Fracture Was Hard to Predict in Some Postmenopausal Women

Osteoporosis screening may miss fracture risk in postmenopausal women between ages 50 and 64

(RxWiki News) Screening tools can help doctors predict which postmenopausal women may have a broken bone due to osteoporosis in the next few years. But those tools may not accurately predict fracture risk in younger postmenopausal women.

A new study found that screening tools often used for older women were not as good at assessing the risk for breaks in younger women who were postmenopausal.

The study authors said screening tools designed for younger postmenopausal women — ages 50 to 64 — could help doctors counsel at-risk patients on how to improve their bone health.

The study was written by Carolyn J. Crandall, MD, of the David Geffen School of Medicine at the University of California in Los Angeles, and colleagues.

They looked at 62,492 postmenopausal women from 40 health centers in the US. The women were between 50 and 64 years old. None were taking medication to stop bone loss.

Women can be prone to fracures as they age for several reasons — including that they face a high risk for osteoporosis. In osteoporosis, the bones become less dense and more likely to fracture. Older people, especially women after menopause, are at risk for this condition. Causes include not getting enough calcium and vitamin D or having a family history of osteoporosis.

Menopause is when a woman has not had a menstrual period for 12 months. Postmenopause is the time after this.

The researchers screened women using three common screening tools. They followed up with the women for 10 years.

The US Preventive Services Task Force (USPSTF) suggests that doctors use the Fracture Risk Assessment Tool (FRAX) to assess which younger postmenopausal women may be at risk for fractures as they age. This tool looks at past bone breaks, smoking status, arthritis and the bone mineral density of the femoral neck. The femoral neck is the piece of bone that connects the thigh bone to the hip. It is a particularly fragile area where fractures often occur if a woman has weak bones.

The other common tools doctors use to predict fracture risk are the Osteoporosis Self-Assessment Tool (OST) and the Simple Calculated Osteoporosis Risk Estimate (SCORE). The OST looks at weight and age, and SCORE focuses on race, age and whether a woman has taken estrogen therapy.

The study authors found that none of the tools accurately predicted fracture risk for the younger postmenopausal women.

In fact, using the FRAX, which was the most specific (it gave the fewest false negative results) of all three tools, the study authors said, spotted fewer than 5 percent of postmenopausal women ages 50 to 54 who went on to break a bone in the next 10 years.

The authors found that the screening tools were better able to predict future bone breaks among women 60 to 64 years old than among the younger women.

The study authors noted that the ability to help doctors predict which younger postmenopausal women were most at risk for fractures was "similar under the three strategies, and not substantially better than chance alone.”

"Our results suggest that our current guidelines for screening in younger post-menopausal women do not accurately identify who will suffer a fracture,” Dr. Crandall said in a press release.

The study authors noted a need for other strategies to better predict bone fractures in younger postmenopausal women.

The study was published online Oct. 16 in The Journal of Clinical Endocrinology and Metabolism.

The research was funded by the National Heart, Lung, and Blood Institute, National Institutes of Health, US Department of Health and Human Services.

Dr. Crandall received support from UCLA's Jonsson Comprehensive Cancer Center. Nelson B. Watts, a study author, received funding from a number of sources, including Amgen, Nordisk and Merck.

Review Date: 
October 24, 2014