Fragile Bones Redefined

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Science  11 Jun 2004:
Vol. 304, Issue 5677, pp. 1567
DOI: 10.1126/science.304.5677.1567b

One of the most important predictors of osteoporotic fractures in postmenopausal women is bone mineral density (BMD). There has been considerable debate about the BMD threshold at which therapies to reduce the risk of fracture (lifestyle changes and/or pharmacological agents) should be initiated. Currently, therapy is recommended primarily for women whose severe bone loss classifies them as “osteoporotic,” whereas “osteopenic” women, who show moderate bone loss, are not treated.

New evidence suggests that osteopenic women are at increased risk for fracture and raises the possibility that they too might benefit from therapeutic intervention. In a large study of postmenopausal Caucasian women in the United States, Siris et al. found that 82% of the women who experienced bone fractures within 1 year of study entry had BMD values in the osteopenic rather than osteoporotic range. Using data from the same cohort of women, Miller et al. designed a classification tool that combines BMD with other risk factors and correctly identified about 75% of the osteopenic women who had sustained a fracture. Current screening strategies for osteoporosis, whose prevalence is rising dramatically with the aging of baby boomers, may thus merit re-examination. — PAK

Arch. Intern. Med. 164, 1108; 1113 (2004).

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