Garvan Institute scientists suggest new approach for targeting patients with brittle bones

13 June 2007

Scientists from the Garvan Institute of Medical Research in Sydney, Australia, are suggesting a new approach to  determining the risk of fracture in individuals with the brittle bone disease, osteoporosis, which could have  treatment implications.    

Their finding, published in the Journal of Bone and Mineral Research, is based on data from a fifteen-year  epidemiology study and shows that calculating bone loss, by having at least two bone mineral density (BMD)  measurements taken a minimum of 1-2 years apart, can improve the accuracy of fracture risk assessment.   

Currently a bone density (DXA) scan is used to diagnose osteoporosis but, in Australia, treatment is usually only  prescribed when an individual has had a fracture - regardless of BMD levels.  Individuals with low BMD, despite  being at high risk of fractures, are not commonly considered for drug treatment even though experts suggest that  they should have preventative medication.   

One in two women and one in three men over the age of 60 will have a fracture due to osteoporosis* and, with an  ageing population, the total numbers of sufferers is increasing.  Fractures are a major cause of pain, disability and  premature death.   

There are medicines available to treat those with brittle bones.  Many clinical trials have shown that a drug that  moderately increases BMD (e.g. by 3 to 4%) can reduce fracture risk by as much as half.  The cost of measuring  BMD by a DXA scan is relatively small, but the cost of treatment - if all individuals with low BMD are treated - is   significant at the population level.  The cost/benefit of mass screening of osteoporosis has been debated in  Australia for some time and the issue boils down to how much money should be spent to prevent one fracture.   

Associate Professor Tuan Nguyen, who is a joint head of the Epidemiology group of the Bone and Mineral  Research Program at the Garvan Institute, says:  "We know that low bone mineral density is the most important   risk factor for fracture; paradoxically, almost half of women with fractures do not have low BMD. If we wish to treat  those most at risk from osteoporotic fractures, a two-stage screening approach where individuals with low   BMD and increased bone loss are treated could improve the cost-effectiveness".   

*This adds up to 70,000 preventable fractures per year, with total direct and indirect costs running to over 7 billion  dollars per year (Osteoporosis Australia).