The Effectiveness of Bone Density Measurement and Associated Treatments for Prevention of Fractures:An International Collaborative Review

Abstract

AbstractThis review assesses the evidence regarding the effectiveness of bone density measurement (BDM) screening and related interventions—hormone replacement therapy (HRT) and intranasal salmon calcitonin (SCT[N])—in menopausal women to prevent fractures in later life. Data sources included systematic reviews of evidence and relevant primary studies identified through literature searches on MEDLINE and EMBASE. Study selection included trials of BDM screening programs, prospective studies exam-ining the predictive value of BDM, randomized controlled trials, cohort studies, and case-controlstudies of HRT and SCT(N). The evidence was evaluated using a classification system incorporatingstudy design and quality. Outcomes were measured in terms of relative risk of fracture for a 1 SDdecrease in bone mineral density below the age-adjusted mean, relative risks or odds ratios forfractures associated with treatments, and proportion of hip fractures potentially prevented by BDMscreening linked to treatments. Fair evidence from prospective cohort studies suggests that BDMcan predict the risk of fractures, but not with high accuracy. Fair evidence from low-quality randomizedcontrolled trials and observational studies suggests that HRT and SCT(N) are efficacious in preventingfractures. Good evidence supports the efficacy of these treatments in preserving bone mass, butthere is fair evidence that the effect wears off after cessation of therapy. There is little evidence onthe impact of screening menopausal women with BDM in association with HRT or SCT(N) treatment.Estimates based on combining existing evidence regarding the predictive value of BDM and efficacyof HRT suggests that 1–7% of hip fractures might be prevented.