BMD) measurement only [4]. Additional imaging studies of the spine have not become routine for a multitude of reasons, including lack of awareness of the vertebral fracture status as independent risk factor and possibly because osteoporosis is a condition secondary to many other diseases and it is not the “core” expertise of many physicians. In addition, considerable underreporting of vertebral fractures on plain X-rays and even on CT at rates of up to 50% has been demonstrated in many countries worldwide [5, 6].