Medium-term transition rates to osteoporosis: DXA analysis in older Asians

Clinicians should consider baseline BMD, age, and sex when assessing osteoporosis risk. Women over 65 with severe osteopenia need close monitoring. Transition rates reached 10.7% at 2 years and 25.9% at 5 years. Routine retesting in low-risk individuals is unnecessary; rescreening should focus on older adults with moderate to severe osteopenia.

The transition rate to osteoporosis based on baseline dual-energy X-ray absorptiometry (DXA) derived bone mineral density (BMD) status in older Asians has not been previously determined. This study was designed to evaluate the rate of transition to osteoporosis in participants aged 50 years and older.

We reviewed 1781 consecutive participants (1211 postmenopausal women and 570 men; mean age, 61.17 ± 9.10 years), who underwent repeat BMD testing with a mean follow-up duration of 2.41 ± 1.20 years. Participants were stratified into four groups according to lowest T-score (proximal femora or lumbar spine): normal BMD (T-score of >  - 1.00), mild osteopenia (- 1.01 to - 1.49), moderate osteopenia (- 1.50 to - 1.99), and severe osteopenia (- 2.00 to - 2.49). The transition rate to osteoporosis was assessed for follow-up interval periods of < 2 years and 2-5 years.

A total of 581 patients (32.62%) transitioned to osteoporosis during follow-up. The transition rate to osteoporosis was higher in women than men (23.5% vs. 11.1%, p < 0.001). Transition rates to osteoporosis from baseline normal BMD and the three osteopenia subgroups (mild, moderate, severe) over 2 to 5 years were 1.2%, 7.8%, 29.9%, and 45.9% for women and 0.8%, 5.4%, 14.8%, and 39.6% for men. Transition rates from baseline normal BMD and the three osteopenia subgroups up to 2 years were 0.0%, 3.7%, 7.7%, and 30.2%, respectively. Transition rates in each category were higher in women than men, except in the severe osteopenia group (p = 0.064). Overall transition rate to osteoporosis was 10.7% for participants up to 2 years and 25.9% for between 2 and 5 years.

This study highlights a significant correlation between osteopenia severity and an increased risk of developing osteoporosis, particularly in older women. Women aged over 65 with severe osteopenia require close monitoring.