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BMD testing: one and done
Question clinique
Are repeat bone mineral density tests necessary to identify women who are susceptible to fracture?
L’Essentiel
Rechecking bone mineral density (BMD) after 3 years does not add additional prognostic information. In other words, not much changes in 3 years with regard to estimating fracture risk and, presumably, need for treatment, so serial testing is not useful. Another study found similar results in older patients, and, similarly, a third study found that BMD monitoring is not necessary after starting treatment with a bisphosphonate. 1b
Référence
Plan de l'etude: Cohort (prospective)
Financement: Government
Cadre: Outpatient (any)
Sommaire
This study evaluated 7419 women who were enrolled in the Women's Health Initiative study. These postmenopausal women, aged 50 and 79 years (mean age 66.1 years), underwent a baseline BMD measurement and a second BMD measurement in 3 years and did not have treatment other than calcium and vitamin D supplementation in the intervening years. The women were followed up for an average of 12.1 years after the initial test. Over this time, 1.9% of the women experienced a hip fracture and 9.9% had a major osteoporotic fracture, defined as hip, clinical spine, forearm, or shoulder fracture. Compared with the baseline BMD test result, a change in BMD over 3 years or the combination of change in BMD with baseline BMD did not predict subsequent hip or major fracture to a greater degree. In other words, the follow-up BMD testing after 3 years did not provide any more clinical information. Associations between bone density and fracture risk were the same when analyzed by risk factors such as the presence of diabetes, age, race and ethnicity, body weight, and baseline T-score.
Reviewer
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA
Commentaires
osteoporosis screening
it is good to know that once is ok
Bone Mineral Density
Finally. I have suspected this fact, that further BMD testing does not add much for years. I also live rural and do not have it available locally and have to send patients hours always to get it done, which adds risk and cost. I have been waiting for something to suggest that it adds not further benefit over baseline.
BMD
How do you assess response to treatment?
BMD measurement
I am surprised by this result. I have seen many patients increase their bone density over 5years and no fractures. But those who have not increased their density suffer toe , hip, vertebral compression fractures. I have referred them on to a Bone Density specialisrt. So it never occurred to me that it was not worth while.
Interesting!
Interesting
No
Non
The study only refers to…
The study only refers to women who had no treatment other than calcium and vitamin D. It doesn’t stratify the women based on their family history, history of a possible prior fragility fracture, or being on medication that is associated with bony demineralization. I don’t see how one can draw any useful conclusions from the material that was presented.