Clinical use of bone densitometry: scientific review
Steven R Cummings1, David Bates, Dennis M Black
1The UCSF Coordinating Center, University of California, San Francisco, USA. scummings@psg.ucsf.edu
JAMA
|October 17, 2002
Summary
Bone mineral density (BMD) testing effectively predicts fracture risk in postmenopausal white women. Guidelines suggest BMD screening for white women over 65 and selected younger women.
Area of Science:
- Osteoporosis research
- Bone health diagnostics
- Clinical epidemiology
Background:
- Osteoporosis leads to significant morbidity and healthcare costs.
- Bone densitometry is crucial for diagnosing osteoporosis and guiding treatment.
- Bone mineral densitometry (BMD) is increasingly utilized in clinical practice.
Purpose of the Study:
- To evaluate the clinical utility of various bone densitometry applications.
- To review existing evidence on the diagnostic and prognostic value of BMD measurements.
Main Methods:
- A comprehensive MEDLINE search updated previous meta-analyses on BMD and fracture risk.
- Data from the Study of Osteoporotic Fractures were used to assess fracture risk in postmenopausal women.
- Emphasis was placed on meta-analyses and systematic reviews where available.
Main Results:
- BMD, particularly hip BMD, is a strong predictor of fracture risk in postmenopausal white women when combined with age.
- Treatment benefits for fracture prevention are more pronounced in women with osteoporosis.
- Insufficient data exist to reliably interpret BMD for fracture risk in men and nonwhite women.
Conclusions:
- Guidelines recommend BMD measurement for white women over 65 and selective screening for younger postmenopausal women.
- Further research is needed for BMD applications in men and nonwhite women.
- Potential areas for further study include BMD monitoring during treatment and identifying secondary osteoporosis causes.
Related Concept Videos
01:55Bone Structure
Within the skeletal system, the structure of a bone, or osseous tissue, can be exemplified in a long bone, like the femur, where there are two types of osseous tissue: cortical and cancellous.
01:40Bone Remodeling
Bone remodeling is a continuous and balanced process of bone resorption by osteoclasts and bone formation by osteoblasts. In adults, it helps maintain bone mass and calcium homeostasis. While mechanical stress can stimulate turnover as part of the normal maintenance and reparative process, several hormones also regulate bone remodeling.
01:31Osteoclasts in Bone Remodeling
Osteoclasts are cells responsible for bone resorption and remodeling. They originate from hematopoietic progenitor cells present in the bone marrow. Numerous progenitor cells fuse to form multinucleated cells, each with 10-20 nuclei. A single osteoclast has a diameter of 150 to 200 µM. These cells have ruffled borders that break down the underlying bone tissue and release minerals such as calcium into the blood in bone resorption. Osteoclasts cling to bones with their ruffled edges during bone...
01:29Bone Disorders
Aging and its effect on bone remodeling is the most common cause of bone disorders. In young and healthy people, bone deposition and resorption happen at an equal rate to maintain optimal bone health.
Bone deposition is also affected by the levels of sex hormones like estrogen and testosterone that promote osteoblast activity and bone matrix synthesis. When the level of these hormones decreases due to aging, it causes a reduction in bone deposition. As a result, bone resorption by osteoclasts...
Bone deposition is also affected by the levels of sex hormones like estrogen and testosterone that promote osteoblast activity and bone matrix synthesis. When the level of these hormones decreases due to aging, it causes a reduction in bone deposition. As a result, bone resorption by osteoclasts...
01:17Hormones and Bone Tissue
The endocrine system produces and secretes hormones, which interact with the skeletal system. These hormones control bone growth, maintain bone once it is formed, and remodel it.
Hormones That Influence Osteoblasts and/or Maintain the Matrix
Several hormones are necessary for controlling bone growth and maintaining the bone matrix. The pituitary gland secretes growth hormone (GH), which, as its name implies, controls bone growth. This happens in several ways: first, it triggers chondrocyte...
Hormones That Influence Osteoblasts and/or Maintain the Matrix
Several hormones are necessary for controlling bone growth and maintaining the bone matrix. The pituitary gland secretes growth hormone (GH), which, as its name implies, controls bone growth. This happens in several ways: first, it triggers chondrocyte...
01:31Bone Remodeling and Repair
Osteoclasts are cells responsible for bone resorption and remodeling. They originate from hematopoietic progenitor cells present in the bone marrow. Numerous progenitor cells fuse to form multinucleated cells, each with 10-20 nuclei. A single osteoclast has a diameter of 150 to 200 µM. These cells have ruffled borders that break down the underlying bone tissue and release minerals such as calcium into the blood in bone resorption. Osteoclasts cling to bones with their ruffled edges during bone...