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Letters Overdiagnosing bone fragility

Authors’ reply to Lee and colleagues

BMJ 2015; 351 doi: (Published 14 July 2015) Cite this as: BMJ 2015;351:h3737
  1. Teppo Järvinen, professor1,
  2. Karl Michaëlsson, professor2,
  3. Jarkko Jokihaara, registrar3,
  4. Gary S Collins, associate professor4,
  5. Thomas L Perry, clinical assistant professor5,
  6. Barbara Mintzes, senior lecturer6,
  7. Vijaya Musini, assistant professor5,
  8. Juan Erviti, head7,
  9. Javier Gorricho, senior evaluation officer8,
  10. James M Wright, professor5,
  11. Harri Sievänen, research director9
  1. 1Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
  2. 2Department of Surgical Sciences, Section of Orthopaedics, Uppsala University, Uppsala, Sweden
  3. 3Department of Hand Surgery, Tampere University Hospital, Tampere, Finland
  4. 4Centre for Statistics in Medicine, Botnar Research Centre, University of Oxford, Oxford, UK
  5. 5Departments of Anesthesiology, Pharmacology, and Therapeutics and Medicine, University of British Columbia, Vancouver, BC, Canada
  6. 6Faculty of Pharmacy and Charles Perkins Centre, University of Sydney, Sydney, Australia
  7. 7Drug Information Unit, Navarre Regional Health Service, Pamplona, Navarre, Spain
  8. 8Department of Health, Government of Navarre, Pamplona, Navarre, Spain
  9. 9UKK Institute for Health Promotion Research, Tampere, Finland
  1. teppo.jarvinen{at}

Lee and colleagues of the National Bone Health Alliance (NBHA) call for expanded fracture liaison services (FLS), because secondary prevention represents the most productive opportunity for pharmacotherapy. Intuitively this seems logical, but supporting arguments do not stand up to scrutiny.1 2

The effectiveness of FLS should be tested in randomised controlled trials (RCTs) to see whether this approach can achieve the “quality outcomes” referred to1—prevention of second fractures—as opposed to the proportion of patients evaluated or prescribed drugs. Presently, evidence on FLS is limited to observational studies or …

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