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

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The summary below is from the full report titled “A Before-and-After Study of Fracture Risk Reporting and Osteoporosis Treatment Initiation.” It is in the 2 November 2010 issue of Annals of Internal Medicine (volume 153, pages 580-586). The authors are W.D. Leslie, S. Morin, and L.M. Lix.

Ann Intern Med. 2010;153(9):I-62. doi:10.7326/0003-4819-153-9-201011020-00003
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What is the problem and what is known about it so far?

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.

Why did the researchers do this particular study?

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.

Who was studied?

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

How was the study done?

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.

What did the researchers find?

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.

What were the limitations of the study?

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.

What are the implications of the study?

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.





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