Is Bone Mineral Density Predictive of Fracture Risk Reduction?

Charles A. Cefalu

Disclosures

Curr Med Res Opin. 2004;20(3) 

In This Article

Conclusions

The data presented in this review indicate that the relationship between BMD and fracture risk reduction is complex, and that BMD is only one of many variables responsibl e for bone strength and fracture risk reduction. Although BMD measurement is a widely available, noninvasive, and accessible means of identifying individuals at high risk for fracture, changes in BMD T-scores resulting from osteoporosis therapy do not correlate linearly to fracture risk reduction. The large, rapid reduction in fracture risk with antiresorptive therapies precedes much of the small overall increase in BMD. Indeed, some postmenopausal women continue to lose BMD during the first year of antiresorptive therapy, and those with the greatest losses during the first year are most likely to gain BMD with continued treatment. Therefore, use of BMD as a surrogate or proxy for antifracture efficacy has limited clinical utility by itself.

Because of the complexity of the relationship between responses to osteoporosis treatments in terms of BMD changes and fracture risk reduction, a reliable clinical marker to predict fracture risk reduction is not currently available. The reliability and validity of newer promising technology discussed previously needs to be confirmed in future research studies. Therefore, physicians will continue to rely on fracture risk reduction data from well-designed clinical trials when judging the efficacy of different treatments for osteoporosis. Future research will elucidate the role of other contributors to fracture risk reduction in both men and women, including changes in bone turnover markers and bone architecture, as well as the potential utilization of these mechanisms to monitor osteoporosis treatment efficacy.

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