Is repeat bone mineral density (BMD) testing necessary to identify women who are susceptible to fracture?
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)
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: Crandall CJ, Larson J, Wright NC, et al. Serial bone density measurement and incident fracture risk discrimination in postmenopausal women. JAMA Intern Med. 2020;180(9):1232–1240.
Editor's Note: Dr. Shaughnessy is an assistant medical editor for AFP.