Monitoring BMD Provides a Useful Index of Efficacy for Osteoporosis Therapy

Summary and Comment |
October 28, 2016

Monitoring BMD Provides a Useful Index of Efficacy for Osteoporosis Therapy

  1. Michael R. McClung, MD, FACP, FACE

Patients who lost bone despite treatment had suboptimal protection against fracture.

  1. Michael R. McClung, MD, FACP, FACE

The role of bone mineral density (BMD) measurement to monitor efficacy of osteoporosis treatment is controversial. In a registry-based Canadian cohort study, 6629 women (mean baseline age, 64) were identified who had baseline BMD tests, began osteoporosis treatment (bisphosphonates in 85%), and had repeat BMD testing a mean 4.5 years later. By BMD criteria, most participants (57%) had osteoporosis while 18% had BMD T scores between −2.0 and −2.5 at baseline.

At the total hip, 30% of women had significant increases in BMD (>0.03 g/cm2), 51% remained stable, and 19% had significant decreases. Risk for major osteoporotic fracture over 5 years was 7.2% in women with stable BMD, 5.9% in those with gains in BMD, and 10.1% among those who experienced bone loss. Results of BMD measurement in the femoral neck or lumbar spine were generally similar but less robust than those at the total hip.

Comment

Many of us thought that the main purpose of monitoring BMD was to identify patients who failed to respond to treatment (i.e., lost BMD) so that their management could be altered. However, in clinical trials, few patients who received therapy experienced bone loss, leading to the conclusion that monitoring was neither cost-effective nor clinically helpful. The present study demonstrates that bone loss occurs much more commonly in practice than in clinical trials, and that patients who lose bone have suboptimal protection against fracture. Explanations for the decrease in BMD were not provided. Nonetheless, this represents the first solid evidence that monitoring BMD after initiating osteoporosis therapy has clinical value. A rational approach for patients receiving bisphosphonate therapy would be to perform follow-up BMD testing 2 to 3 years after starting therapy and again 5 years later (when the “drug holiday” decision is discussed). If bone loss is observed, the patient should be evaluated for possible poor adherence to treatment or underlying medical conditions, and a different therapy should be considered.

Editor Disclosures at Time of Publication

  • Disclosures for Michael R. McClung, MD, FACP, FACE at time of publication Consultant / Advisory board Amgen; Merck; Radius Editorial boards BoneKey; Menopause; Osteoporosis International

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Reader Comments (1)

JOHN MOSER Physician, Family Medicine/General Practice, Elverson, PAo

Useful, concise

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