Consider risk factors in osteoporosis therapy: increased fracture risk seen in those with T scores below -1.8, previous fracture, and fair or poor health.(Gynecology)

NEW YORK -- While bone mineral density T scores clearly are predictive of a postmenopausal woman's osteoporotic fracture risk, treatment decisions should take into account other factors, including her overall health and history of previous fractures, Stephen Honig, M.D., said at a rheumatology meeting sponsored by New York University.

"We have to do better than the T score in deciding who needs treatment for osteoporosis, because the long-term use of bisphosphonates has not been determined to be safe," said Dr. Honig, director of the osteoporosis center at the Hospital for Joint Diseases Spine Center in New York.

Very long-term bisphosphonate therapy may lead to oversuppression of bone turnover, he said. This superhardening can hinder subsequent fracture healing, as was seen in a recent report of nine patients who sustained spontaneous, nonhealing fractures while on alendronate therapy (J. Clin. Endocrinol. Metab. 2005;90:1294-301).

These patients showed histomorpho-metric evidence of markedly suppressed bone formation, Dr. Honig said.

This new finding has heightened interest in targeting osteoporosis treatment. Research findings have begun to provide guidance on which patients can most benefit from treatment.

Most notable was the National Osteoporosis Risk Assessment (NORA) study, which enrolled 200,160 postmenopausal women aged 50 and older.

In that study, bone mineral density (BMD) measurements were obtained at baseline, and the participants were followed for 1 year.