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Letters |17 January 2017

Change in Bone Mineral Density Is an Indicator of Treatment-Related Antifracture Effect

William D. Leslie, MD, MSc; Sumit R. Majumdar, MD, MPH; Suzanne N. Morin, MD, MSc; Lisa M. Lix, PhD

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Dr. Bell and colleagues question whether inclusion of fractures that occurred before the second (follow-up) BMD test might affect results through reverse causation. As noted in our article, the proportional hazards assumption was confirmed, indicating stable effects during follow-up. Indeed, there is progressive divergence in cumulative fracture incidence (Figure 1) that extends beyond the second BMD test (average interval between tests, 4.5 years). The data in Table 3 further show that 10-year cumulative incidence for any fracture is twice the 5-year cumulative incidence regardless of whether it is based on the BMD change category (ratios, 1.98 to 2.05) or compared with stable BMD (ratios, 1.88 to 2.05).
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Leslie WD, Majumdar SR, Morin SN, Lix LM. Change in Bone Mineral Density Is an Indicator of Treatment-Related Antifracture Effect. Ann Intern Med. ;166:152–153. doi: 10.7326/L16-0529

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Published: Ann Intern Med. 2017;166(2):152-153.

DOI: 10.7326/L16-0529

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2017 American College of Physicians
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