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Low Peripheral Bone-Density Measurements Predict Fractures

Although low bone-mineral density (BMD), as measured centrally in the hip and spine, predicts fracture risk in postmenopausal women, the accuracy of measuring BMD peripherally (with less expensive and more available equipment) isn't clear. In this large multisite study, funded by the maker of alendronate, 163,979 postmenopausal women (mean age, 65) were recruited from 4236 primary care practices in 34 states. Women with known osteoporosis or with recent BMD determinations were excluded. Participants were assessed for osteoporosis risk factors, and BMD was measured in the forearm, finger, or heel using standard peripheral dual or single x-ray absorptiometry instruments.

Almost 40% of participants had osteopenia (T scores, 1.0 to 2.5 SD below young-adult norms), and 7% had osteoporosis (T scores, >2.5 SD lower). At 12 months, overall fracture rates were 4 times higher for osteoporotic subjects and were 1.8 times higher for osteopenic subjects than for those who had normal BMD measurements (3.47 and 1.55 vs. 0.86 fractures per 100 person-years). Similar ratios of hip, spine, rib, wrist, and forearm fractures were reported for all 3 groups. Risk factors for osteoporosis and fracture were similar to those found in previous studies (i.e., older age, history of fracture, ever smoking, lack of estrogen replacement, and lack of exercise).

Comment: These results suggest that many patients with undetected osteoporosis could be diagnosed accurately with less expensive, more readily available, office-based instrumentation. An editorialist notes that these findings create a compelling case for aggressive detection and management of osteoporosis in primary care.

— Thomas L. Schwenk, MD

Published in Journal Watch General Medicine January 1, 2002

Citation(s):

Siris ES et al. Identification and fracture outcomes of undiagnosed low bone mineral density in postmenopausal women: Results from the National Osteoporosis Risk Assessment. JAMA 2001 Dec 12; 286:2815-22.

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Chestnut CH III. Osteoporosis, an underdiagnosed disease. JAMA 2001 Dec 12; 286:2865-6.

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• Medline abstract (Free)