Skip to main content Accessibility help
×
Home

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

  • David Hailey (a1), Laura Sampietro-colom (a2), Deborah Marshall (a3), Rosa Rico (a4), Alicia Granados (a2) and José Asua (a5)...

Abstract

This 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.

Copyright

References

Hide All
1.Agence Nationale pour le Développement de l'Evaluation Médicale. Evaluation de I'osteodensitometrie. Paris: ANDEM 1991.
2.Cagnacci, A., Melis, G. B., Soldani, R., et al. Neuroendocrine and clinical effects of transdermal 17 beta-estradiol in postmenopausal women. Maturitas, 1991,13, 283–96.
3.Canadian Task Force on the Periodic Health Examination. The periodic health examination. Canadian Medical Association Journal, 1979, 121, 1193–254.
4.Catalan Agency for Health Technology Assessment. La calcitonina en el tractament de la osteoporosis idiopatica, Barcelona: CAHTA, 1994.
5.Cauley, J. A., Seeley, D. G., Ensrud, K., et al. Estrogen replacement therapy and fractures in older women: Study of osteoporotic Fractures Research Group. Annals of Internal Medicine, 1995, 122, 916.
6.Center for Health Care Technology. Bone densitometry: Patients with end stage disease. Rockville, MD: Agency for Health Care Policy and Research, 1996.
7.Christiansen, C., Christensen, M. S., & Transbol, I.Bone mass in postmenopausal women after withdrawal of oestrogen/gestagen replacement therapy. Lancet, 1981, 1, 459–61.
8.Cicinelli, E., Galantino, P., Pepe, V., et al. Bone metabolism changes after transdermal estradiol dose reduction during estrogen replacement therapy: A 1-year prospective study. Maturitas, 1994, 19, 133–39.
9.Cochrane, A. L., & Holland, W. W.Validation of screening procedures. British Medical Bulletin, 1971, 27, 38.
10.Cooper, C., Kanis, J. A., & Compston, J.How to assess drug efficacy in osteoporosis. Lancet, 1995, 34, 743–44.
11.Cranney, A., Shea, B., Wells, G., et al. Calcitonin treatment of post-menopausal osteoporosis. In Brooks, P., Bosi-ferraz, M., De Bie, R., et al. (eds.), Musculoskeletal module of the Cochrane Database of Systematic Reviews, Oxford: UK Cochrane Centre, 1996.
12.Cummings, S. R., Nevitt, M. C., Browner, W. S., et al. Risk factors for hip fracture in white women: Study of Osteoporotic Fractures Research Group. New England Journal of Medicine, 1995, 332, 767–73.
13.Davis, J. W., Ross, P. D., Johnson, N. E., et al. Estrogen and calcium supplement use among Japanese-American women: Effects upon bone loss when used singly and in combination. Bone, 1995,17, 369–73.
14.Diagnostic and Therapeutic Technology Assessment (DATTA). Measurement of bone density with dual-energy x-ray absorptiometry (DEXA). Journal of the American Medical Association, 1992, 267, 290–94.
15.Draper, J., & Roland, M.Perimenopausal women's views on taking hormone replacement therapy to prevent osteoporosis. British Medical Journal, 1990, 300, 786–88.
16.Ettinger, B., Genant, H. K., & Cann, C. E.Long-term estrogen replacement therapy prevents bone loss and fractures. Annals of Internal Medicine, 1985, 102, 319–24.
17.Felson, D. T., Zhang, Y., Hannan, M. T., et al. The effect of postmenopausal estrogen therapy on bone density in elderly women. New England Journal of Medicine, 1993, 329, 1141–16.
18.Field, C. S., Ory, S. J., Wahner, H. W., et al. Preventive effects of transdermal 17 beta-estradiol on osteoporotic changes after surgical menopause: A two-year placebo controlled trial. American Journal of Obstetrics and Gynecology, 1993, 168, 114–21.
19.Fioretti, P., Gambacciani, M., Taponeco, F., et al. Effects of continuous and cyclic nasal calcitonin administration in ovariectomized women. Maturitas, 1992,15, 225–32.
20.Gennari, C., Agnusdei, D., Montagnani, M., et al. An effective regimen of intranasal salmon calcitonin in early postmenopausal bone loss. Calcified Tissue International, 1992, 50, 381–83.
21.Gluer, C. C., Faulkner, K. G., Estilo, M. J., et al. Quality assurance for bone densitometry research studies: Concept and impact. Osteoporosis International, 1993, 3, 227–35.
22.Hailey, D.INAHTA project on the effectiveness of bone density measurement and associated treatments for prevention of fracture, background paper 1: Methods used in the Predictive value of bone densitometry. Edmonton: Alberta Heritage Foundation forMedical Research, 1996.
23.Hailey, D., Sampietro-Colom, L., Marshall, D., et al. INAHTA project on the effectiveness of bone density measurement and associated treatments for prevention of fracture: Statement of findings. Edmonton: Alberta Heritage Foundation for Medical Research, 1996.
24.Henry, D., Robertson, J., Gillespie, W., et al. Estrogen treatment: Results ofpublished trials and epidemiological studies, assessment of study quality and public health implications. Newcastle, Australia: University of Newcastle, 1995.
25.Henry, D., Robertson, J., O'Connell, D., et al. The skeletal effects of estrogen therapy in post-menopausal women: An assessment of the quality of randomized trials published between 1977 and 1993. Newcastle, Australia: University of Newcastle, 1995.
26.Jovell, A. J., & Navarro-Rubio, M. D.. Evaluacion de la evidencia cientifica. Medicina Clinica, 1995, 105, 740–43.
27.Kanis, J. A.The incidence of hip fracture in Europe. Osteoporosis International, 3,1015.
28.Kanis, J. A., Geusens, P., & Christiansen, C.Guidelines for clinical trials in osteoporosis: A position paper of the European Foundation for Osteoporosis and Bone Disease. Osteoporosis International, 1991, 1, 182–88.
29.Kanis, J. A., Johnell, O., Gullberg, B., et al. Evidence for efficacy of drugs affecting bone metabolism in preventing hip fractures. British MedicalJournat, 1992, 305, 1124–28.
30.Kelsey, J. L., Browner, W. S., Seeley, D. G., et al. Risk factors for fractures of the distal forearm and proximal humerus: The Study of Osteoporotic Fractures Research Group. American Journal of Epidemiology, 1992, 135, 477–89.
31.Kiel, D. P., Felson, D. T., Anderson, J. J., et al. Hip fracture and the use of estrogens in postmenopausal women. The Framingham Study. New England Journal of Medicine, 1987, 317, 1169–74.
32.Knobel, H., Díez, A., Arnau, D., et al. Secuelas de la fractura oseoporótica de fémur en Barcelona. Medicina Clínica, 1992, 98, 441–44.
33.Kroger, H., Huopio, J., Honkanen, R., et al. Prediction of fracture risk using axial bone mineral density in a perimenopausal population: A prospective study. Journal of Bone and Mineral Research, 1995, 10, 302–06.
34.Law, M. R., Wald, N. J., & Meade, T. W.Strategies for prevention of osteoporosis and hip fracture. British Medical Journal, 1991, 303, 453–59.
35.Lindsay, R., Hart, D. M., MacLean, A., et al. Bone response to termination of oestrogen treatment. Lancet, 1978, 1, 1325–27.
36.Luciano, A. A., De Souza, M. J., Roy, M. P., et al. Evaluation of low-dose estrogen and progestin therapy in postmenopausal women: A double-blind, prospective study of sequential versus continuous therapy. Journal of Reproductive Medicine, 1993, 38, 207–14.
37.Lufkin, E. G., Wahner, H. W., O'Fallon, W. M., et al. Treatment of postmenopausal osteoporosis with transdermal estrogen. Annals of Internal Medicine, 1992, 117, 19.
38.MacLennan, A. H., MacLennan, A., Wenzel, S., et al. Continuous low-dose oestrogen and progestogen hormone replacement therapy: A randomized trial. Medical Journal of Australia, 1993, 159, 102–06.
39.Mango, D., Ricci, S., Manna, P., et al. Preventive treatment of cortical bone loss with salmon nasal calcitonin in early postmenopausal women. Minerva Endocrinologica, 1993, 18, 115–21.
40.Marcus, R., Greendale, G., Blunt, B. A., et al. Correlates of bone mineral density in the postmenopausal estrogen/progestin interventions trial. Journal of Bone and Mineral Research, 1994, 9, 1467–76.
41.Marshall, D., Hailey, D., & Jonsson, E.Health policy on bone density measurement technology in Sweden and Australia. Health Policy, 1996, 35, 217–28.
42.Marshall, D., Johnell, O., & Wedel, H.Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. British Medical Journal, 1996, 312, 1254–59.
43.Marshall, D., & Sheldon, T. A.INAHTA project on the effectiveness of bone density measurement and associated treatments for prevention of fracture, background paper 2: Predictive value of bone densitometry. Edmonton: Alberta Heritage Foundation for Medical Research, 1996.
44.Marshall, D., Sheldon, T. A., & Jonsson, E.Recommendations for the application of bone density measurement: What can you conclude? International Journal of Technology Assessment in Health Care, 1997, 13, 411–19.
45.Massie, A., Reid, D. M., & Porter, R. W.Screening for osteoporosis: Comparison between dual energy x-ray absorptiometry and broadband ultrasound attenuation in 1000 perimenopausal women. Osteoporosis International, 1993, 3, 107–10.
46.Mazzuoli, G., Pacitti, M. T., Minisola, S., et al. Effects of salmon calcitonin on bone loss induced by ovariectomy. Revista Clinica Espanola, 1991, 188, 4950.
47.Mazzuoli, G. E., Gennari, C., Passed, M., et al. Hip fracture in Italy: Epidemiology and preventive efficacy of bone-active drugs. Bone, 1993, 14, S8184.
48.Melton, L. J. III, Kan, S. H., Wahner, H. W., et al. Lifetime fracture risk: An approach to hip fracture risk assessment based on bone mineral density and age. Journal of Clinical Epidemiology, 1988, 41, 985–94.
49.Meschia, M., Brincat, M., Barbacini, P., et al. Effect of hormone replacement therapy and calcitonin on bone mass in postmenopausal women. European Journal of Obstetrics, Gynecology, and Reproductive Biology, 1992, 47, 5357.
50.Naessen, T., Persson, I., Adami, H. O., et al. Hormone replacement therapy and the risk for first hip fracture: A prospective, population-based cohort study. Annals of Internal Medicine, 1990, 113, 95103.
51.National Health Technology Advisory Panel. Bone mineral assessment: An update. Canberra: Australian Institute of Health, 1989.
52.NHS Centre for Reviews and Dissemination and Nuffield Institute for Health. Preventing falls and subsequent injury in older people. Effective Health Care, 1996, 2, 116.
53.Office of Technology Assessment. Hip fracture outcomes in people age 50 and over (backgroundpaper). Washington, DC: U.S. Congress, 1994. Report no. OTA-BP-H-120.
54.Osteba. Evaluation de technologias sanitaria: Actuacion ante la osteoporosis en el Pais Vasco. Vitoria-Gasteiz: Osteba, 1994.
55.Overgaard, K.Effect of intranasal salmon calcitonin therapy on bone mass and bone turnover in early menopausal women: A dose-response study. Calcified Tissue International, 1994, 55, 8286.
56.Overgaard, K., Hansen, M. A., Jensen, S. B., et al. Effect of salcatonin given intranasally on bone mass and fracture rates in established osteoporosis: A dose-response study. British Medical Journal, 1992, 305, 556–61.
57.Overgaard, K., Riis, B. J., Christiansen, C., et al. Nasal calcitonin for treatment of established osteoporosis. Clinical Endocrinology, 1989, 30, 435–42.
58.Paganini-Hill, A., Chao, A., Ross, R. K., et al. Exercise and other factors in the prevention of hip fracture: The Leisure World study. Epidemiology, 1991, 2, 1625.
59.Pocock, N. A., Noakes, K. A., Howard, G. M., et al. Screening for osteoporosis: What is the role of heel ultrasound? Medical Journal of Australia, 1996, 164, 367–70.
60.Preventive Services Task Force. Guide to clinical preventive services: An assessment of the effectiveness of 169 interventions. Report of the U.S. Preventive Services Task Force. Baltimore, MD: Williams & Wilkins, 1989.
61.Prince, R. L., Smith, M., Dick, I. M., et al. Prevention of postmenopausal osteoporosis: A comparative study of exercise, calcium supplementation, and hormone-replacement therapy. New England Journal of Medicine, 1991, 325, 1189–95.
62.Quigley, M. E., Martin, P. L., Burnier, A. M., et al. Estrogen therapy arrests bone loss in elderly women. American Journal of Obstetrics and Gynecology, 1987, 156, 1516–23.
63.Reginster, J. Y., Deroisy, R., Lecart, M. P., et al. A double-blind, placebo-controlled, dose-finding trial of intermittent nasal salmon calcitonin for prevention of postmenopausal lumbar spine bone loss. American Journal of Medicine, 1995, 98, 452–58.
64.Reginster, J. Y., Meurmans, L., Deroisy, R., et al. A 5-year controlled randomized study of prevention of postmenopausal trabecular bone loss with nasal salmon calcitonin and calcium. European Journal of Clinical Investigation, 1994, 24, 565–69.
65.Riggs, B. L., & Melton, L. J., III. Involutional osteoporosis. New England Journal of Medicine, 1986, 314, 1676–86.
66.Sampietro-Colom, L., Almazan, C., & Granados, A.Evaluatión de la densitometria ósea. Barcelona: Generalitat de Catalunya, Departament de Sanitat I Seguretat Social, Oficina Tecnica d'Avaluació de Tecnologia Mèdica, 1993.
67.Sampietro-Colom, L., Rico, R., Granados, A., et al. INAHTA project on the effectiveness of bone density measurement and associated treatments for prevention of fracture, background paper 3: A review of the evidence of hormone replacement therapy and calcitonin in reducing bone loss and fractures. Edmonton: Alberta Heritage Foundation for Medical Research, 1996.
68.School of Public Health, University of Leeds and Centre for Health Economics, University of York. Screening for osteoporosis to prevent fractures: Should population based screening programs aimed at the prevention of fractures in elderly women be established? Effective Health Care, 1992, 1, 112.
69.Spector, T. D.Use of oestrogen replacement therapy in high risk groups in the United Kingdom. British Medical Journal, 1989, 299, 1434–35.
70.Spector, T. D., Brennan, P., Harris, P. A., et al. Do current regimes of hormone replacement therapy protect against subsequent fractures? Osteoporosis International, 1992, 2, 219–24.
71.Stevenson, J. C., Crook, D., Godsland, I. F., et al. Oral versus transdermal hormone replacement therapy. International Journal of Fertility and Menopausal Studies, 1993, 38, 3035.
72.Swedish Council on Technology Assessment in Health Care. Mätning av bentäthet. Stockholm: Swedish Council on Technology Assessment in Health Care, 1995.
73.Thamsborg, G., Storm, T. L., Sykulski, R., et al. Effect of different doses of nasal salmon calcitonin on bone mass. Calcified Tissue International, 1991, 48, 302–07.
74.Tinetti, M. E., & Speechley, M.Prevention of falls among the elderly. New England Journal of Medicine, 1989, 320, 1055–59.
75.Tinetti, M. E., Speechley, M., & Ginter, S. F.Risk factors for falls among elderly persons living in the community. New England Journal of Medicine, 1988, 319, 1701–07.
76.Tobias, J. H., Cook, D. G., Chambers, T. J., et al. A comparison of bone mineral density between Caucasian, Asian and Afro-Caribbean women. Clinical Science, 1994, 87, 587–91.
77.Torgerson, D. J., Campbell, M. K., Thomas, R. E., et al. Prediction of perimenopausal fractures by bone mineral density and other factors. Journal of Bone and Mineral Research, 1996, 11, 293–97.
78.Torgerson, D. J., Donaldson, C., & Reid, D. M.Using economics to prioritise research: A case study of randomized trials for the prevention of hip fractures due to osteoporosis. Journal of Health Services Research and Policy, 1996, 1, 141–46.
79.Torgerson, D. J., Donaldson, C., Russell, I. T., et al. Hormone replacement therapy: Compliance and cost after screening for osteoporosis. European Journal of Obstetrics, Gynecology, and Reproductive Biology, 1995, 59, 5760.
80.Wimalawansa, S. J.Combined therapy with estrogen and etidronate has an additive effect on bone mineral density in the hip and vertebrae: Four-year randomized study. American Journal of Medicine, 1995, 99, 3642.

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

  • David Hailey (a1), Laura Sampietro-colom (a2), Deborah Marshall (a3), Rosa Rico (a4), Alicia Granados (a2) and José Asua (a5)...

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed