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October 24/31, 2001

Who Should Be Screened for Osteoporosis?—Reply

Author Affiliations

Copyright 2001 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2001

JAMA. 2001;286(16):1970-1971. doi:10.1001/jama.286.16.1969

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.

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