Bone Mineral Density Measurements and Fracture Risk Discrimination
A recent study1 found that a secondary bone mineral density (BMD) measurement approximately 3 years after baseline assessment was not associated with any additional fracture risk discrimination in postmenopausal women.
For this cohort study, the researchers utilized data from The Women’s Health Initiative to include a total of 7419 women. The participants were assessed for incident major osteoporotic fractures, as well as baseline BMD and absolute change in BMD. The findings of the study suggest that a secondary measurement was not associated with an improved fracture risk.
Consultant360 reached out to Carolyn Crandall, MD, MS, who is the lead study author and a professor of medicine at the University of California at Los Angeles School of Medicine, about these findings and their implications.
Consultant360: For your study, you and your team assessed whether a second BMD measurement 3 years after the initial assessment is associated with improved ability to estimate fracture risk beyond the baseline BMD measurement alone. Why is this objective important to study?
Carolyn Crandall: This is important because clinicians commonly order a repeat BMD measurement after 3 years. However, it was unclear whether the repeat measurement provides meaningful information beyond that provided by the baseline BMD measurement alone.
Consultant360: Your study aimed to assess the fracture risk in postmenopausal women. Why did you choose to focus the study on this population and not include men of a similar age?
CC: Current clinical guidelines state that the optimal frequency of serial BMD measurement is unknown, both in women and in men. We focused on women because osteoporosis is more common in women than in men and because the current US Preventive Services Task Force guidelines state that evidence is insufficient to recommend screening for osteoporosis in men.
Consultant360: The results of your study indicate that a second BMD measurement approximately 3 years after the initial measurement was not associated with improved accuracy of fracture risk. Did you anticipate these results, or did they surprise you?
CC: We anticipated these results. We hypothesized that the change in BMD 3 years after baseline would not be associated with an improved ability to distinguish who will experience a fracture compared with baseline BMD alone.
Consultant360: Your study notes that repeated BMD testing is used to screen for osteoporosis. How do you believe the findings of this study will impact the current standard-of-care for preventing osteoporotic fractures?
CC: The results of our study suggest that repeated BMD testing 3 years after baseline testing in postmenopausal women should not be routinely preformed. We anticipate that our results will inform the subsequent guidelines regarding optimal frequency of serial BMD testing in postmenopausal women in the screening setting.
Consultant360: What knowledge gaps still exist concerning fracture risk in postmenopausal women? What is the next step for research on assessing fracture risk?
CC: Prospective trials that directly compare various frequencies of BMD testing would provide important further insights into the optimal frequency of screening.
- Crandall CJ, Larson J, Wright NC. Serial bone density measurement and incident fracture risk discrimination in post-menopausal women. JAMA Intern Med. 2020;180(9):1232-1240. Doi: 10.1001/jamainternmed.2020.2986