Change in Bone Mineral Density Is an Indicator of Treatment-Related Antifracture Effect
Authors: William D. Leslie, Sumit R. Majumdar, Suzanne N. Morin, Lisa M. Lix
Journal: Annals of Internal Medicine (2017)

Letters17 January 2017Change in Bone Mineral Density Is an Indicator of Treatment-Related Antifracture EffectWilliam D. Leslie, MD, MSc, Sumit R. Majumdar, MD, MPH, Suzanne N. Morin, MD, MSc, and Lisa M. Lix, PhDWilliam D. Leslie, MD, MScFrom University of Manitoba, Winnipeg, Manitoba, Canada; University of Alberta, Edmonton, Alberta, Canada; and McGill University, Montreal, Quebec, Canada.Search for more papers by this author, Sumit R. Majumdar, MD, MPHFrom University of Manitoba, Winnipeg, Manitoba, Canada; University of Alberta, Edmonton, Alberta, Canada; and McGill University, Montreal, Quebec, Canada.Search for more papers by this author, Suzanne N. Morin, MD, MScFrom University of Manitoba, Winnipeg, Manitoba, Canada; University of Alberta, Edmonton, Alberta, Canada; and McGill University, Montreal, Quebec, Canada.Search for more papers by this author, and Lisa M. Lix, PhDFrom University of Manitoba, Winnipeg, Manitoba, Canada; University of Alberta, Edmonton, Alberta, Canada; and McGill University, Montreal, Quebec, Canada.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L16-0529 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:Dr. Bell and colleagues question whether inclusion of fractures that occurred before the second (follow-up) BMD test might affect results through reverse causation. As noted in our article, the proportional hazards assumption was confirmed, indicating stable effects during follow-up. Indeed, there is progressive divergence in cumulative fracture incidence (Figure 1) that extends beyond the second BMD test (average interval between tests, 4.5 years). The data in Table 3 further show that 10-year cumulative incidence for any fracture is twice the 5-year cumulative incidence regardless of whether it is based on the BMD change category (ratios, 1.98 to 2.05) ...References1. Cummings SR, Palermo L, Browner W, Marcus R, Wallace R, Pearson J, et al. Monitoring osteoporosis therapy with bone densitometry: misleading changes and regression to the mean. Fracture Intervention Trial Research Group. JAMA. 2000;283:1318-21. [PMID: 10714731] CrossrefMedlineGoogle Scholar2. Leslie WD, Majumdar SR, Morin SN, Lix LM. Why does rate of bone density loss not predict fracture risk? J Clin Endocrinol Metab. 2015;100:679-83. [PMID: 25611114] doi:10.1210/jc.2014-3777 CrossrefMedlineGoogle Scholar3. Glüer CC, Blake G, Lu Y, Blunt BA, Jergas M, Genant HK. Accurate assessment of precision errors: how to measure the reproducibility of bone densitometry techniques. Osteoporos Int. 1995;5:262-70. [PMID: 7492865] CrossrefMedlineGoogle Scholar4. Shepherd JA, Lu Y, Wilson K, Fuerst T, Genant H, Hangartner TN, et al; International Society for Clinical Densitometry Committee on Standards of Bone Measurement. Cross-calibration and minimum precision standards for dual-energy X-ray absorptiometry: the 2005 ISCD Official Positions. J Clin Densitom. 2006;9:31-6. [PMID: 16731429] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From University of Manitoba, Winnipeg, Manitoba, Canada; University of Alberta, Edmonton, Alberta, Canada; and McGill University, Montreal, Quebec, Canada.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M15-2937. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoChange in Bone Mineral Density Is an Indicator of Treatment-Related Antifracture Effect in Routine Clinical Practice William D. Leslie , Sumit R. Majumdar , Suzanne N. Morin , and Lisa M. Lix Change in Bone Mineral Density Is an Indicator of Treatment-Related Antifracture Effect Katy J.L. Bell , Andrew Hayen , Paul Glasziou , Les Irwig , and Douglas C. Bauer Metrics 17 January 2017Volume 166, Issue 2Page: 152-153KeywordsBone densityBone mineral densityDisclosureHipHip fracturesReproducibilitySpine ePublished: 17 January 2017 Issue Published: 17 January 2017 Copyright & PermissionsCopyright © 2017 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...