Osteoporosis Treatment Based on a Woman's Probability of Fracture FREE

Osteoporosis is a decrease in bone density that puts a person at risk for future fractures. It is diagnosed by using an x-ray test called dual-energy x-ray absorptiometry (or DXA). This test shows whether a person's bone density is normal or has decreased. Bone density is important, but it is not the only risk factor for future fracture. Age, smoking, and leg strength also influence a person's risk for fracture. Experts have developed ways to estimate the probability that someone will have a fracture based on all of his or her risk factors, including bone density. These experts now recommend that doctors calculate that probability for people having bone density testing and recommend treatment based on that probability. In 2006, authorities in Manitoba, Canada, took that advice. When women had bone density testing, authorities calculated their fracture probability and reported it along with the bone density test results.

To determine whether reporting fracture probability with bone density results changed how doctors prescribed medicine for women having bone density testing compared with giving doctors information on bone density alone.

Untreated women 50 years or older who underwent bone density testing and their doctors.

The researchers identified all women who had had their bone density measured in the year before and after the addition of fracture probability reporting. They calculated each woman's probability of fracture and categorized it as low, medium, or high. They then compared the proportion of women in each category who were given drugs for osteoporosis in the year before and in the year after the test.

After authorities started reporting fracture probability with bone density, prescriptions for osteoporosis drugs decreased. The decrease was most apparent for women at low and medium probability of having a fracture. Prescribing did not change for women at high risk for fracture. The number of fractures also did not change.

The study could not determine whether the change in reporting was the primary reason for the changes in prescribing. Not enough fractures occurred in either period to conclude that the change in reporting had no effect on fractures.

People should take osteoporosis drugs on the basis of the probability that they will have a fracture, not just on bone density alone. Calculating fracture probabilities and reporting them to doctors with bone density testing results led to an appropriate decrease in drug prescribing for women at lower risk for fractures.