RT Journal Article
SR Electronic
T1 Bone Mineral Density – Clinical Relevance and Quantitative Assessment
JF Journal of Nuclear Medicine
JO J Nucl Med
FD Society of Nuclear Medicine
SP jnumed.120.256180
DO 10.2967/jnumed.120.256180
A1 Katherine Haseltine
A1 Tariq Chukir
A1 Pinar Smith
A1 Justin Jacob
A1 John Bilezikian
A1 Azeez Farooki
YR 2020
UL http://jnm.snmjournals.org/content/early/2020/12/11/jnumed.120.256180.abstract
AB Bone mineral density (BMD) measurement by dual-energy x-ray absorptiometry (DXA) is an internationally accepted standard-of-care screening tool used to assess fragility fracture risk. Society guidelines have recommended which populations may benefit from DXA screening and the use of the Fracture Risk Assessment Tool (FRAX®) to guide decisions regarding pharmacologic treatment for osteoporosis. According to the United States National Osteoporosis Foundation guidelines, postmenopausal women and men ≥50 years with osteopenic BMD warrant pharmacologic treatment if their FRAX-calculated 10-year probability of either a hip fracture is ≥3% or a major osteoporotic fracture is ≥20%. Patients with osteoporosis defined by a clinical event, namely a fragility fracture, or with an osteoporotic BMD should also be treated. Patients who are treated for osteoporosis should be monitored regularly to track expected gains in BMD by serial DXA scans. With some drug therapies, BMD targets can be reached whereby further improvements in BMD are not associated with further reductions in fracture risk. While reaching this target might suggest a stopping point for therapy, the reversibility of most treatments for osteoporosis, except for the bisphosphonates, has dampened enthusiasm for this approach. In the case of denosumab, it is now apparent that stopping therapy at any point can lead to an increase in multiple fracture risk. For patients who do not respond to antiosteoporosis pharmacologic therapy, with an improvement in BMD or an incident fragility fracture, other intervening issues, such as vitamin D deficiency, and/or compliance should be considered.