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Study: 15-year interval appropriate for osteoporosis screening among older, postmenopausal women with normal BMD

Gourlay ML. N Engl J Med. 2012;366:225-233.

Issue: February 2012

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Retesting bone mineral density among older, postmenopausal women with normal bone density or mild osteopenia every 15 years would result in a diagnosis of osteoporosis among less than 10% of these patients, according to data recently published in the New England Journal of Medicine.

Additionally, rescreening women with moderate osteopenia every 5 years and those with advanced osteopenia every 1 year would result in osteoporosis development among less than 10% of these women.

Researchers conducted competing-risk analyses of data from 4,957 women aged 67 years or older without osteoporosis at baseline, who were followed prospectively for up to 15 years in the Study of Osteoporotic Fractures. The estimated time for 10% of women to transition to osteoporosis before having a hip or clinical vertebral fracture, with adjusting for estrogen use and clinical risk factors, was used to define the BMD testing interval. The researchers also analyzed transitions from normal BMD and from mild, moderate or advanced osteopenia using parametric cumulative incidence models. Competing risks included incident hip and clinical vertebral fractures, and initiation of treatment with bisphosphonates, calcitonin or raloxifene.

The estimated testing interval was 16.8 years for women with normal BMD (95% CI, 11.5-24.6); 17.3 years for those with mild osteopenia (95% CI, 13.9-21.5); 4.7 years for those with moderate osteopenia (95% CI, 4.2-5.2); and 1.1 years for those with advanced osteopenia (95% CI, 1.0-1.3).

“Our results suggest that the baseline T score is the most important determinant of a BMD testing interval,” the researchers wrote. “During the 15-year study period, less than 1% of women with T scores indicating normal BMD and 5% of women with T scores indicating mild osteopenia at their first assessment made the transition to osteoporosis ...”

The clinical science makes good sense, but I have major concerns about the technical implications of this observation. In my blogs, I have ranted repeatedly about how poorly DXA studies are performed in many sites — mainly staffed by persons who have not taken a formal bone density course. But, the suggestion to have a 15-year interval between scans poses a much bigger concern.

Specifically, what is the likelihood of the technology being the same 15 years from now? I would submit that the likelihood is minimal and that many (most?) testing centers would not go through the process of cross-calibrating new DXA instruments as they are installed.

I have no concerns about the article as published and no reason to doubt that cross-calibration was expertly performed during the 15-year interval at major academic centers.

But in the world outside academia or properly trained and staffed bone density centers: nice try, but no cigar!

– Michael Kleerekoper, MD, MACE
Endocrine Today Editorial Board member

Disclosure: Dr. Kleerekoper reports no relevant financial dislcosures.

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