One BMD, History Assessment Predicts Hip Fracture Risk

While there is ample research indicating the ability of bone mineral density (BMD) and other risk factors to predict fracture, we now have evidence showing that a single measure of BMD can predict hip fracture for up to 25 years reasonably well.

The study, “The Ability of a Single BMD and Fracture History Assessment to Predict Fracture Over 25 Years in Postmenopausal Women: The Study of Osteoporotic Fractures,” was published in the Journal of Bone and Mineral Research on July 18, 2017.

Dennis M. Black, M.D., with the Department of Epidemiology and Biostatistics at the University of California, San Francisco, told OTW, “The study of osteoporotic fractures (SOF) is unique in having this long period of follow up to directly assess long- term patterns. SOF began with 10,000 women > age 65 in 1987 and has been continuously funded by NIH [National Institutes of Health] until just May of this year. We thought it would be interesting to look back on this very long and successful study.”

The authors wrote, “A single femoral neck BMD measurement strongly predicted long-term hip fracture risk to 25 years: 29.6% risk in the lowest BMD quartile versus 7.6% with the highest relative hazard…Lifetime hip fracture risk was similar (~30%) regardless of age from 67 to >80 years. History of hip fracture predicted hip fractures only slightly better than history of nonvertebral fracture.

Dr. Black commented to OTW “The key finds are that short-term and long-term risks of fractures remain very high even in women over 80. Clinicians should consider screening and treating these women who often fall under their clinical radar.”

“It was surprising to see that long-term risk of hip fracture was over 22% in older women over 80: many have hypothesized that risk goes down at this age due to increase in mortality. These women should be evaluated for potential treatment with effective agents that can reduce hip fracture risk by 40 to 50% and several are generic with almost no cost.”

“Also surprising how well a single measure of BMD predicted hip fracture for up to 25 years. This underscores the incredible value of BMD which is a stronger predictor of hip fracture than lipids or blood pressure are of heart disease.”

“Also, for orthopedic surgeons, these results also underscore the importance of fractures as predictors of future fracture and that all older people (men or women over age 50 to 60) who have a fracture should get formal evaluation for fracture risk and treated if indicated.”

“It is so important that patients with fractures be referred for BMD scans and evaluation for effective treatment to prevent fractures. Bisphosphonates, which are generic, are proven to reduce risk of vertebral fracture by up to 75% and hip fracture by 40 to 50%. There are oral bisphosphonates and an annual IV [intravenous] infusion. There other effective treatments as well. Most important that something is done to reduce risk after the first fracture.”