Bone mineral density test no longer enough, say experts

Geneva, Switzerland — The Alliance for Better Bone Health has announced that according to evidence presented by an international panel of osteoporosis experts, Bone Mineral Density (BMD) testing does not accurately reflect all factors important to bone strength.

The panel’s findings, presented at the Second Joint Meeting of the European Calcified Tissue Society (ECTS) and the International Bone and Mineral Society (IBMS) in Geneva, Switzerland, are of utmost importance since BMD measurement has long been used to diagnose osteoporosis in untreated patients by obtaining dual-energy X-ray absorptiometry (DXA) scans at the spine, wrist or proximal femur.

In a symposium sponsored by the Alliance for Better Bone Health entitled "Understanding the factors which contribute to fracture risk reduction," leading osteoporosis expert Nelson Watts, M.D., a professor of medicine at the University of Cincinnati’s College of Medicine and director of the University of Cincinnati’s Bone Health and Osteoporosis Center, chaired a series of lectures to discuss the many factors, other than BMD, that contribute to bone strength.

"BMD measurement performs very well in untreated patients to find those at increased risk of fracture and to diagnose osteoporosis," Watts said.

"However, in patients receiving treatment for osteoporosis, the change in BMD explains only a small part of the reduction in fracture risk. There are clearly other factors that contribute to bone strength," he added.

Before the symposium, the Alliance for Better Bone Health hosted a unique demonstration that included an educational morning of paradoxes showcasing the importance of bone quality in osteoporosis treatment and the importance of the "quality" of everyday life.

The event included a re-creation of the different "sensorial" experiences using the five senses: taste, sight, smell, touch and sound.

The purpose of the event was to build awareness among the international media highlighting that what may seem healthy and of similarly good quality upon first appearance may be very different at closer inspection, underlining the significance of maintaining bone quality in the treatment of osteoporosis.

Osteoporosis is characterized by diminished bone strength leading to an increased risk of fracture. For untreated patients, the BMD score strongly correlates with the risk for an osteoporosis-related fracture.

But while BMD plays an important role in the diagnosis of osteoporosis in an untreated patient, it is also important to recognize that low BMD is just one of many factors that contribute to bone strength.

In fact, over the years, multiple studies have demonstrated that a BMD increase with therapy, actually contributes a small percentage to improve bone strength and fracture reduction, accounting for less than one-third of the reduction in fracture risk of antiresorptive agents.

The search for explaining bone quality resulted in the recent introduction of the Bone Quality Framework, a scientific paper written as a means of summarizing and explaining the determinants of bone strength, published in the January 2005 issue of Clinical Therapeutics.

In this framework, bone quality can be understood as a set of characteristics that influence bone strength and explain the inter-relationships of these characteristics.

Leading professors and experts in the field of osteoporosis helped summarize and explain the components of bone strength, saying that not all determinants of bone strength are well represented by a BMD measurement.

"Clinicians have been looking for sometime for a more complete overview of the factors that contribute to bone strength and I believe we are making progress in this area," Watts said.

"This progress will ultimately help improve the assessment of fracture risk and the treatment for women with postmenopausal osteoporosis," he added.

The Alliance for Better Bone Health was formed by Procter & Gamble and Aventis, part of the sanofi-aventis Group, in May 1997 to promote bone health and disease awareness through numerous activities to support physicians and patients around the globe.

Risedronate sodium, a bisphosphonate, is currently approved in 82 countries and is marketed by the Alliance for Better Bone Health.