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Overdiagnosis of bone fragility in the quest to prevent hip fracture
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
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2015 (English)In: BMJ. British Medical Journal, ISSN 0959-8146, E-ISSN 0959-535X, Vol. 350, h2088Article in journal (Refereed) Published
Abstract [en]

Clinical context

Hip fractures cause considerable morbidity and mortality and are associated with high healthcare costs. With a growing elderly population their incidence is predicted to rise

Diagnostic change

Before the late 1980s, osteoporosis was diagnosed after a bone fracture. A new definition was introduced in 1994 based on low bone mineral density, expanding indications for pharmacotherapy. The introduction of fracture risk calculators exacerbated the trend

Rationale for change

Fractures are a function of bone fragility, which is measureable and can be improved with drugs

Leap of faith

Identifying and treating patients with fragile bones is a cost effective strategy to prevent fractures, particularly hip fractures

Impact on prevalence

Current fracture risk predictors have at least doubled the number of candidates for drug treatment. Under US guidelines about 75% of white women aged over 65 years have become candidates for drug treatment

Evidence of overdiagnosis

Rates of hip fracture continue to decline, and most occur in people without osteoporosis. Our meta-analysis indicates that 175 postmenopausal women with bone fragility must be treated for about three years to prevent one hip fracture

Harms from overdiagnosis

Being labelled as at risk of fracture imposes a psychological burden. Drug treatment is associated with adverse events, such as gastrointestinal problems, atypical femoral fractures, and osteonecrosis of the jaw

Limitations of evidence

Hip fractures are caused predominantly by falls in frail older adults. Few studies on preventive pharmacotherapy included adults aged ≥80, but evidence suggests no treatment benefit. Evidence is also sparse on treatment of men and optimum duration of treatment

Place, publisher, year, edition, pages
2015. Vol. 350, h2088
National Category
URN: urn:nbn:se:uu:diva-253691DOI: 10.1136/bmj.h2088ISI: 000355132600001PubMedID: 26013536OAI: oai:DiVA.org:uu-253691DiVA: diva2:815582
Available from: 2015-06-01 Created: 2015-06-01 Last updated: 2016-02-10Bibliographically approved

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Publisher's full textPubMedhttp://www.bmj.com/content/350/bmj.h2088

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