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Repeat BMD test every 2 years may be unnecessary
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Conducting a bone mineral density screening every 2 years to quantify fracture risk may not be necessary in adults aged at least 75 years who have not been treated for osteoporosis, according to recent data.
Researchers conducted a population-based cohort involving 310 men and 429 women (mean age, 74.8 years) from the Framingham Osteoporosis Study. Patients who experienced a hip or major osteoporotic fracture were more likely to be women, report a prior fracture, and have a lower BMI and baseline BMD compared with patients who did not have a major osteoporotic fracture, according to Sarah D. Berry, MD, MPH, of the Institute for Aging Research, Hebrew SeniorLife, Boston, and colleagues.
The annual BMD percentage change per standard deviation (SD) was linked to risk for hip fracture (HR=1.43; 95% CI, 1.16-1.78) and major osteoporotic fracture (HR=1.21; 95% CI, 1.01-1.45) after adjustments, according to data.
Ten-year follow-up data show one SD decrease in the annual percentage of BMD per 100 patients, researchers wrote. Furthermore, the area under the curve was 0.71 (95% CI, 0.65-0.78) for baseline BMD compared with 0.68 (95% CI, 0.62-0.75) for the BMD percent change.
Finally, a second screening of BMD showed patients were reclassified as high risk for hip fracture by 3.9% (95% CI, –2.2 to 9.9) compared with a decrease in the proportion categorized as low risk by –2.2% (95% CI, –4.5 to 0.1), according to data.
“Our study adds evidence that repeating a BMD screening test throughout a short time interval is unlikely to change clinical practice, particularly among individuals with normal or mild bone loss at baseline,” the researchers wrote. “We suggest that further clinical investigation is needed to predict which adults are likely to transition from low to high risk of fracture and may benefit from repeat BMD screening.”
Disclosure: Berry reports royalties from contributions to UpToDate. Other researchers report ties with Amgen, Ammonett Pharma, Eli Lilly, Hologic, Merck Sharp & Dohme, Novartis, Roche and Springer.
Perspective
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Nelson B. Watts, MD
Osteoporosis is a serious public health problem. We talk about primary prevention, which is to identify patients before they have their first fracture, and secondary prevention, which is to keep patients from having another fracture. We’re doing a terrible job with both.
It’s estimated that less than half of patients who should be getting a bone density test, based on age alone, have never had a first one. Medicare has been tracking women aged 67 years and older who have had a fracture each year for 10 years now. In 10 years, the number of women who have had a fracture and are either tested or treated hasn’t changed; it’s about 20%. Four out of five women at high risk for fracture aren’t managing their osteoporosis.
I treat patients who have had repeat bone density tests and are clearly losing ground, where more frequent tests would be desirable but are often denied by insurance. While I can certainly agree that there are plenty of patients with great bone density who do not need to be tested every other year or ever need to be tested again in their lifetime, barriers remain.
A problem with this particular study is that they looked at relatively healthy individuals and, over time, they used not only two different machines but two different technologies.
I believe the timing of repeat bone density testing needs to be individualized. There are some women (and men) whose bone density is so good that they don’t need another test ever and others who can wait 5 to 10 years, but higher-risk patients need to be tested more often.
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