The American Journal of Medicine
Volume 122, Issue 11 , Pages 992-997, November 2009

Assessing Fracture Risk and Effects of Osteoporosis Drugs: Bone Mineral Density and Beyond

  • K. Shawn Davison, PhD

      Affiliations

    • Department of Medicine, Division of Rheumatology and Immunology, Laval University, Quebec, PQ, Canada
    • Corresponding Author InformationReprint requests should be addressed to K. Shawn Davison, PhD, via e-mail
    • ,
  • David L. Kendler, MD

      Affiliations

    • Department of Medicine, University of British Columbia, Vancouver, BC, Canada
    • ,
  • Patrick Ammann, PhD

      Affiliations

    • Division of Bone Diseases, World Health Organization Collaborating Centre for Osteoporosis Prevention, Department of Rehabilitation and Geriatrics, University Hospitals, Geneva, Switzerland
    • ,
  • Douglas C. Bauer, MD

      Affiliations

    • Division of General Internal Medicine, University of California, San Francisco, Calif
    • ,
  • David W. Dempster, PhD

      Affiliations

    • Regional Bone Center, Helen Hayes Hospital, West Haverstraw, New York
    • ,
  • Larry Dian, MD

      Affiliations

    • Department of Medicine, University of British Columbia, Vancouver, BC, Canada
    • ,
  • David A. Hanley, MD

      Affiliations

    • Department of Medicine, Faculty of Medicine, University of Calgary, Calgary, AB, Canada
    • ,
  • Steven T. Harris, MD

      Affiliations

    • University of California, San Francisco, Calif
    • ,
  • Michael R. McClung, MD

      Affiliations

    • Oregon Osteoporosis Center, Portland
    • ,
  • Wojciech P. Olszynski, MD, PhD

      Affiliations

    • Department of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
    • ,
  • Chui K. Yuen, MD

      Affiliations

    • Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Manitoba, and Manitoba Clinic, Winnipeg, MB, Canada

Abstract 

Although there have been numerous advances in the assessment of bone strength and fracture risk, the majority of these techniques can only be performed in research laboratories, making them largely unavailable to practicing clinicians. Prospective epidemiologic studies have identified risk factors that can be assessed within the clinic and combined with bone mineral density to allow clinicians to better identify untreated individuals at heightened risk for fracture and to make informed treatment decisions based on 10-year absolute fracture risk. This article discusses the assessment of fracture risk in clinical practice, reviews currently and soon-available bone measurement tools, and details the impacts of osteoporosis therapies on fracture risk.

Keywords: Antifracture treatment, Bone mineral density, Bone strength, Clinical risk factors, Osteoporosis

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 Funding: Unrestricted educational support from Amgen Canada, Servier Canada, The Alliance for Better Bone Health (sanofi-aventis and P&G Pharmaceuticals), Eli Lilly Canada, Novartis Canada, and Wyeth Canada.

 Conflict of Interest: Dr Davison has received honoraria from and has acted as a consultant for Merck, Amgen, Servier, Procter & Gamble and sanofi-aventis. Dr Kendler consults for, receives research grants from, or is on speakers bureau for Procter & Gamble, Merck, Novartis, Eli Lilly, Wyeth, GlaxoSmithKline, Biosante, Servier, Amgen, Johnson & Johnson, and Pfizer. Dr Bauer has received research funding from Amgen and Novartis. Dr Dian receives research grants from, or is on speakers bureau for Amgen, Novartis, Pfizer, Lundbeck, Merck, Procter & Gamble and sanofi-aventis. Dr Hanley has been a consultant or on a speaker's bureau for Amgen, Eli Lilly, Merck Frosst Canada, Novartis, Pfizer, Procter & Gamble Pharmaceuticals, sanofi-aventis and Servier, and he has conducted clinical trials for Procter & Gamble Pharmaceuticals. Dr Harris has given presentations sponsored by and has acted as a consultant to Amgen, GlaxoSmithKline, Eli Lilly, Merck, Novartis, Procter & Gamble, Roche, sanofi-aventis, and Wyeth. Dr McClung, receiving consulting fees or participating on paid advisory boards for Amgen, Eli Lilly, Merck, and Novartis and receiving lecture fees from Eli Lilly, Novartis, Merck, and sanofi-aventis and grant support from Amgen, GlaxoSmithKline, Eli Lilly, Merck, Novartis, Procter & Gamble, Roche, AstraZeneca, Nordic Bioscience, Radius, and sanofi-aventis. Dr Olszynski has been a consultant or on a speaker's bureau for Amgen, Eli Lilly, Merck Frosst Canada, Novartis, Pfizer, Procter & Gamble Pharmaceuticals and sanofi-aventis, and he has conducted clinical trials for Procter & Gamble Pharmaceuticals. Dr Yuen has received research grants from and is a consultant for Wyeth.

 Authorship: All authors had access to the data and played a role in writing this manuscript.

PII: S0002-9343(09)00660-3

doi:10.1016/j.amjmed.2009.05.018

The American Journal of Medicine
Volume 122, Issue 11 , Pages 992-997, November 2009

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