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We need more emphasis on fracture risk evaluation by Bruce Ettinger, MD


For the past 20 years, we have been fortunate to have bone densitometers that provide a reliable diagnostic test for osteoporosis--- the bone mineral density (BMD) test. This test has led to better identification of people at risk for fracture who can be treated effectively and, on the other hand, to better discriminate people whose risk of fracture is low and who needn’t worry.  Recent studies confirm that BMD changes are relatively small among older women.  The newspapers have interpreted these data in articles that suggest BMD testing is being repeated too often.

Indeed, for most healthy people, repeat BMD testing can be spaced out several years--- because the changes in this test are usually quite small, year by year.  However, although many may not need another BMD test for several years, everyone can reassess their risk of fracture, at least every few years.

Many clinical risk factors contribute important information about a person’s likelihood of having a fracture in the near future. For example, age alone alters our bone health--- every 7-8 years, one’s fracture risk doubles. New illnesses, new medications, and alterations in our muscles and nervous system can contribute to fracture risk--- sometimes much more than changes in BMD. So, while BMD is an important number to know, it’s also important that we get more focused on changes in our health that affects our fracture risk.