title: Change in Bone Mineral Density Is an Indicator of Treatment-Related Antifracture Effect in Routine Clinical Practice: A Registry-Based Cohort Study.
abstract: BACKGROUND
  Whether change in bone mineral density (BMD) is an accurate indicator of antifracture effect in clinical practice is unknown.
  
  
  OBJECTIVE
  To evaluate repeated BMD testing as an indicator of treatment-related fracture risk reduction.
  
  
  METHODS
  Registry-based cohort study.
  
  
  METHODS
  Manitoba, Canada.
  
  
  METHODS
  6629 women aged 40 years or older initiating osteoporosis treatment with 2 consecutive dual-energy x-ray absorptiometry scans (mean interval, 4.5 years).
  
  
  METHODS
  Change in BMD between the first and second dual-energy x-ray absorptiometry scans categorized as stable, detectable decrease, or detectable increase. Incident fractures were ascertained from health services data.
  
  
  RESULTS
  During a mean of 9.2 years, 910 (13.7%) women developed incident fractures, including 198 with hip fractures. After adjustment for baseline fracture probability, women with a detectable decrease in total hip BMD compared with stable BMD had an absolute increase of 2.9% (95% CI, 1.5% to 4.4%) and 5.5% (CI, 2.8% to 8.1%) in the 5- and 10-year cumulative incidence of any fracture, respectively. In contrast, risk for any fracture in women with a detectable increase in total hip BMD was 1.3% (CI, 0.4% to 2.2%) and 2.6% (CI, 0.7% to 4.5%) lower after 5 and 10 years, respectively. Consistent results were seen for change in femoral neck and lumbar spine BMD and across a range of subgroup analyses.
  
  
  CONCLUSIONS
  Lack of standardization in the BMD testing interval.
  
  
  CONCLUSIONS
  Treatment-related increases in total hip BMD are associated with reduced fracture risk compared with stable BMD, whereas decreases in BMD are associated with greater risk for fractures. Monitoring BMD in clinical practice may help to identify women with a suboptimal response to osteoporosis treatment.
  
  
  BACKGROUND
  None.
authors.affiliation: From University of Manitoba, Winnipeg, Manitoba; University of Alberta, Edmonton, Alberta; and McGill University, Montreal, Quebec, Canada.
authors.forename: William D
authors.initials: WD
authors.lastname: Leslie
authors.affiliation: From University of Manitoba, Winnipeg, Manitoba; University of Alberta, Edmonton, Alberta; and McGill University, Montreal, Quebec, Canada.
authors.forename: Sumit R
authors.initials: SR
authors.lastname: Majumdar
authors.affiliation: From University of Manitoba, Winnipeg, Manitoba; University of Alberta, Edmonton, Alberta; and McGill University, Montreal, Quebec, Canada.
authors.forename: Suzanne N
authors.initials: SN
authors.lastname: Morin
authors.affiliation: From University of Manitoba, Winnipeg, Manitoba; University of Alberta, Edmonton, Alberta; and McGill University, Montreal, Quebec, Canada.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Lix
mesh_terms: D015502:Absorptiometry, Photon; D000328:Adult; D000368:Aged; D015519:Bone Density; D015331:Cohort Studies; D005260:Female; D006615:Hip / Q000000981:diagnostic imaging; D006620:Hip Fractures / Q000503:physiopathology / Q000517:prevention & control; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging; D008875:Middle Aged; D010024:Osteoporosis / Q000188:drug therapy* / Q000503:physiopathology*; D058866:Osteoporotic Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000517:prevention & control*; D011336:Probability; D012042:Registries; D012307:Risk Factors; D016103:Spinal Fractures / Q000503:physiopathology / Q000517:prevention & control; D013997:Time Factors