The open-access journal PLoS Medicine has published an essay discussing the flaws in using bone mineral density or "bone quality" as predictors for fragility fractures.
The article raises three flaws with the concept of bone quality. Firstly, there is only a poor link between bone mineral density (BMD) and fragility fractures with less than half of fragility fractures occurring in people with the World Health Organization's definition of osteoporosis. Secondly, the concept of BMD is too imprecise to define bone quality as it provides an overall picture of bone density because there is no accounting for structural changes such as porosity and trabecular thickness. Finally, the overall concept of bone quality is criticised as it incorporates many other indices for bone fragility (non-BMD) without established a unit of measurement or a definition of "good" and "bad" scores.
The National Institute of Health and Clinical Excellence (NICE) are expected to publish guidelines on the primary prevention and secondary prevention of osteoporotic fragility fractures in August 2007.
Action: Clinicians should continue to implement the existing NICE guideline on secondary prevention of osteoporotic fractures. It would also be prudent to avoid initiating treatments based solely upon BMD scores until NICE publish the new guidelines in August.