Potential Mislead And Uselessness In Monitoring Bone Density In Older Women

Editor's Choice
Main Category: Bones / Orthopaedics
Also Included In: Menopause
Article Date: 29 Jun 2009 - 0:00 PDT

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A study published on bmj.com reports that monitoring bone mineral density in postmenopausal women taking osteoporosis drugs, such as bisphosphonates, is pointless and could be misleading. A major public health problem, osteoporosis particularly affects older women. Bone density drops after menopause because estrogen levels decline. Low bone mineral density importantly increases risk factor for fractures.

Several guidelines advise that is necessary to monitor bone mineral density in postmenopausal women. However, it is expensive and many experts argue that those screenings fail to show how patients are responding to treatment.

Researchers from Australia and the USA evaluated the need for monitoring by studying the effects of the drug alendronate which is a widely used bisphosphonate. They looked at the variations between individuals.

They evaluated the data from the Fracture Intervention Trial (FIT), a large randomized trial that compared the effects of alendronate with placebo. The trial included over 6,000 postmenopausal women with low bone mineral density. There were measurements of the bone density of the hip and spine taken at the start of the study and every year for three years.

Results showed that after three years of therapy, 97.5 percent of the women treated with alendronate had a slight increase in hip bone mineral density. In addition, the effects of the treatment did not vary significantly between individuals. The authors explain that those results make the monitoring of individuals´ response to the treatment, useless.

Improving adherence to the treatment is another common motive to carry on with monitoring. But, the authors explain that most problems occur within three months of starting treatment, prior to the first measurement. There is indication that discussing problems with a healthcare professional a few months after starting treatment improves adherence.

The authors conclude that monitoring bone mineral density in postmenopausal women in the first three years after starting treatment with a bisphosphonate is unnecessary. It is wiser to avoid it because of the potential confusing information.

In an associated editorial, Juliet Compston, Professor of Bone Medicine at the University of Cambridge, writes that these findings reinforce the case against routine monitoring of bone mineral density during the first few years of treatment. The apparent allegation for clinical practice is that patients may be given improper advice if treatment is monitored by the changes in bone mineral density.

She writes in conclusion: "Routine monitoring of bone mineral density during the first few years of antiresorptive treatment cannot be justified because it may mislead patients, lead to inappropriate management decisions, and waste scarce healthcare resources."

"Value of routine monitoring of bone mineral density after starting bisphosphonate treatment: secondary analysis of trial data"
Katy J L Bell, research fellow, Andrew Hayen, senior lecturer in biostatistics, Petra Macaskill, associate professor of biostatistics, Les Irwig, professor of epidemiology, Jonathan C Craig, professor of clinical epidemiology, Kristine Ensrud, professor of medicine, Douglas C Bauer, professor of medicine and epidemiology and biostatistics
BMJ 2009; 338:b2266

"Monitoring bone mineral density during antiresorptive treatment for osteoporosis"
Juliet Compston, professor of bone medicine
BMJ 2009; 338:b1276
bmj.com

Written by Stephanie Brunner (B.A.)
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