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Ethel S. Siris, MD; Ya-Ting Chen, PhD; Thomas A. Abbott, PhD; Elizabeth Barrett-Connor, MD; Paul D. Miller, MD; Lois E. Wehren, MD; Marc L. Berger, MD

Arch Intern Med. 2004;164:1108-1112.

Background  Treatment intervention thresholds for prevention of osteoporotic fractures can be derived from reports from the World Health Organization (diagnostic criteria) and National Osteoporosis Foundation (treatment criteria). It is not known how well these thresholds work to identify women who will fracture and are therefore candidates for treatment interventions. We used data from the National Osteoporosis Risk Assessment (NORA) to examine the effect of different treatment thresholds on fracture incidence and numbers of women with fractures within the year following bone mineral density measurement.

Methods  The study comprised 149 524 white postmenopausal women aged 50 to 104 years (mean age, 64.5 years). At baseline, bone mineral density was assessed by peripheral bone densitometry at the heel, finger, or forearm. New fractures during the next 12 months were self-reported.

Results  New fractures were reported by 2259 women, including 393 hip fractures; only 6.4% hadbaseline T scores of –2.5 or less (World Health Organization definition for osteoporosis). Although fracture rates were highest in these women, they experienced only 18% of the osteoporotic fractures and 26% of the hip fractures. By National Osteoporosis Foundation treatment guidelines, 22.6% of the women had T scores of 2.0 or less, or –1.5 or less with 1 or more clinical risk factors. Fracture rates were lower, but 45% of osteoporotic fractures and 53% of hip fractures occurred in these women.

Conclusions  Using peripheral measurement devices, 82% of postmenopausal women with fractures had T scores better than –2.5. A strategy to reduce overall fracture incidence will likely require lifestyle changes and a targeted effort to identify and develop treatment protocols for women with less severe low bone mass who are nonetheless at increased risk for future fractures.

From the Toni Stabile Osteoporosis Center, Columbia-Presbyterian Medical Center, and Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY (Dr Siris); Department of Outcomes Research and Management, Merck & Co Inc, West Point, Pa (Drs Chen, Abbott, and Berger); University of California, San Diego, La Jolla (Dr Barrett-Connor); Colorado Center for Bone Research, Lakewood, and University of Colorado, Denver (Dr Miller); and University of Maryland, Baltimore (Dr Wehren). Drs Siris, Barrett-Connor, Miller, and Wehren receive consulting fees from Merck & Co Inc to compensate them for time spent working on the NORA project.

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