Fracture prediction from repeat BMD measurements in clinical practice

Leslie, William D.; Brennan-Olsen, Sharon L.; Morin, Suzanne N; Lix, Lisa M.

doi:10.1007/s00198-015-3259-y

Cited by 18 publications

(7 citation statements)

References 34 publications

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“…All BMD measurements were obtained from gold standard dual X‐ray absorptiometry (DXA, Table A1). The rationale for total hip, femoral neck and lumbar spine as reference body sites was their high relevance to the risk assessment of major osteoporotic fractures . To increase the accuracy and reproducibility for each body site, all cohorts implemented a strict quality control with cross‐calibration using standardized phantoms to avoid interdevice variability and longitudinal shifts and drifts (Table A2).…”

Section: Methodsmentioning

confidence: 99%

Association between subclinical thyroid dysfunction and change in bone mineral density in prospective cohorts

et al. 2017

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Background Subclinical hyperthyroidism (SHyper) has been associated with increased risk of hip and other fractures, but the linking mechanisms remain unclear. Objective To investigate the association between subclinical thyroid dysfunction and bone loss. Methods Individual participant data analysis was performed after a systematic literature search in MEDLINE/EMBASE (1946–2016). Two reviewers independently screened and selected prospective cohorts providing baseline thyroid status and serial bone mineral density (BMD) measurements. We classified thyroid status as euthyroidism (thyroid‐stimulating hormone [TSH] 0.45–4.49 mIU/L), SHyper (TSH < 0.45 mIU/L) and subclinical hypothyroidism (SHypo, TSH ≥ 4.50–19.99 mIU/L) both with normal free thyroxine levels. Our primary outcome was annualized percentage BMD change (%ΔBMD) from serial dual X‐ray absorptiometry scans of the femoral neck, total hip and lumbar spine, obtained from multivariable regression in a random‐effects two‐step approach. Results Amongst 5458 individuals (median age 72 years, 49.1% women) from six prospective cohorts, 451 (8.3%) had SHypo and 284 (5.2%) had SHyper. During 36 569 person‐years of follow‐up, those with SHyper had a greater annual bone loss at the femoral neck versus euthyroidism: %ΔBMD = −0.18 (95% CI: −0.34, −0.02; I2 = 0%), with a nonstatistically significant pattern at the total hip: %ΔBMD = −0.14 (95% CI: −0.38, 0.10; I2 = 53%), but not at the lumbar spine: %ΔBMD = 0.03 (95% CI: −0.30, 0.36; I2 = 25%); especially participants with TSH < 0.10 mIU/L showed an increased bone loss in the femoral neck (%Δ BMD = −0.59; [95% CI: −0.99, −0.19]) and total hip region (%ΔBMD = −0.46 [95% CI: −1.05, −0.13]). In contrast, SHypo was not associated with bone loss at any site. Conclusion Amongst adults, SHyper was associated with increased femoral neck bone loss, potentially contributing to the increased fracture risk.

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Section: Methodsmentioning

confidence: 99%

Association between subclinical thyroid dysfunction and change in bone mineral density in prospective cohorts

et al. 2017

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“…16 Another test to predict and detect osteoporosis and pathological fracture incidence is bone mineral density (BMD). 17 The risk of fracture increases 2-fold for each standard deviation (SD) score reduction in BMD. 18 However, using BMD alone to assess the risk for fractures results in high specificity but low sensitivity.…”

Section: Resultsmentioning

confidence: 99%

“…It is in line with another study result of a large clinical BMD database in Canada which reported that the BMD test is a strong predictive and good early detector for osteoporosis incidence and pathological fractures. 17 The sensitivity of the BMD examination was 83.33%, which means that of the patients who obtained a positive diagnostic test result, 83.33% of them had pathological fractures. The specificity of the BMD test is 62.50%, which means that 62.5% of all healthy patients will have a negative diagnostic test result.…”

Section: Original Articlementioning

confidence: 98%

Predictive factors and the relationship between the early detection of osteoporosis and pathological fractures in Indonesian menopausal women

Supriyatiningsih¹,

Fredianto²,

Arifuddin³

et al. 2022

Bali Med J.

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Background: Estrogen deficiency in menopausal women induces bone loss and makes them prone to pathological fractures. Age, body mass index (BMI), parental history of osteoporosis, and smoking tobacco also increase bone loss and pathological fractures. This study aims to determine whether age, BMI, parental history of osteoporosis, and smoking tobacco can predict pathological fractures in menopausal women. Moreover, the relationship between the early detection of osteoporosis with pathological fracture incidence will also be determined. Methods: This is an analytic observational epidemiological research with a cross-sectional retrospective design that involved 40 menopausal women. The data were collected from the patients' medical records 2020 in Obstetrics and Gynecology Clinic, Asri Medical Center (AMC) Muhammadiyah Hospital, Yogyakarta. The predictive factors for pathological fracture (age, BMI, parental history, smoking tobacco) were analyzed by using Fisher's exact test and the relationship between osteoporosis early detection, including bone mineral density (BMD) value, parathyroid hormone (PTH) levels, osteocalcin levels, and osteoporosis self-assessment tool for Asians (OSTA) score, with pathological fractures were investigated by using the chi-square test. Result: Age has a significant relationship with the occurrence of pathological fractures in menopausal women (OR = 6.6, 95% CI: 1.128-8.604, p = 0.042), while BMI, parental history of osteoporosis, and smoking tobacco did not have a significant relationship with pathological fractures (p > 0.05). Early detection of BMD and PTH was also found to have a significant relationship to fracture incidence. Additionally, menopausal women with high PTH levels and osteoporosis BMD values are eight times and four times greater risk of acquiring fractures than menopausal women with normal BMD values and PTH levels. Conclusion: Age can be a predictive factor for pathological fractures, and the early detection of PTH and BMD is related to the occurrence of pathological fractures in menopausal women.

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“…Low areal bone mineral density (aBMD) is an established risk factor for fracture in both men and women, even over 25 years . In contrast, changes in BMD have been shown to predict fractures in some but not all studies . In the Osteoporotic Fractures in Men (MrOS) study, we showed that accelerated decrease in aBMD was a strong independent risk factor for hip and nonspine fractures …”

Section: Introductionmentioning

confidence: 83%

Accelerated Bone Loss in Older Men: Effects on Bone Microarchitecture and Strength

Cauley

Burghardt

Harrison

et al. 2018

Journal of Bone and Mineral Research

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Accelerated bone loss (ABL) shown on routine dual-energy X-ray absorptiometry (DXA) may be accompanied by microarchitectural changes, increased cortical porosity, and lower bone strength. To test this hypothesis, we performed a cross-sectional study and used high-resolution peripheral quantitative computed tomography (HR-pQCT) scans (Scanco Medical AG, Brüttisellen, Switzerland) to measure estimated bone strength and microarchitecture in the distal radius and distal and diaphyseal tibia. We studied 1628 men who attended the year 14 exam of the Osteoporotic Fractures in Men (MrOS) study. We retrospectively characterized areal bone mineral density (aBMD) change from the year 7 to year 14 exam in three categories: "accelerated" loss, ≥10% loss at either the total hip or femoral neck (n = 299, 18.4%); "expected" loss, <10% (n = 1061, 65.2%), and "maintained" BMD, ≥0% (n = 268, 16.5%). The ABL cut-off was a safety alert established for MrOS. We used regression models to calculate adjusted mean HR-pQCT parameters in men with ABL, expected loss, or maintained BMD. Men who experienced ABL were older and had a lower body mass index and aBMD and experienced greater weight loss compared with other men. Total volumetric BMD and trabecular and cortical volumetric BMD were lower in men with ABL compared with the expected or maintained group. Men with ABL had significantly lower trabecular bone volume fraction (BV/TV), fewer trabeculae, and greater trabecular separation at both the distal radius and tibia than men with expected loss or who maintained aBMD, all p trend <0.001. Men with ABL had lower cortical thickness and lower estimated bone strength, but there was no difference in cortical porosity except at the tibia diaphyseal site. In summary, men with ABL have lower estimated bone strength, poorer trabecular microarchitecture, and thinner cortices than men without ABL but have similar cortical porosity. These impairments may lead to an increased risk of fracture. © 2018 American Society for Bone and Mineral Research.

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Fracture prediction from repeat BMD measurements in clinical practice

Abstract: Repeat BMD measurements are a robust predictor of fracture in clinical populations; this is not affected by preceding BMD change or recent osteoporosis therapy.

Cited by 18 publications

References 34 publications

Association between subclinical thyroid dysfunction and change in bone mineral density in prospective cohorts

Association between subclinical thyroid dysfunction and change in bone mineral density in prospective cohorts

Predictive factors and the relationship between the early detection of osteoporosis and pathological fractures in Indonesian menopausal women

Accelerated Bone Loss in Older Men: Effects on Bone Microarchitecture and Strength

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