NCHS Data Brief ■ No. 93 ■ April 2012

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

Osteoporosis or Low Bone Mass at the Femur Neck or 

Lumbar Spine in Older Adults: United States, 2005–2008

Anne C. Looker, Ph.D.; Lori G. Borrud, Ph.D.; Bess Dawson-Hughes, M.D.; John A. Shepherd, Ph.D.; 

and Nicole C. Wright, Ph.D.

Many current clinical guidelines recommend that assessment of osteoporosis 

or low bone mass, as defined by the World Health Organization (WHO) (1), be 

based on bone mineral density at either the femur neck region of the proximal 

femur (hip) or the lumbar spine (2,3). This data brief presents the most recent 

national data on osteoporosis or low bone mass at either the femur neck or 

lumbar spine among older adults in the United States population based on these 

WHO categories. Results are presented by age, sex, and race and ethnicity.

Keywords: femur neck • lumbar spine • osteoporosis • low bone mass

In 2005–2008, what was the skeletal status of the 

noninstitutionalized U.S. population aged 50 years and over 

based on bone mineral density at either the femur neck or 

lumbar spine?

Nine percent of persons aged 50 years and over had osteoporosis at either the 

femur neck or lumbar spine in 2005–2008 (Figure 1). Roughly one-half of 

older adults in the population had low bone mass at either the femur neck or 

Key findings

Data from the National 

Health and Nutrition 

Examination Survey, 

2005–2008

• Nine percent of adults 

aged 50 years and over had 

osteoporosis, as defined by the 

World Health Organization, at 

either the femur neck or lumbar 

spine. About one-half had low 

bone mass at either site, while 

48% had normal bone mass at 

both sites. 

• Estimates of poor skeletal 

status at the femur neck or 

lumbar spine when considered 

alone were not the same as 

estimates based on the two 

skeletal sites together because 

some individuals had the 

condition at one site but not the 

other. 

• The prevalence of 

osteoporosis or low bone mass 

at either the femur neck or 

lumbar spine differed by age, 

sex, and race and ethnicity. 

The prevalence was higher in 

women and increased with age. 

Differences between racial and 

ethnic groups varied by sex and 

skeletal status category.

Figure 1. Skeletal status of persons aged 50 years and over: United States, 2005–2008

NOTE: The percentages shown will not add up to 100% due to double counting among those with osteoporosis at either skeletal 

site or low bone mass at either skeletal site.

SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey, 2005–2008.

Normal at

femur neck

and lumbar

spine

Low bone mass 

at femur neck or 

lumbar spine

Osteoporosis at 

femur neck or 

lumbar spine

9%

49%

48%
NCHS Data Brief ■ No. 93 ■ April 2012

■  2  ■

lumbar spine. Forty-eight percent of older adults in the United States had normal bone density at 

both the femur neck and lumbar spine.

What is the prevalence of osteoporosis or low bone mass at the femur neck 

or the lumbar spine when considered separately?

The prevalence of osteoporosis at the femur neck is 5% and the prevalence of osteoporosis at 

the lumbar spine is 6% (Figure 2). The prevalence estimates of low bone mass at the femur neck 

or lumbar spine when considered separately are 39% and 27%, respectively. These prevalence 

estimates are not the same as the prevalence of osteoporosis or low bone mass at either the 

femur neck or lumbar spine when considered together. This occurs because the prevalence 

of osteoporosis or low bone mass at either the femur neck or lumbar spine includes some 

individuals who have the condition at one of the two skeletal sites but not the other. In specific, 

the prevalence of osteoporosis at either the femur neck or lumbar spine is 9%, which consists of 

4% with osteoporosis at the lumbar spine only, 3% with osteoporosis at the femur neck only, and 

2% with osteoporosis at both the lumbar spine and femur neck. The prevalence of low bone mass 

at either skeletal site is 49%, which consists of 10% with low bone mass at the lumbar spine, 22% 

with low bone mass at the femur neck, and 17% with low bone mass at both the lumbar spine and 

femur neck.

SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey, 2005–2008.

Figure 2. Osteoporosis or low bone mass at the femur neck only, lumbar spine only, or either site in adults aged 50 years 

and over

Lumbar spine Either site Femur neck Lumbar spine Either site

Osteoporosis Low bone mass

Femur neck

Percent

0

10

20

30

40

50

3

2

5 6

9

39

22

17 4

3

2

4

2

Spine only

Femur

neck

only

Both femur 

neck and 

spine

27

49

10

22

17

10

17
NCHS Data Brief ■ No. 93 ■ April 2012

■  3  ■

What is the prevalence of osteoporosis or low bone mass at either the 

femur neck or lumbar spine by age?

The prevalence of osteoporosis at either skeletal site by age ranged from 3% to 10% in men and 

7%–35% in women (Figure 3). In men, the prevalence of osteoporosis did not increase with age 

until aged 80 years and over, but in women, it increased for each decade after age 50 years. The 

prevalence of low bone mass at either skeletal site by age ranged from 32% to 60% in men and 

54%–67% in women. In men, the prevalence of low bone mass did not increase with age until 

aged 70 years, after which it increased progressively. In women, the prevalence of low bone mass 

increased until age 70 years, after which it remained stable. Percent

1 p < 0.05 compared with preceding age group within sex and skeletal status category.

2 p < 0.05 for trend by age group within sex for both osteoporosis and low bone mass.

SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey, 2005–2008.

Figure 3. Osteoporosis or low bone mass at the femur neck or lumbar spine, by age in adults aged 50 years and over

Men2 Women2

0

20

40

60

80

100

120

Low bone mass

Osteoporosis

80 and

over

80 and 50–59 60–69 70–79

over

50–59 60–69 70–79

32 32

451

601

54

651

68

67

7 101

271 351

101

3 3 4
NCHS Data Brief ■ No. 93 ■ April 2012

■  4  ■

Does the prevalence of osteoporosis or low bone mass at either the femur 

neck or lumbar spine differ by sex?

The prevalence of osteoporosis or low bone mass at either the femur neck or lumbar spine is 

higher in women than men in each decade (Figure 3) or when compared overall for aged 50 years 

and over after adjusting for age differences between the two sexes (Figure 4). The age-adjusted 

prevalence of osteoporosis at either skeletal site was 16% in women compared with 4% in men 

(Figure 4). The age-adjusted prevalence of low bone mass at either skeletal site was 61% in 

women compared with 38% in men (Figure 4). Age-adjusted percent

1 p < 0.05 compared with men within skeletal status category.

SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey, 2005–2008.

Figure 4. Osteoporosis or low bone mass at the femur neck or lumbar spine, by sex in adults aged 50 years or over

0

20

40

60

80

100

Low bone mass

Osteoporosis

Men Women

611

38

4

161
NCHS Data Brief ■ No. 93 ■ April 2012

■  5  ■

Does the prevalence of osteoporosis or low bone mass at the femur neck 

or lumbar spine differ by race and ethnicity in men?

The prevalence of osteoporosis or low bone mass at either skeletal site differ by race and ethnicity 

in men after adjusting for age differences between the racial and ethnic groups (Figure 5). The 

age-adjusted prevalence of osteoporosis at either skeletal site in men of other races (9%) was 

higher than the prevalence in non-Hispanic white men (4%). The age-adjusted prevalence of low 

bone mass at either skeletal site was lower in non-Hispanic black men (24%) compared with nonHispanic white men (39%). Age-adjusted percent

1 p < 0.05 compared with non-Hispanic white men within skeletal status category.

2

 Prevalence of osteoporosis in non-Hispanic black men not shown because the standard error divided by the percent exceeded 40%. 

SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey, 2005–2008.

Figure 5. Osteoporosis or low bone mass at the femur neck or lumbar spine, by race and ethnicity in men aged 50 years 

and over

Low bone mass

Osteoporosis

Non-Hispanic black Mexican American Other Non-Hispanic white 2

0

20

40

60

80

100

39

241

47 47

91

4 6
NCHS Data Brief ■ No. 93 ■ April 2012

■  6  ■

Does the prevalence of osteoporosis or low bone mass at the femur neck 

or lumbar spine differ by race and ethnicity in women?

The prevalence of osteoporosis or low bone mass at either the femur neck or lumbar spine differ 

by race and ethnicity in women after adjusting for age differences between the racial and ethnic 

groups (Figure 6). When compared with the age-adjusted prevalence of osteoporosis in nonHispanic white women (15%), the age-adjusted prevalence of osteoporosis at either skeletal site 

is higher in Mexican-American women (26%) and lower in non-Hispanic black women (9%). 

When compared with the age-adjusted prevalence in non-Hispanic white women (62%), the 

age-adjusted prevalence of low bone mass at either skeletal site is higher in women of other races 

(72%) and lower in non-Hispanic black women (44%). Age-adjusted percent

1 p < 0.05 compared with non-Hispanic white women within skeletal status category.

SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey, 2005–2008.

Figure 6. Osteoporosis or low bone mass at the femur neck or lumbar spine, by race and ethnicity in women aged 50 

years and over

0

20

40

60

80

100

Low bone mass

Osteoporosis

Non-Hispanic black Mexican American Other Non-Hispanic white 2

62

441

91

60 721

19

261

15

Summary

Nine percent of adults over age 50 years had osteoporosis at either the femur neck or lumbar spine 

and roughly one-half had low bone mass at either of these two skeletal sites. Having osteoporosis 

raises the risk of experiencing fractures (1,2). The prevalence of osteoporosis or low bone mass 

at either the femur neck or lumbar spine was not the same as the prevalence of these conditions 

when the two skeletal sites were considered separately because some individuals had these 

conditions at one of the skeletal sites but not the other. The prevalence of osteoporosis or low 

bone mass differed by age, sex, and race and ethnicity. The prevalence was higher in women and 

increased with age. Differences by race and ethnicity varied depending on sex and skeletal status 

category, but when compared with non-Hispanic white persons, Mexican-American persons, and 

persons of other races tended to be at higher risk, and non-Hispanic black persons tended to be at 

lower risk of either osteoporosis or low bone mass at the femur neck or lumbar spine.
NCHS Data Brief ■ No. 93 ■ April 2012

■  7  ■

Definitions

Low bone mass: A value for bone mineral density more than 1 standard deviation (SD) below the 

young female adult mean but less than 2.5 SD below this value (1). 

Osteoporosis: A value for bone mineral density 2.5 SD or more below the young female adult 

mean (1).

Young female adult mean and standard deviation (SD): For the femur neck, the mean and SD 

were based on data for 20–29-year-old non-Hispanic white females from the Third National 

Health and Nutrition Examination Survey (NHANES III) (4). For the lumbar spine, the mean and 

SD were based on data for 30-year-old white women from the dual-energy x-ray absorptiometry 

densitometer manufacturer (5). 

Other races: Persons from racial and ethnic groups other than non-Hispanic white, non-Hispanic 

black, or Mexican American. This group consists primarily of Hispanic persons other than 

Mexican American, Asian, Native American, and multiracial persons, among others.

Data source and methods

The National Health and Nutrition Examination Survey (NHANES) data were used for these 

analyses. NHANES is a cross-sectional survey designed to monitor the health and nutritional 

status of the civilian, noninstitutionalized U.S. population (6). The survey consists of interviews 

conducted in participants’ homes and standardized physical examinations that include laboratory 

tests utilizing blood and urine specimens provided by participants during the physical examination.

The NHANES sample is selected through a complex, multistage design that includes selection of 

primary sampling units (counties), household segments within the counties, and finally sample 

persons from selected households. The sample design includes oversampling to obtain reliable 

estimates of health and nutritional measures for population subgroups. In 1999, NHANES 

became a continuous survey, fielded on an ongoing basis. Each year of data collection is based on 

a representative sample covering all ages of the civilian, noninstitutionalized population. Publicuse data files are released in 2-year cycles.

Sample weights, which account for the differential probabilities of selection, nonresponse, 

and noncoverage, were incorporated into the estimation process. The standard errors of the 

percentages were estimated using Taylor Series Linearization, a method that incorporates the 

sample weights and sample design. Prevalence estimates were age adjusted to the 2000 U.S. 

standard population using the following age groups: 50–59, 60–69, 70–79, and aged 80 years and 

over. Differences between groups were evaluated using a t-statistic at the p < 0.05 significance 

level. Tests of trends were done using the p < 0.05 significance level. All results presented have 

a relative standard error less than 30%. All differences reported are statistically significant unless 

otherwise indicated. Statistical analyses were conducted using the SAS System for Windows 

(release 9.2; SAS Institute Inc., Cary, N.C.) and SUDAAN (release 10.0; Research Triangle 

Institute, Research Triangle Park, N.C.).
U.S. DEPARTMENT OF

HEALTH & HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

3311 Toledo Road

Hyattsville, MD 20782

OFFICIAL BUSINESS 

PENALTY FOR PRIVATE USE, $300

FIRST CLASS MAIL 

POSTAGE & FEES PAID 

CDC/NCHS

PERMIT NO. G-284

NCHS Data Brief ■ No. 93 ■ April 2012

About the authors

Anne C. Looker and Lori G. Borrud are with the Centers for Disease Control 

and Prevention’s National Center for Health Statistics, Division of Health 

and Nutrition Examination Surveys. Bess Dawson-Hughes is with the 

USDA Nutrition Center at Tufts University. John A. Shepherd is with the 

Department of Radiology at the University of California at San Francisco. 

Nicole C. Wright is with the Department of Epidemiology at the University 

of Alabama at Birmingham.

References 

1. Kanis JA, McCloskey EV, Johansson H, et al. A reference standard for the 

description of osteoporosis. Bone 42(4) 67–75. 2008.

2. National Osteoporosis Foundation. Clinician’s Guide to Prevention and 

Treatment of Osteoporosis. National Osteoporosis Foundation, Washington, 

DC. 1–36. 2008.

3. Baim S, Binkley N, Bilezikian JP, Kendler DL, et al. Official positions of 

the International Society for Clinical Densitometry and executive summary 

of the 2007 ISCD Position Development Conference. J Clin Densitom 11:75–

91. 2008.

4. Looker AC, Wahner HW, Dunn WL, Calvo MS, et al. Updated data on 

proximal femur bone mineral levels of U.S adults. Osteoporos Int 8:468–89. 

1998.

5. Kelly TJ. Bone mineral density reference databases for American men 

and women. J Bone Miner Res 5 (Suppl1):S249. 1990.

6. Centers for Disease Control and Prevention, National Center for Health 

Statistics. 1999 – Current National Health and Nutrition Examination Survey 

(NHANES). Available from: http://www.cdc.gov/nchs/nhanes/nhanes1999-

2000/nhanes99_00.htm. Accessed March 12, 2012. 1990.

Suggested citation

Looker AC, Borrud LG, Dawson-Hughes B, 

Shepherd JA, Wright NC. Osteoporosis or 

low bone mass at the femur neck or lumbar 

spine in older adults: United States, 

2005–2008. NCHS data brief no 93. 

Hyattsville, MD: National Center for Health 

Statistics. 2012.

Copyright information

All material appearing in this report is in 

the public domain and may be reproduced 

or copied without permission; citation as to 

source, however, is appreciated.

National Center for Health 

Statistics

Edward J. Sondik, Ph.D., Director

Jennifer H. Madans, Ph.D., Associate 

Director for Science

Division of Health and Nutrition 

Examination Surveys

Clifford L. Johnson, M.S.P.H., Director

For e-mail updates on NCHS publication 

releases, subscribe online at: 

http://www.cdc.gov/nchs/govdelivery.htm.

For questions or general information about 

NCHS: Tel: 1–800–232–4636

E-mail: cdcinfo@cdc.gov

Internet: http://www.cdc.gov/nchs

ISSN 1941–4927 (Print ed.)

ISSN 1941–4935 (Online ed.)

DHHS Publication No. (PHS) 2012–1209

CS231230