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Scientific Review

Steven R. Cummings, MD; David Bates, MD,MSc; Dennis M. Black, PhD

JAMA. 2002;288:1889-1897.

Context  Osteoporosis causes substantial morbidity and costs $13.8 billion annually in the United States. Measurement of bone mass by densitometry is a primary part of diagnosing osteoporosis and deciding a preventive treatment course. Bone mineral densitometry has become more widely available and commonly used in practice.

Objective  To review evidence about the value of various clinical applications of bone densitometry.

Data Sources  A MEDLINE search was performed to update previous meta-analyses of the relationship between various measurements of bone density and risk of vertebral and hip fracture. We used data from the prospective Study of Osteoporotic Fractures to estimate risk of fracture from bone density and age in postmenopausal women.

Study Selection and Data Extraction  When available, meta-analyses and systematic reviews are emphasized in the review.

Data Synthesis  Bone mineral density (BMD) predicts fracture and can be used in combination with age to estimate absolute risk of fractures in postmenopausal white women. Hip BMD predicts hip fracture more strongly than other measurements of BMD. There are insufficient data to translate BMD results into risk of fracture for men and nonwhite women. The benefits of treatments to prevent fractures depend on BMD: women with osteoporosis have a greater risk of fractures and greater benefit from treatments than women without osteoporosis.

Conclusions  Guidelines based on systematic reviews and a cost-effectiveness analysis have suggested that it is worthwhile to measure BMD in white women older than 65 years and perhaps to use risk factors to select younger postmenopausal women for densitometry. Other potential clinical applications of BMD that have not yet been adequately studied include screening men or nonwhite women, monitoring BMD in patients receiving treatment, and using BMD to identify patients who should be evaluated for secondary causes of osteoporosis.

Author Affiliations: The UCSF Coordinating Center (Drs Cummings and Black), Department of Medicine (Dr Cummings), and Department of Epidemiology and Biostatistics, University of California, San Francisco (Drs Cummings and Black); and Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass (Dr Bates).

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