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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

BMD is not the only fracture risk

The Journal of the Canadian Medical Association has published the results of a study into the relationship between fracture events and bone mineral density (BMD) in postmenopausal women.

This study was a retrospective cohort study involving 16,505 women aged 50 or older who underwent a baseline bone mineral density assessment at the spine and hip between May 1998 and October 2002. Approximately half of the participants in the study were over 65 years old. The average period of follow up was 3.2 years.

765 fracture events were recorded (186 hip; 208 spine; 189 forearm; 228 humerus) with 520 (68%) of these occurring in women over 65 years old. 59.7% to 67.8% of fractures occurred in patients with a T-score that was non-osteoporotic depending on the site used for baseline assessment of BMD.

This study is limited because it was not a random sample of the population but was a physician selected population on the basis of referral for assessment of BMD. The authors conclude that there is a "strong relation between low bone mineral density and increased fracture risk" but also point out "the fact that most fractures occur in women with normal or osteopenic bone mineral density".

Action: Clinicians should ensure that treatment decisions to prevent fractures are based upon overall fracture risk. The existing NICE Guidance should be used to guide treatment initiations with bisphosphonates.

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