Published 23 June 2009, doi:10.1136/bmj.b2266
Cite this as: BMJ 2009;338:b2266

Research

Value of routine monitoring of bone mineral density after starting bisphosphonate treatment: secondary analysis of trial data

Katy J L Bell, research fellow1, Andrew Hayen, senior lecturer in biostatistics1, Petra Macaskill, associate professor of biostatistics1, Les Irwig, professor of epidemiology1, Jonathan C Craig, professor of clinical epidemiology1, Kristine Ensrud, professor of medicine2, Douglas C Bauer, professor of medicine and epidemiology and biostatistics3

1 Screening and Test Evaluation Program, School of Public Health, Edward Ford Building (A27), University of Sydney, NSW 2006, Australia, 2 University of Minnesota Medical School, Veterans Affairs Medical Center, One Veterans Drive (111-0), Minneapolis, MN 55417, USA, 3 Box 0560, 185 Berry Street 5700, University of California, San Francisco, CA 94143–0560, USA

Correspondence to: K J L Bell katyb{at}health.usyd.edu.au

Objective: To assess the value of monitoring response to bisphosphonate treatment by means of measuring bone mineral density.

Design Secondary analysis of trial data using mixed models.

Data source The Fracture Intervention Trial, a randomised controlled trial that compared the effects of alendronate and placebo in 6459 postmenopausal women with low bone mineral density recruited between May 1992 and May 1993. Bone density measurements of hip and spine were obtained at baseline and at one, two, and three years after randomisation.

Main outcome measures Between-person (treatment related) variation and within-person (measurement related) variation in hip and spine bone mineral density.

Results The mean effect of three years’ treatment with alendronate was to increase hip bone mineral density by 0.030 g/cm2. There was some between-person variation in the effects of alendronate, but this was small in size compared with within-person variation. Alendronate treatment is estimated to result in increases in hip bone density ≥0.019 g/cm2 in 97.5% of patients.

Conclusions: Monitoring bone mineral density in postmenopausal women in the first three years after starting treatment with a potent bisphosphonate is unnecessary and may be misleading. Routine monitoring should be avoided in this early period after bisphosphonate treatment is commenced.

© Bell et al 2009
This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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This article has been cited by other articles:

  • (2009). Is Monitoring BMD Necessary in Patients Who Take Bisphosphonates?. JWatch Women's Health 2009: 5-5 [Full text]  
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  • Compston, J. (2009). Monitoring bone mineral density during antiresorptive treatment for osteoporosis. BMJ 338: b1276-b1276 [Full text]  
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