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Clinical Crossroads | Clinician's Corner

A 55-Year-Old Woman With Osteopenia

Steven R. Cummings, MD, Discussant
JAMA. 2006;296(21):2601-2610. doi:10.1001/jama.296.21.2601.
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About half of postmenopausal women have a bone density T score at the femoral neck between −1.0 and −2.5. Bone density in this range was termed “osteopenia” by a World Health Organization working group. Osteopenia is not a disease and the label can cause unnecessary anxiety. Osteopenia encompasses a wide range of fracture risks; an individual patient's risk can be estimated from her age, bone mineral density, and clinical risk factors. Regardless of bone mineral density, regular exercise and adherence with vitamin D and calcium intake may reduce the risk of hip fracture. Osteopenia by itself is not an indication for treatment. Decisions about pharmacological treatment to prevent fractures should be based on the patient's risk of fractures, evidence about the efficacy and nonskeletal effects of the specific treatment, and the patient's preferences.

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Figure 1. Age-Adjusted Logistic Model of Association Between Femoral Neck Bone Mineral Density (BMD) and Risk of Hip Fracture
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Previously unpublished data from 5 years of more than 98% follow-up of 8134 women aged 67 years or older after measurement of hip BMD by dual x-ray absorptiometry. Dashed lines indicate 95% confidence intervals. Methods described in Cummings et al.1

Figure 2. Five-Year Risk of Fractures in White Women by Age and Femoral Neck Bone Mineral Density (BMD) T Score
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A, Risk of low trauma nonspine (nonvertebral) fracture. B, Risk of a radiograph-defined vertebral fracture. C, Risk of hip fracture.2

Figure 3. Percent of the Total Days of Limited Activity Due to Certain Types of Fractures in Women Who Have a Vertebral Fracture and in Women Who Have Only Low Bone Density
Graphic Jump Location

Low femoral neck bone mineral density (BMD) is defined as T score <−1.5. Based on data from the placebo group for the Fracture Intervention Trial (FIT).65,68,70,80 No vertebral fractures at baseline data are derived from the participants who had low BMD of the femoral neck (T score <1.5 but no vertebral fracture65). Vertebral fractures at baseline data are derived from participants who had a vertebral fracture.70 The percentage is a function of the mean number of self-reported days of limited activity following each type of fracture81 and the incidence of that type of fracture. Methods for assessing days of disability for each type of fracture are described by Fink and colleagues,81 and the incidence of various types of fractures in FIT have also been published.65,68

Figure 4. Effect of Alendronate on Reduction in Risk of Nonvertebral Fractures in Women With Low Femoral Neck Bone Mineral Density (BMD) T Score −1.6 or Less Without a Vertebral Fracture, by Subgroups of Baseline Hip BMD T Score
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The subgroup analysis was prespecified and the interaction between baseline BMD and the effect of alendronate was P = .02.65

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