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Association between Screening for Osteoporosis and the Incidence of Hip Fracture

Lisa M. Kern, MD, MPH; Neil R. Powe, MD, MPH, MBA; Michael A. Levine, MD; Annette L. Fitzpatrick, PhD; Tamara B. Harris, MD, MS; John Robbins, MD; and Linda P. Fried, MD, MPH
[+] Article and Author Information

From Robert Wood Johnson Clinical Scholars Program, Johns Hopkins School of Medicine, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; University of Washington, Seattle, Washington; National Institute on Aging, Bethesda, Maryland; and University of California, Davis, Sacramento, California.


Acknowledgments: The authors thank Leon Gordis, MD, DrPH, for his thoughtful review of the research proposal.

Grant Support: The Cardiovascular Health Study was funded by the National Heart, Lung, and Blood Institute (contracts N01-HC-85079 through N01-HC-85086, N01-HC-35129, and N01-HC-15103). For a full list of participating CHS investigators and institutions, see http://128.208.129.3/chs/pi.htm. The bone density scans were funded by the National Institute on Aging (intra-agency agreements Y02-AG-4-0251 and 1-Y02-HC-40205). Dr. Kern (maiden name, Korn) was supported as a fellow in the Robert Wood Johnson Foundation Clinical Scholars Program at the time this study was conducted. Dr. Powe is supported in part by the National Institute of Diabetes and Digestive and Kidney Diseases (grant K24DK02643).

Potential Financial Conflicts of Interest: Honoraria: M.A. Levine (Merck & Co. Inc., Lilly Research Laboratories, Procter & Gamble); Stock ownership or options (other than mutual funds): M.A. Levine (Merck & Co., Inc.); Other: J. Robbins (Novartis, Wyeth).

Requests for Single Reprints: Lisa M. Kern, MD, MPH, Department of Public Health, Weill Medical College of Cornell University, 411 East 69th Street, Room KB-311, New York, NY 10021; e-mail, lmk2003@med.cornell.edu.

Current Author Addresses: Dr. Kern: Department of Public Health, Weill Medical College of Cornell University, 411 East 69th Street, Room KB-311, New York, NY 10021.

Dr. Powe: Welch Center for Prevention, Epidemiology & Clinical Research, Johns Hopkins Medical Institutions, 2024 East Monument Street, Suite 2-600, Baltimore, MD 21205.

Dr. Levine: The Children's Hospital, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Mailcode A120, Cleveland, OH 44195.

Dr. Fitzpatrick: Collaborative Health Studies Coordinating Center, University of Washington, Box 354922, Building 29, Suite 310, 6200 NE 74th Street, Seattle, WA 98115.

Dr. Harris: Laboratory of Epidemiology, Demography and Biometry, National Institute on Aging, Gateway Building, Suite 3C309, 7201 Wisconsin Avenue, MSC 9205, Bethesda, MD 20892.

Dr. Robbins: Department of Internal Medicine, Division of General Internal Medicine, University of California, Davis, 4150 V Street, Suite 2400, Sacramento, CA 95817.

Dr. Fried: The Johns Hopkins Center on Aging and Health, 2024 East Monument Street, Suite 2-700, Baltimore, MD 21205.

Author Contributions: Conception and design: L.M. Kern, N.R. Powe, L.P. Fried.

Analysis and interpretation of the data: L.M. Kern, N.R. Powe, A.L. Fitzpatrick, L.P. Fried.

Drafting of the article: L.M. Kern, M.A. Levine, T.B. Harris.

Critical revision of the article for important intellectual content: L.M. Kern, N.R. Powe, M.A. Levine, A.L. Fitzpatrick, T.B. Harris, J. Robbins, L.P. Fried.

Final approval of the article: L.M. Kern, N.R. Powe, M.A. Levine, A.L. Fitzpatrick, T.B. Harris, J. Robbins, L.P. Fried.

Provision of study materials or patients: T.B. Harris, J. Robbins, L.P. Fried.

Statistical expertise: N.R. Powe, A.L. Fitzpatrick.

Obtaining of funding: T.B. Harris, J. Robbins.

Administrative, technical, or logistic support: N.R. Powe, M.A. Levine.

Collection and assembly of data: N.R. Powe, T.B. Harris, J. Robbins.


Ann Intern Med. 2005;142(3):173-181. doi:10.7326/0003-4819-142-3-200502010-00007
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In this large cohort study of community-dwelling adults 65 years of age and older, we found that screening for osteoporosis with hip DEXA was associated with an absolute and statistically significant reduction of 3.4 hip fractures per 1000 person-years, compared with usual medical care. This was equal to an adjusted relative reduction of 36% over 6 years.

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Figure.
Derivation of the study cohort.

The proportions excluded did not significantly differ, except that deaths before 1994–1995 were more common in Washington County and Forsyth County (  < 0.001) and 466 participants were not offered screening in Sacramento County and Pittsburgh (Allegheny County) because they came to their study visits when screening was not yet or no longer offered. *For most participants (  = 5201), baseline evaluation occurred in 1989–1990. An additional 687 African Americans were recruited in 1992–1993, including 449 in Sacramento County and Pittsburgh (Allegheny County) and 238 in Washington County and Forsyth County. CHS = Cardiovascular Health Study.

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Comments

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Screening risk of fracture in Osteoporosis
Posted on February 7, 2005
Francisco R. Lafita
Gabinet Mèdic
Conflict of Interest: None Declared

Bone fractures (especially femoral neck fractures) are one of the main concerns in patients with osteoporosis. (1) Kern and colleagues (2) interesting study shows how screening for osteoporosis was associated with a lower incidence of hip fractures over 6 years as compared with patients on usual medical care. Screened population showed a rate of low bone mineral density (BMD) of 33% and in 25 participants (1.8%) BMD was 2 SDs below the age-matched controls. Thirty-three incident fractures (2.4%) occurred in the screened group vs. 69 (4.0%) of the unscreened population. However it should be interesting to further investigate if fractures found in the screened group correlated with BMD decreases and if urinary bone resorption markers (NTx, CTx"¦) were previously increased in patients who suffered fractures as compared with those who did not. Authors also stated that not significant differences in hip fractures were noted among those patients in the screened group with low BMD users of bone enhancing medications as compared to not users. Therefore, serial determinations of BMD (3) and resorption markers (4) and their relationship with the use of bone enhancing medications should be interesting to perform in both groups of patients, in order to try to clear up the mechanism of the association found between screening for osteoporosis and reduction of fractures.

1. Contribution of bone mineral density and bone turnover markers to the estimation of risk of osteoporotic fracture in postmenopausal women. Garnero P, Delmas PD. Musculoskelet Neuronal Interact. 2004 Mar;4(1):50- 63.

2. Association between screening for osteoporosis and the incidence of hip fracture. Kern LM, Powe NR, Levine MA, Fitzpatrick AL, Harris TB, Robbins J, Fried LP. Ann Intern Med. 2005 Feb 1;142(3):173-81.

3. How should a DEXA scan be used to evaluate bisphosphonate therapy for osteoporosis? Koval PG, Easterling L, Pettus D, Mackler L, Gottschall AB. J Fam Pract. 2005 Jan;54(1):65-71.

4. Recommendations for monitoring antiresorptive therapies in postmenopausal osteoporosis. Roux C, Garnero P, Thomas T, Sabatier JP, Orcel P, Audran M; pour le Comite Scientifique du GRIO. Joint Bone Spine. 2005 Jan;72(1):26-31.

Conflict of Interest:

None declared

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Summary for Patients

Association between Osteoporosis Screening and Hip Fracture Rates in Adults 65 Years of Age and Older

The summary below is from the full report titled “Association between Screening for Osteoporosis and the Incidence of Hip Fracture.” It is in the 1 February 2005 issue of Annals of Internal Medicine (volume 142, pages 173-181). The authors are L.M. Kern, N.R. Powe, M.A. Levine, A.L. Fitzpatrick, T.B. Harris, J. Robbins, and L.P. Fried.

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