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Cited by 3,709Bone health and osteoporosis researchMenopause: Health Impacts and TreatmentsHip and Femur Fractures

Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures

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Marshall, Deborah, Johnell, Olof, Wedel, Hans·1996·BMJ
DOI 10.1136/bmj.312.7041.1254PMC PMC2351094
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Abstract

Objective : To determine the ability of measurements of bone density in women to predict later fractures. Design : Meta-analysis of prospective cohort studies published between 1985 and end of 1994 with a baseline measurement of bone density in women and subsequent follow up for fractures. For comparative purposes, we also reviewed case control studies of hip fractures published between 1990 and 1994. Subjects : Eleven separate study populations with about 90000 person years of observation time and over 2000 fractures. Main outcome measures : Relative risk of fracture for a decrease in bone mineral density of one standard deviation below age adjusted mean. Results : All measuring sites had similar predictive abilities (relative risk 1.5 (95% confidence interval 1.4 to 1.6)) for decrease in bone mineral density except for measurement at spine for predicting vertebral fractures (relative risk 2.3 (1.9 to 2.8)) and measurement at hip for hip fractures (2.6 (2.0 to 3.5)). These results are in accordance with results of case-control studies. Predictive ability of decrease in bone mass was roughly similar to (or, for hip or spine measurements, better than) that of a 1 SD increase in blood pressure for stroke and better than a 1 SD increase in serum cholesterol concentration for cardiovascular disease. Conclusions : Measurements of bone mineral density can predict fracture risk but cannot identify individuals who will have a fracture. We do not recommend a programme of screening menopausal women for osteoporosis by measuring bone density. Key messages: Measuring bone mineral density has been suggested as a method of identifying individuals at high risk of fracture in a preventive context Our meta-analysis of prospective studies showed that all studies measuring bone density at any site had similar predictive ability for a decrease of 1 SD in bone density except for measurements at hip and spine, which have better predictive ability for fractures in hip and spine respectively Predictive ability of decrease in bone mass was roughly similar to (or, for hip or spine measurements, better than) that of a 1 SD increase in blood pressure for stroke and better than a 1 SD increase in serum cholesterol concentration for cardiovascular disease Although bone mineral density measurements can predict fracture risk, they cannot identify individuals who will have a fracture, and a screening programme for osteoporosis cannot be recommended

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Authors
Marshall, D., Johnell, O., & Wedel, H.
Affiliations
  • SBU - Swedish Agency for Health Technology Assessment and Assessment of Social Services (SE)
  • Skåne University Hospital (SE)
  • Nordic School of Public Health (SE)
ORCID
Venue
BMJ
Publisher
BMJ
Published
1996-05-18
Volume
312
Issue
7041
Pages
1254-1259
ISSN
  • 0007-1447 (ISSN-L)
  • 0959-8138
  • 1468-5833
DOI
10.1136/bmj.312.7041.1254
PMC
PMC2351094
OpenAlex
W2036125852
Cited by
3,709
References
2
Citations by year
2026: 62 · 2025: 79 · 2024: 101 · 2023: 81 · 2022: 97 · 2021: 104 · 2020: 118 · 2019: 107 · 2018: 103 · 2017: 120 · 2016: 143 · 2015: 127 · 2014: 137 · 2013: 151 · 2012: 155
FWCI
12.70
Type
journal article
Language
en
Open access
Licence
www.bmj.com/company/legal-information/terms-conditions/legal-information/tdm-licencepolicy (tdm)
Locations
  • BMJ (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • HighWire Press Open Archive (submittedVersion)
Topics
  • Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Menopause: Health Impacts and Treatments
  • Health Sciences › Medicine › Surgery › Hip and Femur Fractures
Keywords
bone mineral density, osteoporotic fractures, fracture risk prediction, hip fracture, vertebral fractures, menopausal women, osteoporosis screening, bone loss, serum cholesterol, blood pressure
MeSH terms
Aged, Female, Follow-Up Studies, Forecasting, Hip Fractures, Humans, Predictive Value of Tests, Prospective Studies, Risk Factors, Sensitivity and Specificity, Cohort Studies, Bone Density, Osteoporosis, Postmenopausal, Fractures, Bone

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