Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorJody W.ZylkeMD, Contributing EditorIndividualAuthor
In Reply: The primary objective of our study
was to evaluate decision rules for identifying women who would benefit from
initial BMD testing by DXA. Women with a diagnosis of osteoporosis prior to
entry into the Canadian Multicentre Osteoporosis Study would not have been
eligible for this case-finding study because they would have been previously
diagnosed and managed.
The National Osteoporosis Foundation based their recommendations for
treatment1 on data from a comprehensive
cost-effectiveness analysis2 finding that
treating women with a BMD T score less than −2.0 was cost effective
to decrease fractures compared with lack of treatment. This outcome, termed
the treatment threshold, was used as our primary outcome. Osteoporosis is
defined clinically as a BMD T score of −2.5 or less, indicating that
a woman is at high risk for fractures. It is important to identify women for
whom treatment would be beneficial and not wait until the BMD becomes osteoporotic.
We thus feel that evaluating decision rules to identify women below the treatment
threshold is a fair primary outcome.
Cadarette SM, Jaglal SB, Murray TM, McIsaac WJ. Who Should Be Screened for Osteoporosis?—Reply. JAMA. 2001;286(16):1970-1971. doi:10.1001/jama.286.16.1969