Carolyn J. Crandall and colleagues, from the University of California in Los Angeles, examined whether a second BMD measurement about three years after the initial assessment is associated with improved ability to estimate fracture risk.
This cohort study included 7,419 women from the Women's Health Initiative, with a mean follow-up of 12.1 years between 1993 and 2010. Data analysis for this observational study was conducted between May 2019 and December 2019. The main parameters that were assessed were major osteoporotic fracture (i.e., hip, clinical spine, forearm, or shoulder fracture), hip fracture, baseline BMD, and absolute change in BMD.
The findings revealed the following key facts.
- During the study follow-up, 139 women (1.9%) experienced hip fractures, and 732 women (9.9%) experienced a major osteoporotic fracture.
- It was noted while discriminating between women who experience hip fractures and those who do not, AU-ROC values were 0.71 (95% CI, 0.67-0.75) for baseline total hip BMD, 0.61 (95% CI, 0.56-0.65) for change in total hip BMD, and 0.73 (95% CI, 0.69-0.77) for the combination of baseline total hip BMD and change in total hip BMD.
- The femoral neck and lumbar spine BMD values had similar discrimination for hip fractures.
- Femoral neck and lumbar spine BMD values had similar ability to discriminate between women who experienced a major osteoporotic fracture and those who did not.
- There was no difference in associations between change in bone density and fracture risk by subgroup, including diabetes, age, race/ethnicity, body mass index, or baseline BMD T score.
Researchers suggested that as repeated bone mineral density (BMD) testing to screen for osteoporosis requires resources, it is very important for clinicians to know whether repeated BMD measurement (compared with baseline BMD measurement alone) improves the ability to discriminate between postmenopausal women who will and will not experience a fracture.
"Thus, our evidence suggests that repeated BMD testing three years after baseline BMD in postmenopausal women should not be routinely performed," the authors wrote.
Primary source: JAMA Internal Medicine
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