The clinical application of serial bone mass measurements

Although the short-term precision of various bone mineral content (BMC) measurements is known, questions about the clinical use of serial BMC measurements remain: how frequently should BMC be measured? When is it appropriate to calculate bone loss rates? How are estimates of loss rate interpreted? This paper discusses both biological and technical sources of uncertainty, and the estimation of confidence limits for measured bone loss rates. For many, possibly most, patients, calculation of bone loss rate may not be necessary; however, repeated measures of BMC can still be useful for re-evaluating fracture risk. Indications for repeating BMC measurements may include low initial BMC (moderate to high fracture risk), anticipation of rapid bone loss (e.g., menopause, estrogen discontinuation), and verification of treatment efficacy.