brand logo

Am Fam Physician. 2021;103(5):311

Clinical Question

Is repeat bone mineral density (BMD) testing necessary to identify women who are susceptible to fracture?

Bottom Line

Rechecking BMD after three years does not add additional prognostic information. Serial BMD testing is not useful in estimating fracture risk and assessing the need for treatment because BMD does not change much within three years. Another study found similar results in older patients, and a third study found that BMD monitoring is not necessary after starting treatment with a bisphosphonate. (Level of Evidence = 1b)

Synopsis

This study evaluated 7,419 women who were enrolled in the Women's Health Initiative study. The postmenopausal women, between 50 and 79 years of age (mean age 66.1 years), had a baseline BMD measurement and a second BMD measurement in three years and did not have treatment other than calcium and vitamin D supplementation in the intervening years. Follow-up was an average of 12.1 years after the initial test. Over this time, 1.9% of the women experienced a hip fracture, and 9.9% had a major osteoporotic fracture, defined as hip, clinical spine, forearm, or shoulder fracture. Compared with the baseline BMD test result, a change in BMD over three years or the combination of change in BMD with baseline BMD did not predict subsequent hip or major fracture to a greater degree. The follow-up BMD testing after three years did not provide any more clinical information. Associations between bone density and fracture risk were the same when analyzed by risk factors such as the presence of diabetes mellitus, age, race and ethnicity, body weight, and baseline T-score.

Study design: Cohort (prospective)

Funding source: Government

Setting: Outpatient (any)

Reference:CrandallCJLarsonJWrightNCet alSerial bone density measurement and incident fracture risk discrimination in postmenopausal women. JAMA Intern Med2020;180(9):1232–1240.

Editor's Note: Dr. Shaughnessy is an assistant medical editor for AFP.

Already a member/subscriber?  Log In

Subscribe

From $145
  • Immediate, unlimited access to all AFP content
  • More than 130 CME credits/year
  • AAFP app access
  • Print delivery available
Subscribe

Issue Access

$59.95
  • Immediate, unlimited access to this issue's content
  • CME credits
  • AAFP app access
  • Print delivery available

Article Only

$25.95
  • Immediate, unlimited access to just this article
  • CME credits
  • AAFP app access
  • Print delivery available
Purchase Access:  Learn More

POEMs (patient-oriented evidence that matters) are provided by Essential Evidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, see http://www.essentialevidenceplus.com. Copyright Wiley-Blackwell. Used with permission.

For definitions of levels of evidence used in POEMs, see http://www.essentialevidenceplus.com/product/ebm_loe.cfm?show=oxford.

To subscribe to a free podcast of these and other POEMs that appear in AFP, search in iTunes for “POEM of the Week” or go to http://goo.gl/3niWXb.

This series is coordinated by Sumi Sexton, MD, editor-in-chief.

A collection of POEMs published in AFP is available at https://www.aafp.org/afp/poems.

Continue Reading

More in AFP

More in Pubmed

Copyright © 2021 by the American Academy of Family Physicians.

This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP.  See permissions for copyright questions and/or permission requests.