Fracture prediction from repeat BMD measurements in clinical practice

Area of Science:

• Osteoporosis research
• Clinical diagnostics
• Geriatric medicine

Background:

• Repeat bone mineral density (BMD) measurements are common in clinical practice.
• The utility of repeat BMD measurements for fracture risk assessment needs clarification.
• The influence of BMD changes and osteoporosis therapy on repeat BMD utility is uncertain.

Purpose of the Study:

• To determine if repeat BMD measurements are useful for fracture risk assessment in clinical populations.
• To investigate if preceding BMD changes affect the predictive value of repeat BMD measurements.
• To assess if recent osteoporosis therapy impacts the reliability of repeat BMD measurements for fracture prediction.

Main Methods:

• Analysis of a large clinical BMD database (n=50,215) from Manitoba, Canada (1990-2009).
• Inclusion of men and women aged ≥ 50 years with at least one repeat BMD measurement.
• Utilized Cox proportional hazards models linking BMD data with administrative records for therapy, fractures, and covariates.

Main Results:

• Total hip BMD consistently predicted major osteoporotic fracture (MOF) across all measurement time points.
• In patients with two BMD measurements (n=13,481), prediction accuracy was similar for the first and second measurements (aHRs 1.45 vs. 1.64 per SD).
• No significant interaction was found between repeat BMD results and preceding BMD change or osteoporosis therapy (p>0.2).

Conclusions:

• Repeat BMD measurements are a robust predictor of fracture risk in clinical settings.
• The predictive value of repeat BMD measurements is not diminished by prior BMD fluctuations.
• Recent osteoporosis therapy does not compromise the effectiveness of repeat BMD measurements in fracture risk assessment.