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Fracture prediction from repeat BMD measurements in clinical practice

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Abstract

Summary

We investigated whether repeat BMD measurements in clinical populations are useful for fracture risk assessment. We report that repeat BMD measurements are a robust predictor of fracture in clinical populations; this is not affected by preceding BMD change or recent osteoporosis therapy.

Introduction

In clinical practice, many patients selectively undergo repeat bone mineral density (BMD) measurements. We investigated whether repeat BMD measurements in clinical populations are useful for fracture risk assessment and whether this is affected by preceding change in BMD or recent osteoporosis therapy.

Methods

We identified women and men aged ≥50 years who had a BMD measurement during 1990–2009 from a large clinical BMD database for Manitoba, Canada (n = 50,215). Patient subgroups aged ≥50 years at baseline with repeat BMD measures were identified. Data were linked to an administrative data repository, from which osteoporosis therapy, fracture outcomes, and covariates were extracted. Using Cox proportional hazards models, we assessed covariate-adjusted risk for major osteoporotic fracture (MOF) and hip fracture according to BMD (total hip, lumbar spine, femoral neck) at different time points.

Results

Prevalence of osteoporosis therapy increased from 18 % at baseline to 55 % by the fourth measurement. Total hip BMD was predictive of MOF at each time point. In the patient subgroup with two repeat BMD measurements (n = 13,481), MOF prediction with the first and second measurements was similar: adjusted-hazard ratio (HR) per SD 1.45 (95 % CI 1.34–1.56) vs. 1.64 (95 % CI 1.48–1.81), respectively. No differences were seen when the second measurement results were stratified by preceding change in BMD or osteoporosis therapy (both p-interactions >0.2). Similar results were seen for hip fracture prediction and when spine and femoral neck BMD were analyzed.

Conclusion

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

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Acknowledgments

The authors acknowledge the Manitoba Centre for Health Policy (MCHP) for use of data contained in the Population Health Research Data Repository (HIPC project number #2007/2008-49). The results and conclusions are those of the authors, and no official endorsement by the MCHP, Manitoba Health, or other data providers is intended or should be inferred. This article has been reviewed and approved by the members of the Manitoba Bone Density Program Committee.

Conflicts of interest

William Leslie has received Speaker fees from Amgen, Eli Lilly, and Novartis, and Research grants from Amgen, and Genzyme. Suzanne Morin has acted as a Consultant to Amgen and Eli Lilly, and received Research grants from Amgen, and Merck. Sharon Brennan-Olsen and Lisa Lix have nothing to disclose.

Funding

No funding support was received for this research project.

Fellowships

SNM is chercheur-clinicien boursier des Fonds de la Recherche du Québec en Santé. LML is supported by a Manitoba Research Chair. SLB-O is supported by a National Health and Medical Research Council of Australia Early Career Fellowship (1012472, 2011–14) and an Alfred Deakin Postdoctoral Research Fellowship (2015–16).

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Correspondence to W. D. Leslie.

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Leslie, W., Brennan-Olsen, S., Morin, S. et al. Fracture prediction from repeat BMD measurements in clinical practice. Osteoporos Int 27, 203–210 (2016). https://doi.org/10.1007/s00198-015-3259-y

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