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Monitoring BMD After Starting Bisphosphonate Treatment

The authors recommend against routine early screening.

Some guidelines recommend routine monitoring of patients for effects of antiresorptive treatment with bisphosphonates on bone-mineral density (BMD) within the first few years of treatment. However, little evidence supports this recommendation. To assess the value of such routine monitoring, investigators examined data from the industry-supported randomized Fracture Intervention Trial, in which the effects of alendronate were compared with those of placebo in 6500 postmenopausal women with low BMD.

BMD measurements were obtained at baseline and at 1, 2, and 3 years. At 3 years, mean hip-bone density had risen by 0.030 g/cm² with alendronate treatment and had declined by 0.012 g/cm² with placebo. Mean hip-bone density rose by >0.019 g/cm² in 97.5% of alendronate recipients. Notably, despite similar 3-year gains in bone density in most alendronate recipients, large variability was noted in serial BMD measurements within individual patients.

Comment: These results suggest that routine BMD monitoring within 3 years of starting bisphosphonates in postmenopausal women is not helpful, because nearly all these patients benefit from treatment, and — as an editorialist notes — "the large variability associated with the measurement of bone mineral density obscures the true treatment response in the individual, which makes monitoring of bone mineral density unnecessary and potentially misleading." In the absence of evidence to the contrary, BMD monitoring after 3 years of treatment seems reasonable.

— Paul S. Mueller, MD, MPH, FACP

Published in Journal Watch General Medicine July 9, 2009

Citation(s):

Bell KJL et al. Value of routine monitoring of bone mineral density after starting bisphosphonate treatment: Secondary analysis of trial data. BMJ 2009 Jun 23; 338:b2266. (http://dx.doi.org/10.1136/bmj.b2266)

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Compston J. Monitoring bone mineral density during antiresorptive treatment for osteoporosis. BMJ 2009 Jun 23; 338:b1276. (http://dx.doi.org/10.1136/bmj.b1276)

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