Monitoring treatment for osteoporosis by using bone densitometry

https://doi.org/10.1053/snuc.2001.23528Get rights and content

In recent years, the range of treatments available for patients with osteoporosis has greatly increased. A decade ago, the only proven therapy was estrogen, but today the choices include bisphosphonates, selective estrogen-receptor modulators, calcitonin, and parathyroid hormone. Clinical trials involving bone mineral density (BMD) scans of the spine and femur have had an important role in the evaluation of these new therapies. In particular, the efficacy of treatments has now been verified in large studies powered to show reductions in fracture risk. In contrast with the use of BMD scans in research studies, their value for monitoring response to treatment in individual patients is less certain. In many cases, the increases in BMD are too small to reliably distinguish between true changes and measurement error. However, experience with estrogen and bisphosphonates suggests that these treatments have a beneficial effect on bone in most patients. Follow-up scans for patients taking these agents are therefore of limited value, apart from offering reassurance to the patient and the doctor. However, when new therapies are first introduced, follow-up scans have a useful role in building up the physician's experience and confidence.

References (68)

  • MillerPD et al.

    Cyclical editronate in the treatment of postmenopausal osteoporosis: Efficacy and safety after seven years of treatment

    Am J Med

    (1997)
  • DelmasPD

    How does antiresorptive therapy decrease the risk of fracture in women with osteoporosis?

    Bone

    (2000)
  • FaulknerKG

    Bone densitometry: Choosing the proper skeletal site to measure

    J Clin Densitom

    (1998)
  • KanisJA et al.

    Guidelines for diagnosis and treatment of osteoporosis

    Osteoporos Int

    (1997)
  • CooperC et al.

    Hip fractures in the elderly: A world-wide projection

    Osteoporos Int

    (1992)
  • RayNF et al.

    Medical expenditures for the treatment of osteoporotic fractures in the United States in 1995: Report from the National Osteoporosis Foundation

    J Bone Miner Res

    (1997)
  • EastellR

    Treatment of postmenopausal osteoporosis

    N Engl J Med

    (1998)
  • LufkinEG et al.

    Treatment of postmenopausal osteoporosis with transdermal oestrogen

    Ann Intern Med

    (1992)
  • ChapuyMC et al.

    Vitamin D3 and calcium to prevent fractures in elderly women

    N Engl J Med

    (1992)
  • LibermanUA et al.

    Effect of oral alendronate on bone mineral density and the incidence of fractures in postmenopausal osteoporosis

    N Engl J Med

    (1995)
  • DelmasPD et al.

    Effects of raloxifine on bone mineral density, serum cholesterol concentrations, and uterine endometrium in postmenopausal women

    N Engl J Med

    (1997)
  • MortensenL et al.

    Risedronate increases bone mass in an early postmenopausal population: Two years of treatment plus one year of follow-up

    J Clin Endocrinol Metab

    (1998)
  • CosmanF et al.

    Is parathyroid hormone a therapeutic option for osteoporosis? A review of the clinical evidence

    Calcif Tissue Int

    (1998)
  • GradyD et al.

    Hormone therapy to prevent disease and prolong life in postmenopausal women

    Ann Intern Med

    (1992)
  • RyanPJ et al.

    Compliance with hormone replacement therapy (HRT) after screening for postmenopausal osteoporosis

    Br J Obstet Gynaecol

    (1992)
  • Breast cancer and hormone replacement therapy: Collaborative reanalysis of data from 51 epidemiological studies of 52,705 women with breast cancer and 108,411 women without breast cancer

    Lancet

    (1997)
  • LufkinEG et al.

    Treatment of established postmenopausal osteoporosis with raloxifene: A randomized trial

    J Bone Miner Res

    (1998)
  • CummingsSR et al.

    The effect of raloxifene on risk of breast cancer in postmenopausal women: Results from the MORE randomised trial

    JAMA

    (1999)
  • BaranDT et al.

    Diagnosis and management of osteoporosis: Guidelines for the utilization of bone densitometry

    Calcif Tissue Int

    (1997)
  • Assessment of fracture risk and its application to screening for postmenopausal osteoporosis

  • StegmanMR et al.

    Fracture risk as determined by prospective and retrospective study designs

    Osteoporos Int

    (1992)
  • SeeleyDG et al.

    Which fractures are associated with low appendicular bone mass in elderly women?

    Ann Intern Med

    (1991)
  • MeltonLJ et al.

    Long-term fracture prediction by bone mineral assessed at different skeletal sites

    J Bone Miner Res

    (1993)
  • MarshallD et al.

    Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures

    Br Med J

    (1996)
  • Cited by (11)

    View all citing articles on Scopus
    View full text