Monitoring bone mineral density during antiresorptive treatment for osteoporosis

doi:10.1136/bmj.b1276

Published 23 June 2009, doi:10.1136/bmj.b1276
Cite this as: BMJ 2009;338:b1276

Editorials

Monitoring bone mineral density during antiresorptive treatment for osteoporosis

Is potentially misleading and a misuse of healthcare resources

The first 150 words of the full text of this article appear below.

Antiresorptive treatment for osteoporosis is usually prescribedfor a minimum of five years. Although it reduces the risk offracture, it does not relieve symptoms caused by existing fracturesand may have side effects. Understandably, therefore, patientsand their doctors seek reassurance that the treatment is working.The most common way to monitor response is repeated measurementof bone mineral density using dual energy x ray absorptiometry(DXA), an approach endorsed by recent guidelines.¹ ² Routinemonitoring is costly, however, and—if it does not reducedisease burden—may divert healthcare resources away frommore deserving causes. In the linked study (doi:10.1136/bmj.b2266),Bell and colleagues assess the need to monitor the responseto bisphosphonate treatment by estimating how much the effectsof alendronate differ between individuals.³

Treatment aims to reduce the rate of fractures; therefore, monitoringshould detect whether treatment will reduce the risk of fracturein individual patients. The effectiveness . . . [Full text of this article]

Juliet Compston, professor of bone medicine

¹ University of Cambridge School of Clinical Medicine, Cambridge CB2 0SP

jec1001@cam.ac.uk