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Research shows opportunity for more accurate measurement of bone mineral density and predicting fracture risk

May 17, 2004

A new method of determining the ability of a hip to withstand fracture following a fall was introduced at the IOFWorld Congress on Osteoporosis held in Rio de Janeiro, Brazil.

Improved Methods for Predicting Bone Fracture Risk

Measuring bone mineral density (BMD) is the method of choice among physicians trying to gauge if their patients are at risk for sustaining a fragility fracture of a major bone. But taking additional factors into consideration yields a Fall Index that is a better predictor than BMD alone, researchers reported this week at the IOF World Congress on Osteoporosis.

Hip fractures are more frequent in the elderly population, many of whom suffer from osteoporosis, a disorder that causes gradual leeching of bone minerals. Results from bone density scans are typically used to identify patients who may have osteoporosis and who are at risk for fragility fractures, particularly of the hip. Combining this data with measurements of bone geometry, age, height, and weight can produce a Fall Index that better predicts risk, reported Dr. Kenneth Faulkner and colleagues from GE Healthcare and the Osteoporosis Diagnostic and Treatment Center, Richmond, Virginia, USA (conference abstract OC3).

Faulkner and colleagues measured BMD and Fall Index in 422 women, 58 of whom had a previous fracture. The Fall Index, mathematically determined, indicates the ability of a hip to withstand a fall. Faulkner and colleagues found the Fall Index was significantly lower in the 58 women who had sustained a broken hip. BMD measurements were also significantly lower in these women.

"The Fall Index predicts hip fracture better than bone density alone," said Faulkner, adding that verification studies are needed to confirm the results. In addition, the Fall Index will need to be reviewed by regulatory agencies for approval before it could be used in the clinic.

Measuring the index requires the uses of bone densitometers that can measure not just bone density but also bone geometry, such as cross sectional area. Most modern densitometers are equipped with these capabilities.

Low bone density not the entire story

While bone mineral density is a reliable indicator for osteoporosis, about half of women who sustain fragility fractures have bone mineral densities above the WHO diagnostic threshold for osteoporosis. Some of these patients have osteopenia, a less severe loss of bone minerals. In these patients, the combination bone mineral loss and a prior fracture was a powerful indication of increased risk for another vertebral or non-vertebral fracture, according to a study by Dr. Elizabeth Sornay-Rendu and colleagues, INSERM, Lyon, France (conference abstract OC15).

The study followed 668 postmenopausal women for an average of just over nine years, measuring bone mineral densities of the spine and hip, and also biological markers of bone turnover such as the enzyme alkaline phosphatase. The latter is released during bone resorption and can be detected in the blood. Sornay-Rendu found that the risk of fracture for osteopenic women with prior fractures and/or high bone turnover markers was almost equal to that of women with osteoporosis.

"The assessment of risk factors for fractures (bone turnover markers and history of prior fracture) may play an important role in identifying women at high risk of fracture who could not be adequately detected by BMD measurement alone," said Sornay-Rendu. These patients would likely benefit from therapeutic intervention. She added that the findings should be corroborated by larger longitudinal studies.

Link between osteoarthritis and vertebral fracture risk

The same authors also reported that osteoarthritis is associated with an increased risk for vertebral fracture in postmenopausal women. This finding suggests that the increase in bone mineral density that usually accompanies osteoarthritis does not necessarily reduce the risk of sustaining a fracture (conference abstract OC24).

The findings came from analyzing data collected from the OFELY cohort, a group of 1,000 women of varying ages who were enrolled to help examine factors that contribute to osteoporosis and osteoarthritis. Sornay-Rendu found that narrowing of vertebral discs was associated with an increased risk for vertebral fracture, and that this was independent of bone mineral density.

"These data indicate that the risk of osteoporotic fracture should not be underestimated in women with spine osteoarthritis, said Sornay-Rendu," who suggested that future studies be carried out to evaluate disc narrowing before fractures. One limitation of the OFELY study is that it was designed to compare data from a cross-section of the population, not to follow patients over time. "For this reason we cannot imply a temporal or causal relationship with fracture," Sornay-Rendu commented.


The International Osteoporosis Foundation (IOF) is a worldwide organization dedicated to the fight against osteoporosis. It brings together scientists, physicians, patient societies and corporate partners. Working with its 165 member societies in more than 85 locations, and other healthcare-related organizations around the world, IOF encourages awareness and prevention, early detection and improved treatment of osteoporosis.

Osteoporosis, in which the bones become porous and break easily, is one of the world's most common and debilitating diseases. The result: pain, loss of movement, inability to perform daily chores, and in many cases, death. One out of three women over 50 will experience osteoporotic fractures, as will one out of eight men(1). Unfortunately, screening for people at risk is far from being a standard practice. Osteoporosis can, to a certain extent, be prevented, it can be easily diagnosed and effective treatments are available.

1 Melton U, Chrischilles EA, Cooper C et al. How many women have osteoporosis? Journal of Bone Mineral Research, 1992; 7:1005-10

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