Bone mineral density testing after fragility fracture: Informative test results likely

Joshua Posen; Dorcas E. Beaton; Joanna Sale; Earl R. Bogoch

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Figure 1.
Proportion of participants with normal BMD, mild bone loss, and severe bone loss in each of 20 studies: Horizontal bar represents cumulative percent to 100% of BMD test results reported in that study. Black line represents the most conservative cutoff delineating low bone density (69%) from normal bone density (31%).

BMD—bone mineral density.
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Figure 2.
Frequency distribution of studies by proportion of patients with low BMD: N=20.

BMD—bone mineral density.
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Figure 3.
Proportion of patients from each study (N=20) with “low BMD” (T score of ≤ −1.0): Studies with 2 or more selection factors of potential influence* are separated at the right. Y-axis minimum is 60%.

BMD—bone mineral density.

*Selection factors of potential bias included study of wrist fractures only, younger age, study sample not restricted to fragility fractures (ie, might have included moderate-trauma fractures but no high-trauma fractures), and BMD testing received as part of an integrated program (ie, more people with normal BMD might have been tested).

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Table 1.

Proportion of patients from each study with normal test results, osteopenia, and osteoporosis, as well as descriptive data extracted from the studies: N = 20.

STUDY NO.	AUTHOR, YEAR	COUNTRY	SETTING	NO. OF BMD TEST RESULTS	BMD TEST RESULTS			2 OR MORE SELECTION FACTORS OF POTENTIAL INFLUENCE^*
STUDY NO.	AUTHOR, YEAR	COUNTRY	SETTING	NO. OF BMD TEST RESULTS	NORMAL, %	OSTEOPENIA, %	OSTEOPOROSIS, %	2 OR MORE SELECTION FACTORS OF POTENTIAL INFLUENCE^*
1	Schmid et al,³⁰ 2004	Switzerland	Outpatient fracture clinic	29	0	28	72
2	Sidwell et al,³¹ 2004	New Zealand	Orthogeriatric rehabilitation ward	158	4	17	79
3	Becker et al,²⁹ 2006	United States	Orthopedic and rehabilitation inpatient wards	61	7	23	70
4	Hegeman et al,³² 2005	The Netherlands	Outpatient fracture clinic	100	13	20	67
5	Astrand et al,³³ 2006	Sweden	Emergency department and orthopedic inpatient ward	239	13	45	42	X
6	Mulherin et al,³⁴ 2003	United Kingdom	Emergency department	91	14	34	52
7	Chevalley et al,³⁵ 2002	Switzerland	Orthopedic inpatient ward and outpatient clinic	242	14	45	41
8	Hegeman et al,³⁶ 2004	The Netherlands	Departments of surgery and traumatology	94	15	34	51
9	Levasseur et al,³⁷ 2007	France	Orthopedic inpatient ward	32	16	50	34
10	Rozental et al,²⁸ 2008	United States	Orthopedic outpatient clinic	32	16	50	34	X
11	Gallacher,³⁸ 2005	United Kingdom	Orthopedic and trauma departments	NR	17	46	37
12	Harrington et al,³⁹ 2005	United States	Orthopedic inpatient ward and outpatient clinic	154	18	50	32
13	McLellan et al,²⁶ 2003	United Kingdom	Emergency department, orthopedic inpatient ward, and fracture clinic	2077	18	42	40
14	van Helden et al,²⁷ 2008	The Netherlands	Emergency department and orthopedic inpatient ward	568	21	44	35	X
15	Majumdar et al,⁴⁰ 2007	Canada	Orthopedic surgery department	120	21	34	45
16	Harrington and Lease,⁴¹ 2007	United States	Orthopedic inpatient ward and outpatient clinic	232	2	57	21
17	Kuo et al,⁴² 2007	Australia	Outpatient fracture clinic	135	24	46	30	X
18	Majumdar et al,⁴³ 2008	Canada	Emergency and fracture clinics	95	28	52	20	X
19	Cuddihy et al,⁴⁴ 2004	United States	Orthopedic inpatient ward and outpatient clinic	42	29	50	21	X
20	Majumdar et al,⁴⁵ 2004	Canada	Emergency department	42	31	17	52

BMD—bone mineral density, NR—not reported.
↵* Selection factors of potential bias included study of wrist fractures only, younger age, study sample not restricted to fragility fractures (ie, might have included moderate-trauma fractures but no high-trauma fractures), and BMD testing received as part of an integrated program (ie, more people with normal BMD might have been tested).