Overdiagnosis of bone fragility in the quest to prevent hip fracture

Abstract

Despite widespread endorsement, Teppo Järvinen and colleagues argue that evidence for stratifying risk of fracture and subsequent drug therapy to prevent hip fracture is insufficient to warrant our current approach

A comprehensive fracture prevention strategy in older adults: The European Union Geriatric Medicine Society (EUGMS) statement

“…Whereas there are well established definitions of osteoporosis (13,14), there is much current debate on what is the target population that may potentially benefit from treatments acting on bone metabolism (TABM) (13,14,(48)(49)(50)(51).…”

“…The cost-effectiveness of the pharmacological approach of treating osteoporosis (and therefore on searching for osteoporosis by Dual-Energy X-Ray Absorptiometry (DXA)) is also debated (13). However, several licensed TABM have shown their ability to prevent major fractures in people (most often women) with a T-score ≤-2.5 at the spine or the hip (raloxifene has only been shown effective in preventing vertebral fractures) (14,61) or after a hip fracture (61).…”

“…Relative risk reductions of spine and non-vertebral fractures by TABM in subjects with bone densitometry diagnosed osteoporosis are 40-60% and 20-40%, respectively (14,61). Number-Needed-to-Treat (NNT) to prevent a fracture is lower in people at high risk of fractures, and especially in those with prior fragility fractures (13,37,(61)(62)(63)(64)(65)(66)(67)(68)(69)(70)(71)(72)(73).…”

“…With the global growth of the older population, prevention of fractures has become an international public health priority (4,9,10). The most appropriate and cost-effective strategy to prevent major fractures in older people however remains a hotly debated topic (11)(12)(13)(14). In the present statement, the Interest Group on Falls and Fracture Prevention of the European Union Geriatric Medicine Society (EUGMS), in collaboration with the International Association of Gerontology and Geriatrics for the European Region (IAGG-ER), the European Union of Medical Specialists (EUMS), the International Osteoporosis Foundation -European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis, outlines its views on the main points in the current debate.…”

Osteoporosis: recent advances in diagnosis and management

“…5 Primary prevention in those who have not fractured is controversial, 6 except perhaps when considering prevention of medication-induced bone fragility, particularly that associated with glucocorticoids. 7 The three most commonly used treatment thresholds when considering secondary fracture prevention are: low bone density, thresholds devised by NOGG that vary with age, and fixed treatment thresholds.…”