Healthcare professions should not bother with bone mineral density (BMD) testing in postmenopausal women during the first three years of drug (bisphosphonate) therapy for osteoporosis, Australian researchers reported this week.
According to a report in MedPage, patients in the first three years of a large prospective drug trial showed wide variation in bone mineral density results from one scan to the next according to a study reported online in BMJ.
The researchers told MedPage the findings suggested that bone density measurements in these early years give no useful information about actual treatment response.
“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,” the researchers wrote.
The take home points:
- Bisphosphonates (like Fosamax [alendronate], Boniva [ibandronate], Actonel [risedronate]) are drugs that are commonly prescribed to treat osteoporosis and reduce fracture risk.
- Bone mineral density (BMD) measurement is used to diagnose osteoporosis and monitor treatment response.
- This study drew on data for a single type of oral bisphosphonate drug, although the authors said it was reasonable to believe the findings apply to the entire class.
The findings were based on data from the Fracture Intervention Trial, a randomized, placebo-controlled study of alendronate (Fosamax) in 6,459 postmenopausal women with low baseline bone mineral density.
The trial, which began in 1992, included annual bone density measurements at the hip and spine during the first three years of therapy.
The researchers wrote, “This means that, even though we found the effects of alendronate to vary between individuals, the size of this variation is not clinically relevant and monitoring individual response is not needed.”
They noted that earlier studies had reached similar conclusions – one found that even four years of treatment was not enough to predict an eventual benefit from bisphosphonate treatment.
Another study had demonstrated reduced fracture risk in women with declining bone mineral density measurements during alendronate treatment.
“Failure to recognize this measurement variation may lead clinicians to make inappropriate changes to treatment or to delay taking action when they should intervene,” the researchers warned.
In an accompanying editorial, Juliet Compston, MD, of Cambridge University in England, agreed that routine monitoring during the early years of bisphosphonate therapy is unnecessary.
“If true nonresponders to antiresorptive treatment do exist, they are rare, and most cases of nonresponse are caused by failure to persist with treatment,” she wrote.
“This is best tackled by carefully explaining the treatment to patients before they start, and follow up after about three months to discuss problems related to treatment,” added Dr. Compston.
“Routine monitoring of bone mineral density during the first few years of antiresorptive treatment cannot be justified because it may mislead patients, lead to inappropriate management decisions, and waste scarce healthcare resources,” she said.
So, what’s the bottom line?
If you have a BMD showing osteoporosis or osteopenia, and your doctor prescribes a bisphosphonate, you do NOT need to spend the money on a follow-up BMD test for at least the first three or four years.