Many women at fracture risk may not know it: study

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Many women at fracture risk may not know it: study

By Amy Norton

NEW YORK, Dec 11 (Reuters Health) - Many postmenopausal women may

unknowingly have bone loss great enough to put them at short-term risk

of fractures, the results of a US study show.

Researchers found that nearly half of the more than 200,000 women they

studied had previously unrecognized low bone mass. For 7%, the loss was

significant enough for doctors to diagnose them with the brittle-bone

disease osteoporosis.

What's more, all of these women were at increased risk of bone breaks in

the year after their bone mass was measured, according to findings

published in the December 12th issue of The Journal of the American

Medical Association.

This finding " affirms the immediacy of risk " associated with low bone

mineral density (BMD) measurements, conclude researchers led by Dr.

Ethel S. Siris of Columbia Presbyterian Medical Center in New York City.

Their study was funded by drugmaker Merck & Co, which markets the

osteoporosis medication Fosamax.

The women in the study were seen by primary care providers in 34 US

states, where they had their BMD measured through x-rays or ultrasounds

of " peripheral sites " --the forearm, finger or heel. All were age 50 or

older and had not been previously diagnosed with osteoporosis.

Overall, almost 40% had osteopenia, or below-normal BMD. A little more

than 7% had osteoporosis.

About 164,000 of the women were then followed-up a year later. Those who

had been diagnosed with osteopenia were 80% more likely to have had a

bone break than women with normal BMD readings were. The risk was four

times greater among women who had been diagnosed with osteoporosis.

These findings confirm in the " real-world " setting of primary care what

many osteoporosis researchers have suspected, according to Dr.

H. Chesnut III of the University of Washington Medical Center in

Seattle.

" Over the past 10 or 12 years, we've had increased awareness of

osteoporosis, " he said in an interview with Reuters Health. " But I don't

think we've ever been aware of just how prevalent (bone loss) is in the

practice environment. "

Chesnut, who wrote an editorial accompanying the report, said that

" armed with this information, we need to consider treating these women. "

It is estimated that half of women older than 50 will have an

osteoporosis-related fracture in their lifetime. The risk increases with

age, and lifestyle factors such as smoking, inactivity and low intake of

vitamin D and calcium over the years also boost the odds of osteoporosis

and bone breaks.

There are several drugs available for the prevention and treatment of

osteoporosis.

As far as when women should get a BMD measurement, Chesnut said that

once a woman has gone through menopause she should " think very strongly "

about it, especially if she has risk factors for osteoporosis.

In the current study, several of these traditional risk factors

increased the odds of an osteoporosis diagnosis--including older age,

lower body mass, smoking and family history of fracture. Asian, Hispanic

and white women were more likely than African-American women to have the

brittle-bone disease.

In addition, at the start of the study 11% of the women overall said

they had suffered at least one fracture of the wrist, rib, hip or spine

since the age of 45--a finding the researchers call " disturbing. "

Chesnut said that many questions remain about bone health in younger,

premenopausal women, including whether some should have BMD measurements

taken.

SOURCE: The Journal of the American Medical Association

2001;286:2815-2822, 2865-2866.