Hostname: page-component-586b7cd67f-t7fkt Total loading time: 0 Render date: 2024-11-24T21:50:01.279Z Has data issue: false hasContentIssue false
  • English
  • Français

The Effectiveness of Bone Density Measurement and Associated Treatments for Prevention of Fractures: An International Collaborative Review

Published online by Cambridge University Press:  10 March 2009

David Hailey ,
Laura Sampietro-colom ,
Deborah Marshall ,
Rosa Rico ,
Alicia Granados  and
José Asua
David Hailey
Affiliation:
Alberta Heritage Foundation for Medical Research
Laura Sampietro-colom
Affiliation:
Catalan Agency for Health Technology Assessment
Deborah Marshall
Affiliation:
Alberta Heritage Foundation for Medical Research and Swedish Council on Technology Assessment in Health Care
Rosa Rico
Affiliation:
Basque Office for Technology Assessment
Alicia Granados
Affiliation:
Catalan Agency for Health Technology Assessment
José Asua
Affiliation:
Basque Office for Health Technology Assessment
Get access Rights & Permissions [Opens in a new window]

Abstract

This review assesses the evidence regarding the effectiveness of bone density measurement (BDM) screening and related interventions—hormone replacement therapy (HRT) and intranasal salmon calcitonin (SCT[N])—in menopausal women to prevent fractures in later life. Data sources included systematic reviews of evidence and relevant primary studies identified through literature searches on MEDLINE and EMBASE. Study selection included trials of BDM screening programs, prospective studies exam-ining the predictive value of BDM, randomized controlled trials, cohort studies, and case-controlstudies of HRT and SCT(N). The evidence was evaluated using a classification system incorporatingstudy design and quality. Outcomes were measured in terms of relative risk of fracture for a 1 SDdecrease in bone mineral density below the age-adjusted mean, relative risks or odds ratios forfractures associated with treatments, and proportion of hip fractures potentially prevented by BDMscreening linked to treatments. Fair evidence from prospective cohort studies suggests that BDMcan predict the risk of fractures, but not with high accuracy. Fair evidence from low-quality randomizedcontrolled trials and observational studies suggests that HRT and SCT(N) are efficacious in preventingfractures. Good evidence supports the efficacy of these treatments in preserving bone mass, butthere is fair evidence that the effect wears off after cessation of therapy. There is little evidence onthe impact of screening menopausal women with BDM in association with HRT or SCT(N) treatment.Estimates based on combining existing evidence regarding the predictive value of BDM and efficacyof HRT suggests that 1–7% of hip fractures might be prevented.

Type
General Essays
Information
International Journal of Technology Assessment in Health Care , Volume 14 , Issue 2 , Spring 1998 , pp. 237 - 254
Copyright
Copyright © Cambridge University Press 1998

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.Agence Nationale pour le Développement de l'Evaluation Médicale. Evaluation de I'osteodensitometrie. Paris: ANDEM 1991.Google Scholar
2.Cagnacci, A., Melis, G. B., Soldani, R., et al. Neuroendocrine and clinical effects of transdermal 17 beta-estradiol in postmenopausal women. Maturitas, 1991,13, 283–96.CrossRefGoogle ScholarPubMed
3.Canadian Task Force on the Periodic Health Examination. The periodic health examination. Canadian Medical Association Journal, 1979, 121, 1193–254.Google Scholar
4.Catalan Agency for Health Technology Assessment. La calcitonina en el tractament de la osteoporosis idiopatica, Barcelona: CAHTA, 1994.Google Scholar
5.Cauley, J. A., Seeley, D. G., Ensrud, K., et al. Estrogen replacement therapy and fractures in older women: Study of osteoporotic Fractures Research Group. Annals of Internal Medicine, 1995, 122, 9–16.CrossRefGoogle ScholarPubMed
6.Center for Health Care Technology. Bone densitometry: Patients with end stage disease. Rockville, MD: Agency for Health Care Policy and Research, 1996.Google Scholar
7.Christiansen, C., Christensen, M. S., & Transbol, I.Bone mass in postmenopausal women after withdrawal of oestrogen/gestagen replacement therapy. Lancet, 1981, 1, 459–61.Google Scholar
8.Cicinelli, E., Galantino, P., Pepe, V., et al. Bone metabolism changes after transdermal estradiol dose reduction during estrogen replacement therapy: A 1-year prospective study. Maturitas, 1994, 19, 133–39.Google Scholar
9.Cochrane, A. L., & Holland, W. W.Validation of screening procedures. British Medical Bulletin, 1971, 27, 3–8.CrossRefGoogle ScholarPubMed
10.Cooper, C., Kanis, J. A., & Compston, J.How to assess drug efficacy in osteoporosis. Lancet, 1995, 34, 743–44.Google Scholar
11.Cranney, A., Shea, B., Wells, G., et al. Calcitonin treatment of post-menopausal osteoporosis. In Brooks, P., Bosi-ferraz, M., De Bie, R., et al. (eds.), Musculoskeletal module of the Cochrane Database of Systematic Reviews, Oxford: UK Cochrane Centre, 1996.Google Scholar
12.Cummings, S. R., Nevitt, M. C., Browner, W. S., et al. Risk factors for hip fracture in white women: Study of Osteoporotic Fractures Research Group. New England Journal of Medicine, 1995, 332, 767–73.Google Scholar
13.Davis, J. W., Ross, P. D., Johnson, N. E., et al. Estrogen and calcium supplement use among Japanese-American women: Effects upon bone loss when used singly and in combination. Bone, 1995,17, 369–73.CrossRefGoogle ScholarPubMed
14.Diagnostic and Therapeutic Technology Assessment (DATTA). Measurement of bone density with dual-energy x-ray absorptiometry (DEXA). Journal of the American Medical Association, 1992, 267, 290–94.Google Scholar
15.Draper, J., & Roland, M.Perimenopausal women's views on taking hormone replacement therapy to prevent osteoporosis. British Medical Journal, 1990, 300, 786–88.CrossRefGoogle ScholarPubMed
16.Ettinger, B., Genant, H. K., & Cann, C. E.Long-term estrogen replacement therapy prevents bone loss and fractures. Annals of Internal Medicine, 1985, 102, 319–24.Google Scholar
17.Felson, D. T., Zhang, Y., Hannan, M. T., et al. The effect of postmenopausal estrogen therapy on bone density in elderly women. New England Journal of Medicine, 1993, 329, 1141–16.CrossRefGoogle Scholar
18.Field, C. S., Ory, S. J., Wahner, H. W., et al. Preventive effects of transdermal 17 beta-estradiol on osteoporotic changes after surgical menopause: A two-year placebo controlled trial. American Journal of Obstetrics and Gynecology, 1993, 168, 114–21.Google Scholar
19.Fioretti, P., Gambacciani, M., Taponeco, F., et al. Effects of continuous and cyclic nasal calcitonin administration in ovariectomized women. Maturitas, 1992,15, 225–32.CrossRefGoogle ScholarPubMed
20.Gennari, C., Agnusdei, D., Montagnani, M., et al. An effective regimen of intranasal salmon calcitonin in early postmenopausal bone loss. Calcified Tissue International, 1992, 50, 381–83.Google Scholar
21.Gluer, C. C., Faulkner, K. G., Estilo, M. J., et al. Quality assurance for bone densitometry research studies: Concept and impact. Osteoporosis International, 1993, 3, 227–35.Google Scholar
22.Hailey, D.INAHTA project on the effectiveness of bone density measurement and associated treatments for prevention of fracture, background paper 1: Methods used in the Predictive value of bone densitometry. Edmonton: Alberta Heritage Foundation forMedical Research, 1996.Google Scholar
23.Hailey, D., Sampietro-Colom, L., Marshall, D., et al. INAHTA project on the effectiveness of bone density measurement and associated treatments for prevention of fracture: Statement of findings. Edmonton: Alberta Heritage Foundation for Medical Research, 1996.Google Scholar
24.Henry, D., Robertson, J., Gillespie, W., et al. Estrogen treatment: Results ofpublished trials and epidemiological studies, assessment of study quality and public health implications. Newcastle, Australia: University of Newcastle, 1995.Google Scholar
25.Henry, D., Robertson, J., O'Connell, D., et al. The skeletal effects of estrogen therapy in post-menopausal women: An assessment of the quality of randomized trials published between 1977 and 1993. Newcastle, Australia: University of Newcastle, 1995.Google Scholar
26.Jovell, A. J., & Navarro-Rubio, M. D.. Evaluacion de la evidencia cientifica. Medicina Clinica, 1995, 105, 740–43.Google Scholar
27.Kanis, J. A.The incidence of hip fracture in Europe. Osteoporosis International, 3,10–15.CrossRefGoogle Scholar
28.Kanis, J. A., Geusens, P., & Christiansen, C.Guidelines for clinical trials in osteoporosis: A position paper of the European Foundation for Osteoporosis and Bone Disease. Osteoporosis International, 1991, 1, 182–88.CrossRefGoogle ScholarPubMed
29.Kanis, J. A., Johnell, O., Gullberg, B., et al. Evidence for efficacy of drugs affecting bone metabolism in preventing hip fractures. British MedicalJournat, 1992, 305, 1124–28.CrossRefGoogle Scholar
30.Kelsey, J. L., Browner, W. S., Seeley, D. G., et al. Risk factors for fractures of the distal forearm and proximal humerus: The Study of Osteoporotic Fractures Research Group. American Journal of Epidemiology, 1992, 135, 477–89.Google Scholar
31.Kiel, D. P., Felson, D. T., Anderson, J. J., et al. Hip fracture and the use of estrogens in postmenopausal women. The Framingham Study. New England Journal of Medicine, 1987, 317, 1169–74.Google Scholar
32.Knobel, H., Díez, A., Arnau, D., et al. Secuelas de la fractura oseoporótica de fémur en Barcelona. Medicina Clínica, 1992, 98, 441–44.Google Scholar
33.Kroger, H., Huopio, J., Honkanen, R., et al. Prediction of fracture risk using axial bone mineral density in a perimenopausal population: A prospective study. Journal of Bone and Mineral Research, 1995, 10, 302–06.CrossRefGoogle Scholar
34.Law, M. R., Wald, N. J., & Meade, T. W.Strategies for prevention of osteoporosis and hip fracture. British Medical Journal, 1991, 303, 453–59.CrossRefGoogle ScholarPubMed
35.Lindsay, R., Hart, D. M., MacLean, A., et al. Bone response to termination of oestrogen treatment. Lancet, 1978, 1, 1325–27.CrossRefGoogle ScholarPubMed
36.Luciano, A. A., De Souza, M. J., Roy, M. P., et al. Evaluation of low-dose estrogen and progestin therapy in postmenopausal women: A double-blind, prospective study of sequential versus continuous therapy. Journal of Reproductive Medicine, 1993, 38, 207–14.Google ScholarPubMed
37.Lufkin, E. G., Wahner, H. W., O'Fallon, W. M., et al. Treatment of postmenopausal osteoporosis with transdermal estrogen. Annals of Internal Medicine, 1992, 117, 1–9.CrossRefGoogle ScholarPubMed
38.MacLennan, A. H., MacLennan, A., Wenzel, S., et al. Continuous low-dose oestrogen and progestogen hormone replacement therapy: A randomized trial. Medical Journal of Australia, 1993, 159, 102–06.Google Scholar
39.Mango, D., Ricci, S., Manna, P., et al. Preventive treatment of cortical bone loss with salmon nasal calcitonin in early postmenopausal women. Minerva Endocrinologica, 1993, 18, 115–21.Google Scholar
40.Marcus, R., Greendale, G., Blunt, B. A., et al. Correlates of bone mineral density in the postmenopausal estrogen/progestin interventions trial. Journal of Bone and Mineral Research, 1994, 9, 1467–76.CrossRefGoogle ScholarPubMed
41.Marshall, D., Hailey, D., & Jonsson, E.Health policy on bone density measurement technology in Sweden and Australia. Health Policy, 1996, 35, 217–28.CrossRefGoogle Scholar
42.Marshall, D., Johnell, O., & Wedel, H.Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. British Medical Journal, 1996, 312, 1254–59.Google Scholar
43.Marshall, D., & Sheldon, T. A.INAHTA project on the effectiveness of bone density measurement and associated treatments for prevention of fracture, background paper 2: Predictive value of bone densitometry. Edmonton: Alberta Heritage Foundation for Medical Research, 1996.Google Scholar
44.Marshall, D., Sheldon, T. A., & Jonsson, E.Recommendations for the application of bone density measurement: What can you conclude? International Journal of Technology Assessment in Health Care, 1997, 13, 411–19.Google Scholar
45.Massie, A., Reid, D. M., & Porter, R. W.Screening for osteoporosis: Comparison between dual energy x-ray absorptiometry and broadband ultrasound attenuation in 1000 perimenopausal women. Osteoporosis International, 1993, 3, 107–10.Google Scholar
46.Mazzuoli, G., Pacitti, M. T., Minisola, S., et al. Effects of salmon calcitonin on bone loss induced by ovariectomy. Revista Clinica Espanola, 1991, 188, 49–50.Google Scholar
47.Mazzuoli, G. E., Gennari, C., Passed, M., et al. Hip fracture in Italy: Epidemiology and preventive efficacy of bone-active drugs. Bone, 1993, 14, S81–84.Google Scholar
48.Melton, L. J. III, Kan, S. H., Wahner, H. W., et al. Lifetime fracture risk: An approach to hip fracture risk assessment based on bone mineral density and age. Journal of Clinical Epidemiology, 1988, 41, 985–94.Google Scholar
49.Meschia, M., Brincat, M., Barbacini, P., et al. Effect of hormone replacement therapy and calcitonin on bone mass in postmenopausal women. European Journal of Obstetrics, Gynecology, and Reproductive Biology, 1992, 47, 53–57.Google Scholar
50.Naessen, T., Persson, I., Adami, H. O., et al. Hormone replacement therapy and the risk for first hip fracture: A prospective, population-based cohort study. Annals of Internal Medicine, 1990, 113, 95–103.CrossRefGoogle ScholarPubMed
51.National Health Technology Advisory Panel. Bone mineral assessment: An update. Canberra: Australian Institute of Health, 1989.Google Scholar
52.NHS Centre for Reviews and Dissemination and Nuffield Institute for Health. Preventing falls and subsequent injury in older people. Effective Health Care, 1996, 2, 1–16.Google Scholar
53.Office of Technology Assessment. Hip fracture outcomes in people age 50 and over (backgroundpaper). Washington, DC: U.S. Congress, 1994. Report no. OTA-BP-H-120.Google Scholar
54.Osteba. Evaluation de technologias sanitaria: Actuacion ante la osteoporosis en el Pais Vasco. Vitoria-Gasteiz: Osteba, 1994.Google Scholar
55.Overgaard, K.Effect of intranasal salmon calcitonin therapy on bone mass and bone turnover in early menopausal women: A dose-response study. Calcified Tissue International, 1994, 55, 82–86.Google Scholar
56.Overgaard, K., Hansen, M. A., Jensen, S. B., et al. Effect of salcatonin given intranasally on bone mass and fracture rates in established osteoporosis: A dose-response study. British Medical Journal, 1992, 305, 556–61.CrossRefGoogle Scholar
57.Overgaard, K., Riis, B. J., Christiansen, C., et al. Nasal calcitonin for treatment of established osteoporosis. Clinical Endocrinology, 1989, 30, 435–42.CrossRefGoogle ScholarPubMed
58.Paganini-Hill, A., Chao, A., Ross, R. K., et al. Exercise and other factors in the prevention of hip fracture: The Leisure World study. Epidemiology, 1991, 2, 16–25.Google Scholar
59.Pocock, N. A., Noakes, K. A., Howard, G. M., et al. Screening for osteoporosis: What is the role of heel ultrasound? Medical Journal of Australia, 1996, 164, 367–70.Google Scholar
60.Preventive Services Task Force. Guide to clinical preventive services: An assessment of the effectiveness of 169 interventions. Report of the U.S. Preventive Services Task Force. Baltimore, MD: Williams & Wilkins, 1989.Google Scholar
61.Prince, R. L., Smith, M., Dick, I. M., et al. Prevention of postmenopausal osteoporosis: A comparative study of exercise, calcium supplementation, and hormone-replacement therapy. New England Journal of Medicine, 1991, 325, 1189–95.Google Scholar
62.Quigley, M. E., Martin, P. L., Burnier, A. M., et al. Estrogen therapy arrests bone loss in elderly women. American Journal of Obstetrics and Gynecology, 1987, 156, 1516–23.Google Scholar
63.Reginster, J. Y., Deroisy, R., Lecart, M. P., et al. A double-blind, placebo-controlled, dose-finding trial of intermittent nasal salmon calcitonin for prevention of postmenopausal lumbar spine bone loss. American Journal of Medicine, 1995, 98, 452–58.Google Scholar
64.Reginster, J. Y., Meurmans, L., Deroisy, R., et al. A 5-year controlled randomized study of prevention of postmenopausal trabecular bone loss with nasal salmon calcitonin and calcium. European Journal of Clinical Investigation, 1994, 24, 565–69.Google Scholar
65.Riggs, B. L., & Melton, L. J., III. Involutional osteoporosis. New England Journal of Medicine, 1986, 314, 1676–86.Google Scholar
66.Sampietro-Colom, L., Almazan, C., & Granados, A.Evaluatión de la densitometria ósea. Barcelona: Generalitat de Catalunya, Departament de Sanitat I Seguretat Social, Oficina Tecnica d'Avaluació de Tecnologia Mèdica, 1993.Google Scholar
67.Sampietro-Colom, L., Rico, R., Granados, A., et al. INAHTA project on the effectiveness of bone density measurement and associated treatments for prevention of fracture, background paper 3: A review of the evidence of hormone replacement therapy and calcitonin in reducing bone loss and fractures. Edmonton: Alberta Heritage Foundation for Medical Research, 1996.Google Scholar
68.School of Public Health, University of Leeds and Centre for Health Economics, University of York. Screening for osteoporosis to prevent fractures: Should population based screening programs aimed at the prevention of fractures in elderly women be established? Effective Health Care, 1992, 1, 1–12.Google Scholar
69.Spector, T. D.Use of oestrogen replacement therapy in high risk groups in the United Kingdom. British Medical Journal, 1989, 299, 1434–35.Google Scholar
70.Spector, T. D., Brennan, P., Harris, P. A., et al. Do current regimes of hormone replacement therapy protect against subsequent fractures? Osteoporosis International, 1992, 2, 219–24.CrossRefGoogle ScholarPubMed
71.Stevenson, J. C., Crook, D., Godsland, I. F., et al. Oral versus transdermal hormone replacement therapy. International Journal of Fertility and Menopausal Studies, 1993, 38, 30–35.Google Scholar
72.Swedish Council on Technology Assessment in Health Care. Mätning av bentäthet. Stockholm: Swedish Council on Technology Assessment in Health Care, 1995.Google Scholar
73.Thamsborg, G., Storm, T. L., Sykulski, R., et al. Effect of different doses of nasal salmon calcitonin on bone mass. Calcified Tissue International, 1991, 48, 302–07.CrossRefGoogle ScholarPubMed
74.Tinetti, M. E., & Speechley, M.Prevention of falls among the elderly. New England Journal of Medicine, 1989, 320, 1055–59.Google ScholarPubMed
75.Tinetti, M. E., Speechley, M., & Ginter, S. F.Risk factors for falls among elderly persons living in the community. New England Journal of Medicine, 1988, 319, 1701–07.Google Scholar
76.Tobias, J. H., Cook, D. G., Chambers, T. J., et al. A comparison of bone mineral density between Caucasian, Asian and Afro-Caribbean women. Clinical Science, 1994, 87, 587–91.Google Scholar
77.Torgerson, D. J., Campbell, M. K., Thomas, R. E., et al. Prediction of perimenopausal fractures by bone mineral density and other factors. Journal of Bone and Mineral Research, 1996, 11, 293–97.Google Scholar
78.Torgerson, D. J., Donaldson, C., & Reid, D. M.Using economics to prioritise research: A case study of randomized trials for the prevention of hip fractures due to osteoporosis. Journal of Health Services Research and Policy, 1996, 1, 141–46.CrossRefGoogle ScholarPubMed
79.Torgerson, D. J., Donaldson, C., Russell, I. T., et al. Hormone replacement therapy: Compliance and cost after screening for osteoporosis. European Journal of Obstetrics, Gynecology, and Reproductive Biology, 1995, 59, 57–60.Google Scholar
80.Wimalawansa, S. J.Combined therapy with estrogen and etidronate has an additive effect on bone mineral density in the hip and vertebrae: Four-year randomized study. American Journal of Medicine, 1995, 99, 36–42.Google Scholar