Carolyn J Crandall1, Joseph Larson2, Nicole C Wright3, Deepika Laddu4, Marcia L Stefanick5, Andrew M Kaunitz6, Nelson B Watts7, Jean Wactawski-Wende8, Catherine R Womack9, Karen C Johnson10, Laura D Carbone11, Rebecca D Jackson12, Kristine E Ensrud13. 1. Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles. 2. Fred Hutchinson Cancer Research Center, Seattle, Washington. 3. Department of Epidemiology, University of Alabama at Birmingham, Birmingham. 4. Department of Physical Therapy, University of Illinois, Chicago. 5. Department of Medicine, Stanford University School of Medicine, Stanford, California. 6. Department of Obstetrics and Gynecology, University of Florida College of Medicine, Jacksonville. 7. Mercy Health Osteoporosis and Bone Health Services, Cincinnati, Ohio. 8. Department of Epidemiology and Environmental Health, University at Buffalo, The State University of New York, Buffalo. 9. Division of General Internal Medicine, Department of Medicine, The University of Tennessee Health Science Center College of Medicine, Memphis. 10. Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis. 11. Division of Rheumatology, Medical College of Georgia at Augusta University, Augusta. 12. Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, The Ohio State University, Columbus. 13. Division of Epidemiology & Community Health, Department of Medicine, University of Minnesota and Veterans Affairs Health Care System, Minneapolis.
Abstract
Importance: Repeated bone mineral density (BMD) testing to screen for osteoporosis requires resources. For patient counseling and optimal resource use, it is important for clinicians to know whether repeated BMD measurement (compared with baseline BMD measurement alone) improves the ability to discriminate between postmenopausal women who will and will not experience a fracture. Objective: To assess whether a second BMD measurement approximately 3 years after the initial assessment is associated with improved ability to estimate fracture risk beyond the baseline BMD measurement alone. Design, Setting, and Participants: The Women's Health Initiative is a prospective observational study. Participants in the present cohort study included 7419 women with a mean (SD) follow-up of 12.1 (3.4) years between 1993 and 2010 at 3 US clinical centers. Data analysis was conducted between May 2019 and December 2019. Main Outcomes and Measures: Incident major osteoporotic fracture (ie, hip, clinical spine, forearm, or shoulder fracture), hip fracture, baseline BMD, and absolute change in BMD were assessed. The area under the receiver operating characteristic curve (AU-ROC) for baseline BMD, absolute change in BMD, and the combination of baseline BMD and change in BMD were calculated to assess incident fracture risk discrimination during follow-up. Results: Of 7419 participants, the mean (SD) age at baseline was 66.1 (7.2) years, the mean (SD) body mass index was 28.7 (6.0), and 1720 (23%) were nonwhite individuals. During the study follow-up (mean [SD] 9.0 [3.5] years after the second BMD measurement), 139 women (1.9%) experienced hip fractures, and 732 women (9.9%) experienced major osteoporotic fracture. In discriminating between women who experience hip fractures and those who do not, AU-ROC values were 0.71 (95% CI, 0.67-0.75) for baseline total hip BMD, 0.61 (95% CI, 0.56-0.65) for change in total hip BMD, and 0.73 (95% CI, 0.69-0.77) for the combination of baseline total hip BMD and change in total hip BMD. Femoral neck and lumbar spine BMD values had similar discrimination for hip fracture. For discrimination of major osteoporotic fracture, AU-ROC values were 0.61 (95% CI, 0.59-0.63) for baseline total hip BMD, 0.53 (95% CI, 0.51-0.55) for change in total hip BMD, and 0.61 (95% CI, 0.59-0.63) for the combination of baseline total hip BMD and change in total hip BMD. Femoral neck and lumbar spine BMD values had similar ability to discriminate between women who experienced major osteoporotic fracture and those who did not. Associations between change in bone density and fracture risk did not differ by subgroup, including diabetes, age, race/ethnicity, body mass index, or baseline BMD T score. Conclusions and Relevance: The findings of this study suggest that a second BMD assessment approximately 3 years after the initial measurement was not associated with improved discrimination between women who did and did not experience subsequent hip fracture or major osteoporotic fracture beyond the baseline BMD value alone and should not routinely be performed.
Importance: Repeated bone mineral density (BMD) testing to screen for osteoporosis requires resources. For patient counseling and optimal resource use, it is important for clinicians to know whether repeated BMD measurement (compared with baseline BMD measurement alone) improves the ability to discriminate between postmenopausal women who will and will not experience a fracture. Objective: To assess whether a second BMD measurement approximately 3 years after the initial assessment is associated with improved ability to estimate fracture risk beyond the baseline BMD measurement alone. Design, Setting, and Participants: The Women's Health Initiative is a prospective observational study. Participants in the present cohort study included 7419 women with a mean (SD) follow-up of 12.1 (3.4) years between 1993 and 2010 at 3 US clinical centers. Data analysis was conducted between May 2019 and December 2019. Main Outcomes and Measures: Incident major osteoporotic fracture (ie, hip, clinical spine, forearm, or shoulder fracture), hip fracture, baseline BMD, and absolute change in BMD were assessed. The area under the receiver operating characteristic curve (AU-ROC) for baseline BMD, absolute change in BMD, and the combination of baseline BMD and change in BMD were calculated to assess incident fracture risk discrimination during follow-up. Results: Of 7419 participants, the mean (SD) age at baseline was 66.1 (7.2) years, the mean (SD) body mass index was 28.7 (6.0), and 1720 (23%) were nonwhite individuals. During the study follow-up (mean [SD] 9.0 [3.5] years after the second BMD measurement), 139 women (1.9%) experienced hip fractures, and 732 women (9.9%) experienced major osteoporotic fracture. In discriminating between women who experience hip fractures and those who do not, AU-ROC values were 0.71 (95% CI, 0.67-0.75) for baseline total hip BMD, 0.61 (95% CI, 0.56-0.65) for change in total hip BMD, and 0.73 (95% CI, 0.69-0.77) for the combination of baseline total hip BMD and change in total hip BMD. Femoral neck and lumbar spine BMD values had similar discrimination for hip fracture. For discrimination of major osteoporotic fracture, AU-ROC values were 0.61 (95% CI, 0.59-0.63) for baseline total hip BMD, 0.53 (95% CI, 0.51-0.55) for change in total hip BMD, and 0.61 (95% CI, 0.59-0.63) for the combination of baseline total hip BMD and change in total hip BMD. Femoral neck and lumbar spine BMD values had similar ability to discriminate between women who experienced major osteoporotic fracture and those who did not. Associations between change in bone density and fracture risk did not differ by subgroup, including diabetes, age, race/ethnicity, body mass index, or baseline BMD T score. Conclusions and Relevance: The findings of this study suggest that a second BMD assessment approximately 3 years after the initial measurement was not associated with improved discrimination between women who did and did not experience subsequent hip fracture or major osteoporotic fracture beyond the baseline BMD value alone and should not routinely be performed.
Authors: Susan J Curry; Alex H Krist; Douglas K Owens; Michael J Barry; Aaron B Caughey; Karina W Davidson; Chyke A Doubeni; John W Epling; Alex R Kemper; Martha Kubik; C Seth Landefeld; Carol M Mangione; Maureen G Phipps; Michael Pignone; Michael Silverstein; Melissa A Simon; Chien-Wen Tseng; John B Wong Journal: JAMA Date: 2018-06-26 Impact factor: 56.272
Authors: Teresa A Hillier; Katie L Stone; Doug C Bauer; Joanne H Rizzo; Kathryn L Pedula; Jane A Cauley; Kristine E Ensrud; Marc C Hochberg; Steve R Cummings Journal: Arch Intern Med Date: 2007-01-22
Authors: Kelley Pettee Gabriel; James J McClain; Chong D Lee; Pamela D Swan; Brent A Alvar; Melanie R Mitros; Barbara E Ainsworth Journal: Med Sci Sports Exerc Date: 2009-07 Impact factor: 5.411
Authors: Andrea Z LaCroix; Jane A Cauley; Mary Pettinger; Judith Hsia; Douglas C Bauer; Joan McGowan; Zhao Chen; Cora E Lewis; S Gene McNeeley; Maureen D Passaro; Rebecca D Jackson Journal: Ann Intern Med Date: 2003-07-15 Impact factor: 25.391
Authors: Zhao Chen; Charles Kooperberg; Mary B Pettinger; Tamsen Bassford; Jane A Cauley; Andrea Z LaCroix; Cora E Lewis; Simon Kipersztok; Carolyn Borne; Rebecca D Jackson Journal: Menopause Date: 2004 May-Jun Impact factor: 2.953
Authors: Kristine E Ensrud; Li-Yung Lui; Carolyn J Crandall; Eric S Orwoll; Lisa Langsetmo; John T Schousboe; Howard A Fink; Nancy E Lane; Deborah M Kado; Jane A Cauley; Marcia L Stefanick; Peggy M Cawthon Journal: J Clin Endocrinol Metab Date: 2022-08-18 Impact factor: 6.134
Authors: Ana Pimentel; Pablo Ureña-Torres; Jordi Bover; Jose Luis Fernandez-Martín; Martine Cohen-Solal Journal: Calcif Tissue Int Date: 2020-11-21 Impact factor: 4.333