BMD Changes During Osteoporosis Therapy Are Associated with Changes in Fracture Risk

Summary and Comment |
July 21, 2016

BMD Changes During Osteoporosis Therapy Are Associated with Changes in Fracture Risk

  1. Thomas L. Schwenk, MD

Bone-mineral density monitoring might be useful, but guidance on specific intervals is lacking.

  1. Thomas L. Schwenk, MD

Fracture risk is related to bone-mineral density (BMD) at baseline testing, but whether BMD monitoring after initial evaluation provides any additional benefit is unknown. In this Canadian study, investigators used a population-based BMD registry linked to pharmacy and healthcare databases to identify 6629 women (mean age, 64) who had BMD determinations before starting treatment for osteoporosis and at a mean 4.5 years later. At baseline, more than half of the women (57%) met BMD criteria for osteoporosis, and another 18% had osteopenia. Nearly 90% of patients received bisphosphonates at some point between the two BMD tests.

Between BMD determinations, total hip BMD detectably increased in 30% of women and detectably decreased in 19%; for lumbar spine BMD, detectable increases and decreases were observed in 40% and 10% of women, respectively. (Detectable increases or decreases in total hip BMD and lumbar spine BMD were defined as changes of >0.030 g/cm2 and >0.050 g/cm2, respectively.) During median follow-up of 9.2 years, 910 women (13.7%) experienced fractures. Absolute risk for any fracture was 1.3% lower at 5 years and 2.6% lower at 10 years, in those with detectable increases in total hip BMD versus stable BMD; among those with detectable decreases in total hip BMD, absolute risk was 2.9% higher at 5 years and 5.5% higher at 10 years.

Comment

This prospective cohort study shows that BMD changes during treatment for osteoporosis are associated with changes in fracture risk. A substantial proportion of these treated women had decreases in BMD over time; reasons are unclear, but might include nonadherence to treatment, drug resistance, or influence of secondary causes of osteoporosis. Clinicians would benefit from protocols that specify evidence-based BMD monitoring intervals and response to changes in BMD.

Editor Disclosures at Time of Publication

  • Disclosures for Thomas L. Schwenk, MD at time of publication Editorial boards UpToDate

Citation(s):

Reader Comments (1)

Jerry Amos Other, Other, Retired

Journal of Gerontology 55 (2000) M585-M592 Frasetto et. al. "A high ratio of vegetable to animal protein consumption was found to be impressively associated with a virtual disappearance of bone fractures (in elderly women)".

A more convenient summary and chart is on pages 206-208 of "The China Study" (2006) by Cornell nutritional biochemist prof. T. Colin Campbell. This is a very effective way to really reduce osteoporosis risk. At a ratio of 5:1 vegetable to animal protein the bone fracture rate is shown essentially zero. Per 500 calories, equal portions of tomatoes, spinach, lima beans, peas, potatoes has 33 g protein comparing quite well to equal parts beef, pork, chicken, whole milk at 34 g protein.

I'm 81, ski, fall hard, no breaks. My wife's recemt pelvis and lateral hip xray shows satisfactory bony mineralization. She doesn't usually fall.

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