According to information in the articles, the most important predictor of bone fracture in postmenopausal women without a previous fracture is bone mineral density (BMD). As bone mineral density decreases (as measured in terms of T scores) the risk of fracture increases. Women with even moderately low T scores (those with osteopenia), are also at risk for bone fracture. However, there is little agreement on the level of bone reduction (i.e., the ideal T score) at which to begin treatment (including dietary and pharmacological interventions) to reduce the risk for fractures.

According to the World Health Organization, a T score of -2.5 or lower indicates osteoporosis, and a T score of -1.0 to -2.49 indicates osteopenia. Many clinicians and reimbursement sources use the WHO definition of osteoporosis as the threshold for treatment. According to the National Osteoporosis Foundation (NOF), women with a T score of -2.0 or less or -1.5 or less with at least one risk factor should be treated to reduce the risk of fracture.

Ethel S. Siris, M.D., of Columbia-Presbyterian Medical Center, New York, and colleagues used data from 149,524 white postmenopausal women (average age, 64.5 years) enrolled in the National Osteoporosis Risk Assessment (NORA) study to examine the relationship between different treatment thresholds (based on T scores) and fracture incidence within a year of bone mineral density testing. Women received a bone mineral density assessment at the beginning of the study and were followed up for new fractures for 12 months.

New fractures were reported by 2,259 women, including 393 hip fractures, but only 6.4 percent of women reporting fractures had T scores of -2.
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Contact: Bryan Dotson
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JAMA and Archives Journals
24-May-2004