A second measure of bone mineral density (BMD) within 4 years of a first measure did not meaningfully improve prediction of hip or major osteoporotic fracture in a cohort of men and women, who were not being treated for osteoporosis, according to astudy published in the September 25 issue of JAMA.
The Study: Sarah D. Berry, MD, MPH, from the Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, and colleagues conducted a population-based cohort study of 310 men and 492 women from the Framingham Osteoporosis Study who had 2 measures of femoral neck BMD taken from 1987 through 1999. Participants had a mean age of 74.8 years.
A total of 1766 participants in the Framingham Osteoporosis Study were alive in January 1992, when second-round BMD testing began. The researchers excluded 931 (52.7%) participants who lacked a second test, and 33 (1.9%) who had hip fractures that occurred before the second test.
Results: After a median follow-up of 9.6 years after the second BMD test, 113 people (14.1%) had 1 or more major osteoporotic fracture. They were more likely to be women, to report a prior fracture, and to have a lower body mass index and lower baseline BMD than participants who did not experience an osteoporotic event. The researchers found that the second BMD measurement increased the proportion of participants reclassified after the second test as high risk for hip fracture by 3.9% and decreased the proportion reclassified as low risk.
Medicare (USA) reimburses for BMD screening every 2 years, and the average time between tests is 2.2 years, the researchers write. According to Healthcare Blue Book, the price can be $111. Other sources put prices ranging from $150 to $250 without insurance to a copay with insurance.
“The second BMD measure resulted in a small proportion of individuals reclassified as high risk of hip or major osteoporotic fracture, and it is unclear whether this reclassification justifies the current US practice of performing serial BMD tests at 2.2-year intervals,” the researchers write.
My Take: Patients receiving osteoporosis treatments sometimes do not gain mass and may actually lose mass. Dr. Recker, a critic of the authors’ conclusions offers: “There are a lot of situations where you need a bone mass measurement that is less than 2 years or 4 years. In other situations, you don’t. As a practitioner, I need to have the ability to make those decisions without excessive cost and hassle. I point out that all you have to do is prevent one hip fracture and you’ve saved between $40,000 and $60,000.” While I think there is a role for individualization, this study provides some evidence suggesting that average-risk patients may be able to reduce the frequency of their bone mineral density testing. Ask your valued healthcare provider about the optimal interval for you. And don’t forget your weight-bearing exercise! I’m Dr. Michael Hunter.
The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page.
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References: JAMA. 2013;310:1256-1262; http://www.medscape.com/viewarticle/811604.