title: Fracture prediction from repeat BMD measurements in clinical practice.
abstract: We investigated whether repeat BMD measurements in clinical populations are useful for fracture risk assessment. We report that repeat BMD measurements are a robust predictor of fracture in clinical populations; this is not affected by preceding BMD change or recent osteoporosis therapy.
  
  
  BACKGROUND
  In clinical practice, many patients selectively undergo repeat bone mineral density (BMD) measurements. We investigated whether repeat BMD measurements in clinical populations are useful for fracture risk assessment and whether this is affected by preceding change in BMD or recent osteoporosis therapy.
  
  
  METHODS
  We identified women and men aged ≥ 50 years who had a BMD measurement during 1990-2009 from a large clinical BMD database for Manitoba, Canada (n = 50,215). Patient subgroups aged ≥ 50 years at baseline with repeat BMD measures were identified. Data were linked to an administrative data repository, from which osteoporosis therapy, fracture outcomes, and covariates were extracted. Using Cox proportional hazards models, we assessed covariate-adjusted risk for major osteoporotic fracture (MOF) and hip fracture according to BMD (total hip, lumbar spine, femoral neck) at different time points.
  
  
  RESULTS
  Prevalence of osteoporosis therapy increased from 18 % at baseline to 55 % by the fourth measurement. Total hip BMD was predictive of MOF at each time point. In the patient subgroup with two repeat BMD measurements (n = 13,481), MOF prediction with the first and second measurements was similar: adjusted-hazard ratio (HR) per SD 1.45 (95 % CI 1.34-1.56) vs. 1.64 (95 % CI 1.48-1.81), respectively. No differences were seen when the second measurement results were stratified by preceding change in BMD or osteoporosis therapy (both p-interactions >0.2). Similar results were seen for hip fracture prediction and when spine and femoral neck BMD were analyzed.
  
  
  CONCLUSIONS
  Repeat BMD measurements are a robust predictor of fracture in clinical populations; this is not affected by preceding BMD change or recent osteoporosis therapy.
authors.affiliation: University of Manitoba, Winnipeg, Manitoba, Canada. bleslie@sbgh.mb.ca.|Department of Medicine (C5121), 409 Tache Avenue, R2H 2A6, Winnipeg, MB, Canada. bleslie@sbgh.mb.ca.
authors.forename: W D
authors.initials: WD
authors.lastname: Leslie
authors.affiliation: School of Medicine, Deakin University, Geelong, VIC, Australia.|Institute for Health and Ageing, Australian Catholic University, Melbourne, VIC, Australia.
authors.forename: S L
authors.initials: SL
authors.lastname: Brennan-Olsen
authors.affiliation: McGill University, Montreal, QC, Canada.
authors.forename: S N
authors.initials: SN
authors.lastname: Morin
authors.affiliation: University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: L M
authors.initials: LM
authors.lastname: Lix
mesh_terms: D015502:Absorptiometry, Photon / Q000379:methods; D000368:Aged; D015519:Bone Density / Q000502:physiology*; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D016208:Databases, Factual; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D005272:Femur Neck / Q000503:physiopathology; D006620:Hip Fractures / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology; D006801:Humans; D008159:Lumbar Vertebrae / Q000503:physiopathology; D008297:Male; D008350:Manitoba / Q000453:epidemiology; D008498:Medical Record Linkage; D008875:Middle Aged; D010024:Osteoporosis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology; D058866:Osteoporotic Fractures / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology*; D011237:Predictive Value of Tests; D011379:Prognosis; D018570:Risk Assessment / Q000379:methods
chemical_list: D050071:Bone Density Conservation Agents
keywords: Bone mineral density; Densitometry; Fracture prediction; Osteoporosis treatment