Correction and Addendum to BoneSource Alert October 2009

The recent issue of BoneSource Alert included an incorrect citation for the article Value of routine monitoring of bone mineral density after starting bisphosphonate treatment: secondary analysis of trial data(Bell, et. al.). The correct citation is BMJ 2009;338:b2266. The accompanying editorial, written by an English osteoporosis expert and reflecting a United Kingdom perspective, is Monitoring bone mineral density during antiresorptive treatment for osteoporosis is potentially misleading and a misuse of healthcare resources (Compston, J. BMJ 2009;338:b1276).

As an addendum to the October 2009 BoneSource Alert newsletter, NOF would like to call your attention to two responses to the British Medical Journal article, recently published in the Journal of Bone and Mineral Research, which reflect current views of leading experts on the value and use of bone mineral density testing in clinical practice in the United States today.

In the first of these, Clinical value of monitoring BMD in patients treated with bisphosphonates for osteoporosis, Watts, et. al. (JBMR October 2009, Vol. 24, No. 10, 1643-1646) argue that the methodology utilized to conduct a post hoc analysis of data from the FIT trial with alendronate result in flawed assumptions and conclusions. As clinical trial populations are tightly controlled, interpretations of the secondary analysis only apply to the study population and cannot be generalized to average patients in real world situations or to other treatments. Osteoporosis remains a serious problem largely because it is under-diagnosed and under-managed and Dual Energy X-ray Absorptiometry (DXA) remains the standard for identifying those at risk for osteoporosis and associated fractures. The authors strongly recommend that until there is evidence to the contrary, clinicians obtain a bone mineral density test after one year of treatment and periodically thereafter to monitor response to treatment.

Adler and Favus, in their article Following BMD in patients on bisphosphonates: Another perspective, (JBMR October 2009, Vol. 24, No. 10, 1647-1648) present their view that the use of bone mineral density in the U.S. is appropriate but sequential DXA testing should be considered on an individual basis. When DXA testing is combined with the information the clinician learns about what patients are actually doing in their day-to-day personal disease management, clinical judgments regarding the frequency of testing are better informed.

The National Osteoporosis Foundation strongly recommends that practicing clinicians read both of these commentaries as they reflect not only the views of NOF, but also the current standard of osteoporosis care in the U.S. today.