Should prophylaxis against osteoporotic fractures ignore bone mineral density?
On p 862 Wilkins argues that measuring bone density is almost irrelevant to preventing osteoporotic fractures. He cites a meta-analysis that shows that bone mineral densities cannot predict individuals who will have a fracture and points out that antiresorptive treatment has little effect on bone densitywhereas it does reduce bone turnover. Wilkins claims that fractures occur when high bone turnover is combined with frequent impact. He suggests that prophylaxis should be aimed not at maintaining bone density throughout menopausal life but at restoring normal bone turnover in those at greatest risk of impact.
On p 862 Wilkins argues that measuring bone density is almost irrelevant to preventing osteoporotic fractures. He cites a meta-analysis that shows that bone mineral densities cannot predict individuals who will have a fracture and points out that antiresorptive treatment has little effect on bone density—whereas it does reduce bone turnover. Wilkins claims that fractures occur when high bone turnover is combined with frequent impact. He suggests that prophylaxis should be aimed not at maintaining bone density throughout menopausal life but at restoring normal bone turnover in those at greatest risk of impact.
