Kristine E Ensrud professorcore investigator, Brent C Taylor associate professorcore investigator, Katherine W Peters statistician, Margaret L Gourlay assistant professor, Meghan G Donaldson research associate, William D Leslie professor et al
Ensrud K E, Taylor B C, Peters K W, Gourlay M L, Donaldson M G, Leslie W D et al.
Implications of expanding indications for drug treatment to prevent fracture in older men in United States: cross sectional and longitudinal analysis of prospective cohort study
BMJ 2014; 349 :g4120
doi:10.1136/bmj.g4120
Re: Implications of expanding indications for drug treatment to prevent fracture in older men in United States: cross sectional and longitudinal analysis of prospective cohort study
We read with interest Ensrud and colleagues' excellent study and wish to congratulate the authors on work which adds to our knowledge and understanding of the difficult clinical problem of preventing fracture in older men through drugs[1]. However, we have some concerns regarding the paper and wish to share them.
The authors said that they contacted surviving participants every four months about incident hip and major osteoporotic (hip, clinical vertebral, wrist, or humerus) fracture during the subsequent 10 year follow-up period and all the fractures were confirmed by review of radiographic reports. However, 5880 old men averaged 73.6 years, and at this age they inevitably suffer from various medical diseases--for example, chronic kidney disease. In clinical practice, there are a lot of mild vertebral osteoporotic compression fractures in such patients and a considerable part of the vertebral fracture does not have any clinical pain symptoms, which even could be caused by coughing[2-4]. Those fractures can be easily missed just in X-ray examination, which is sensitive to MRI examniation. But we cannot fund MRI examination even for suspicious vertebral fractures, which cannot be diagnosed by X-ray. So the real incidence of osteoporotic fracture may be underestimated in this study.
References
1. Ensrud KE, Taylor BC, Peters KW, et al. Implications of expanding indications for drug treatment to prevent fracture in older men in United States: cross sectional and longitudinal analysis of prospective cohort study.BMJ. 2014 Jul 3;349:g4120
2. Jamal SA, West SL, Nickolas TL.2014 The clinical utility of FRAX to discriminate fracture status in men and women with chronic kidney disease.Osteoporos Int. 25:71-76.
3. Faur D, Pérez-Bovet J, Ferrer SM,et al. 2013 Pathologic cervical fracture in a patient with secondary hyperparathyroidism.Kidney Int. 83:974.
4. Jamal S, Cheung AM, West S,et al. 2012 Bone mineral density by DXA and HR pQCT can discriminate fracture status in men and women with stages 3 to 5 chronic kidney disease.Osteoporos Int. 23:2805-2813.
Competing interests: No competing interests