Overdiagnosis of bone fragility in the quest to prevent hip fracture

• Clinical contextHip fractures cause considerable morbidity and mortality and are associated with high healthcare costs. With a growing elderly population their incidence is predicted to riseDiagnostic changeBefore the late 1980s, osteoporosis was diagnosed after a bone fracture. A new definition was introduced in 1994 based on low bone mineral density, expanding indications for pharmacotherapy. The introduction of fracture risk calculators exacerbated the trendRationale for changeFractures are a function of bone fragility, which is measureable and can be improved with drugsLeap of faithIdentifying and treating patients with fragile bones is a cost effective strategy to prevent fractures, particularly hip fracturesImpact on prevalenceCurrent fracture risk predictors have at least doubled the number of candidates for drug treatment. Under US guidelines about 75% of white women aged over 65 years have become candidates for drug treatmentEvidence of overdiagnosisRates of hip fracture continue to decline, and most occur in people without osteoporosis. Our meta-analysis indicates that 175 postmenopausal women with bone fragility must be treated for about three years to prevent one hip fractureHarms from overdiagnosisBeing labelled as at risk of fracture imposes a psychological burden. Drug treatment is associated with adverse events, such as gastrointestinal problems, atypical femoral fractures, and osteonecrosis of the jawLimitations of evidenceHip fractures are caused predominantly by falls in frail older adults. Few studies on preventive pharmacotherapy included adults aged ≥80, but evidence suggests no treatment benefit. Evidence is also sparse on treatment of men and optimum duration of treatment

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Ortopedi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Orthopaedics (hsv//eng)

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