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Regular bone density testing may be unnecessary for some older women
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A recent study by Australian and U.S. researchers concludes that routine monitoring of bone mineral density (BMD) in postmenopausal women during the first 3 years of bisphosphonate treatment is unnecessary and potentially misleading.
“Routine monitoring of bone mineral density during the first few years of antiresorptive treatment cannot be justified because it may mislead patients, lead to inappropriate management decisions and waste health care resources,” Juliet E. Compston, MD, FRCP, a professor of bone medicine at the University of Cambridge, wrote in an editorial accompanying the study. The research appears in the online version of the British Medical Journal.
Using data from the Fracture Intervention Trial, which compared more than 6,000 postmenopausal women randomized to placebo or alendronate treatment (Fosamax, Merck), the investigators determined the need for regular BMD monitoring by studying the difference in treatment effect among those taking alendronate. The bone density of the women’s hips and spines were measured at the start of the study and at 1, 2 and 3 years after initiating treatment, according to a British Medical Journal press release.
The investigators discovered that 97.5% of the women in the alendronate group showed at least a modest increase in hip BMD after 3 years of treatment. In addition, they found no significant difference in the treatment effect of alendronate among the women. Therefore, the investigators concluded that individual monitoring of patients’ response to treatment was unnecessary, according to the press release.
Although advocates of routine monitoring say that the practice improves patients’ adherence to treatment, the authors of the study noted that most issues occur within 3 months of initiating treatment, which is well before the first BMD measurement at 1 year. They also cited evidence that shows improved adherence when patients discuss issues with health care professionals soon after starting treatment.
Based on their findings and the potential for misleading results, the investigators said in the press release that monitoring BMD in these patients should be avoided in the first 3 years of starting treatment.
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