Monitoring Of Bone Mineral Density Research Articles

Prevalence and Risk Factors of Low Bone Mineral Density in Korean HIV-Infected Patients: Impact of Abacavir and Zidovudine

Low bone mineral density (BMD) is common in HIV-infected patients. We aimed to describe the prevalence of low BMD and risk factors in Korean HIV-infected patients and to assess the effects of antiretroviral therapy (ART) on BMD. We retrospectively evaluated 224 HIV infected-patients. The prevalence of osteopenia and osteoporosis were 41.5% and 12.9%. These were much higher in 53 patients aged 50 yr and older (52.8% and 34.0%). Older age, lower body mass index, and ART > 3 months were independent risk factors for low BMD. Osteoporosis was more prevalent in patients on the abacavir-based regimen for < 1 yr than ≥ 1 yr; however, it was more prevalent in patients on the zidovudine-based regimen for ≥ 1 yr than < 1 yr (P = 0.017). Osteoporosis in patients on the abacavir-based regimen was more common in the spine than in the femur (P = 0.01). Given such a high prevalence of low BMD, close monitoring of BMD for HIV-infected patients on ART is required. The different prevalence of osteoporosis over time and affected areas between two regimens suggest they may play roles in different mechanisms in bone loss.

282P - Evaluation of Bone Mineral Density (BMD) in Early Breast Cancer (EBC) Patients Treated With Up-Front or Switch Schedules of Aromatase Inhibitors (AIS): Results of a Single Centre Retrospective Study

ABSTRACT Background Aromatase inhibitors (AIs) are the standard adjuvant treatment of hormone responsive early breast cancer (EBC) in postmenopausal women. AIs are well tolerated but are associated with specific toxicities, including effect on bone (accelerated bone loss, bone fracture, osteoporosis) and musculoskeletal symptoms (ostealgia, arthralgia, myalgia) Aim: The present observational study investigated the effect of BMD in postmenopausal women with EBC scheduled to receive AIs up-front or switch treatment after standard 2-3 years of adjuvant Tamoxifen (TAM-AIs). Patients and methods We reviewed data for 89 patients with hormone receptor-positive EBC: 64 postmenopausal women received up-front AIs for 5 years; 25 patients received TAM-AIs. BMD were assessed at baseline and during hormonal treatment once a year. Osteopenic patients received Calcium and vitamin D; osteoporotic patients received also oral biphosphonates. Results No patient with a normal baseline BMD (T-score >-1) became osteoporotic during 5 years of follow-up. However, it was noted that more women receiving AIs up-front became osteopenic, as compared with TAMaAI treated women (AIs = 58% vs. TAM-AIs = 26%, p= Conclusion The data suggest that only those women with a T-score of less than -1.5 are at risk of developing osteoporosis during the AIs adjuvant therapy. This cut-off value might reduce the costs both for BMD monitoring and supplementary comedications. Finally, the correct management of treatment-related symptoms might improve patient's compliance and the adherence to treatment. Disclosure All authors have declared no conflicts of interest.

HIV-Associated Osteoporosis in Ireland: Prevalence and Risk Factors

Effective antiretroviral therapy has transformed HIV infection into a chronic disease. The emphasis is now on the management of the consequences of life-long treatment and associated toxicities, including osteoporosis and fragility fractures. There is a paucity of data on HIV-associated osteoporosis in Ireland. Aims: The study aims to investigate the prevalence and relevant risk factors for HIV-associated osteoporosis. Methods: A cross-sectional study of 146 HIV-positive patients from two different tertiary referral hospitals in Dublin was employed. Results: The prevalence of osteopenia and osteoporosis of the hip and/or lumbar spine was 53.4 and 9.6%, respectively. We found significant association between decreased hip bone mineral density (BMD) and increasing age, male gender, cigarette smoking, ethnicity, intravenous drug use and lower nadir CD4. A low BMI was the single most important independent predictor of reduced BMD in our study cohort. Conclusion: Low BMD affects a large proportion of HIV-positive patients in Ireland. Our results suggest that BMD screening, monitoring and treatment (if indicated) should be considered in all HIV-positive patients.

Stable bone mineral density over 6 years in HIV-infected men treated with highly active antiretroviral therapy (HAART)

Most longitudinal studies of bone mineral density (BMD) in HIV-infected cohorts have been of short duration, typically 1-2 years. Some studies, especially of cohorts treated with highly active antiretroviral therapy (HAART), report short-term stable or increasing BMD, but other studies, often in cohorts initiating HAART, report short-term losses in BMD. We assessed BMD changes over the medium term in HIV-infected men already established on HAART at baseline. Six-year, prospective, longitudinal study. Forty-four HIV-infected men treated with HAART and 37 uninfected, healthy controls. Participants had measurements of BMD at baseline, 2 and 6 years. In the HIV-infected men at baseline, the mean age was 49 years, the mean duration of infection was 8 years, and the mean duration of HAART was 50 months. Over 6 years of follow-up, there was a greater increase in lumbar spine BMD (5·3%, 95% CI 3·8-6·5%) in the HIV-infected men compared with controls (0·3%, 95% CI -1·0 to 1·6%), P < 0·001. There was no difference between the groups in the change in BMD over time at the total hip (HIV group: -0·6%, 95% CI -1·7 to 0·4%, controls -1·0%, 95% CI -2·2 to 0%, P = 0·8) or at the total body (HIV group, 0·3%, 95% CI -0·3 to 1·0%; controls, 0·5%, 95% CI -0·2 to 1·1%, P = 0·15). Lean mass increased in the HIV group, but not in the controls. There was no evidence of accelerated bone loss over 6 years in middle-aged, HIV-infected men treated with HAART. For such patients, routine monitoring of BMD is not necessary over the short/medium term.

Bone effects of cancer therapies

Agents used for systemic chemotherapy can alter normal bone homeostasis through mechanisms that affect both osteoblast and osteoclast function. The identification of those agents that influence maintenance of the bone-remodeling compartment is an important component of the drug development and testing process. This brief review focuses on preclinical and clinical data illustrating the effect of several classes of chemotherapeutic agents on skeletal development and bone remodeling. New preclinical data demonstrate that several classes of chemotherapeutic agents, including histone deacetylase inhibitors and proteasome inhibitors, alter osteoblast and osteoclast function. Preclinical data on retinoic acid analogues demonstrate that these agents inhibit osteoclastogenesis. In addition, a dose-dependent effect of methotrexate treatment on growth plate thickness and primary spongiosa height in rats has been demonstrated. Two recently published analyses of clinical data from trials of bortezomib in myeloma patients found increased biochemical markers of bone formation and evidence of increased bone deposition after bortezomib treatment. Several classes of chemotherapeutic agents alter bone metabolism and negatively impact bone homeostasis. Bone mineral density (BMD) monitoring guidelines for patients receiving systemic chemotherapy are not established. Limited guidelines exist for BMD monitoring in patients receiving long-term hormonal modulation; however, the negative effect of other chemotherapeutic agents on the skeleton is underappreciated.

Stable Bone Density in HAART-Treated Individuals with HIV: A Meta-Analysis

Longitudinal studies of bone mineral density (BMD) in HIV have reported conflicting results. We investigated whether temporal changes in BMD differ by highly active antiretroviral therapy (HAART) status at baseline. Data sources included MEDLINE, EMBASE, and the Web of Science for English language studies (1966 to September 2010) and conference abstracts (1997-2010). Longitudinal studies reporting BMD at least 48 wk apart in adult patients with HIV with a comparable uninfected control group were eligible. Uncontrolled studies were included in secondary analyses. Data were independently extracted by two researchers. Data were pooled using random-effects models. In the primary analysis of six controlled studies (follow-up 1.5-2.7 yr), there were no significant differences in the percent change from baseline in BMD at the total hip or femoral neck between HIV cohorts and controls and a decrease of 0.6% (95% confidence interval = -1.1 to -0.1) at the spine in the HIV cohorts. In the secondary analysis of 37 studies (31 uncontrolled, six controlled), cohorts treated with HAART at baseline had stable or slight increases in BMD at 1 yr, stable or slight decreases in BMD at 2 yr, and stable BMD at 2.5 yr or later. In cohorts that were HAART-naive/untreated at baseline, there was accelerated loss of BMD at all time points, and the annualized rate of BMD change was greatest at 1 yr, but thereafter decreased. BMD is stable in HIV cohorts established on HAART, whereas cohorts initiating HAART have short-term accelerated BMD loss followed by a longer period of BMD stability/increases. Routine monitoring of BMD in many HAART-treated patients may not be necessary.

Changes in bone mineral density of the os calcis as measured by quantitative ultrasound during pregnancy and 24 months after delivery

To evaluate the use of quantitative ultrasound measurement of the os calcis to monitor bone mineral density (BMD) changes in pregnancy and 24 months after delivery. Low-risk patients booked before 20 weeks of gestation were recruited prospectively over a period of 12 months. BMD measurements of the os calcis were taken using quantitative ultrasound between 14 and 20 weeks and after 36 weeks using the Hologic Sahara system. Body weight and fat composition were also measured at each occasion. The measurements were repeated 24-28 months after the index delivery. Those who were delivered preterm or those diagnosed to have significant medical or antenatal complications were excluded. A total of 95 patients completed the study, of which 55 (57.8%) were primiparous and 40 (42%) were multiparous. A mean fall in BMD of 0.0389 g/cm(2) was demonstrable from early to late gestation. The mean BMD difference between the 2-year assessment and early pregnancy (Δ BMD) was -0.008 g/cm(2) . Δ BMD was negligible for multiparous women compared to a small loss in primiparous women (0.0006 vs. -0014 g/cm(2) , P = 0.026). There were no significant differences in Δ BMD between those who lactated for over 16 weeks (n=35) and those who did not (n=60). A logistic regression model showed that the extent of BMD loss during pregnancy and pregnancy weight gain were significant factors associated with BMD changes 24 months after delivery. Bone mineral density loss during pregnancy that was detectable by quantitative ultrasound at the os calcis has largely recovered at 24 months after delivery.

High prevalence of and progression to low bone mineral density in HIV-infected patients: a longitudinal cohort study

Low bone mineral density (BMD) is an emerging metabolic condition in HIV-infected patients; however, data on progression of this disease are scarce. We studied 671 patients with at least one dual-energy X-ray absorptiometry scan (391 of them ≥2 scans) to determine the prevalence and progression of BMD and establish related factors. Linear regression and logistic polytomic regression were used for the cross-sectional study and mixed effects and generalized estimating equations were used for the longitudinal study. Osteopenia and osteoporosis were diagnosed in 47.5 and 23%, respectively. Progression to bone demineralization was observed in 28% of the patients over a median of 2.5 years (12.5% progressed to osteopenia and 15.6% to osteoporosis). In the 105 patients with at least 5 years of follow-up, progression was 47% (18% to osteopenia; 29% to osteoporosis). Factors associated with bone loss and progression were age [odds ratio (OR) 1.07; 95% confidence interval (CI) 1.05-1.08; P < 0.0001], male sex (OR 2.23; 95% CI 1.77-2.8; P < 0.0001), low body mass index (OR 1.14; 95% CI 1.11-1.17; P < 0.0001), time on protease inhibitor (OR 1.18; 95% CI 1.12-1.24; P < 0.0001), time on tenofovir (OR 1.08; 95% CI 1.03-1.14; P < 0.0019), and current use of protease inhibitors (OR 1.64; 95% CI 1.35-2.04; P < 0.0001). Our results show a high prevalence of and considerable progression to osteopenia/osteoporosis in our cohort. Our findings support the importance of applying adequate strategies to prevent bone demineralization and of close monitoring of BMD in HIV-infected patients, specifically in at-risk patients who are taking antiretrovirals that affect bone mineralization.

Reversal of skeletal effects of endocrine treatments in the Intergroup Exemestane Study

The adjuvant use of aromatase inhibitors in breast cancer is associated with adverse effects on bone health. We previously reported a decline in bone mineral density (BMD) following the switch from tamoxifen to exemestane in the Intergroup Exemestane Study (IES). Here we report effects of endocrine treatment withdrawal on BMD, bone turnover markers (BTM) and fracture rates. 4,724 patients took part in IES, and 206 patients were included in a bone sub-study. BMD and BTM were assessed pre-randomization, during and after the end of treatment (EOT). To evaluate treatment withdrawal effects, 12- and 24-month post EOT BMD results are available for 122 and 126 patients, respectively. Similar patient numbers had BTM measured post EOT. Following treatment withdrawal, the differences in BMD observed between the two endocrine strategies were partially reversed. At 24 months from EOT, spine BMD increased by 1.53% (95%CI 0.63-2.43; p = 0.001) after stopping exemestane and fell by 1.93% (95%CI -2.91 to 0.95; p = 0.0002) following tamoxifen withdrawal. A similar pattern of changes was observed at the hip. At 2 years post EOT, BMD changes from baseline were similar with both treatment strategies. Corresponding inverse changes in BTM were seen, with an increase following tamoxifen withdrawal and a reduction after exemestane. A higher number of fractures occurred during exemestane treatment, but fracture rates were similar after treatment withdrawal. With the switch strategy used in IES, the on treatment adverse bone effects of exemestane are reversed. Ongoing monitoring of BMD is therefore not routinely required.

Skeletal Effects of Interventions in Mild Primary Hyperparathyroidism: A Meta-Analysis

Uncertainty exists as to the optimal management and monitoring of the skeletal consequences of mild primary hyperparathyroidism (PHPT). The aim of this study was to determine the effects of surgical treatment, medical treatment and no treatment on bone mineral density (BMD) in mild PHPT. Our sources were Medline, EMBASE, and Cochrane CENTRAL prior to January 2009, and abstracts from meetings of international bone and mineral societies from 1987-2008. Eligible studies were of at least 1-yr duration and included more than 10 participants with mild PHPT (serum calcium < 12 mg/dl) who had BMD measured by dual-energy x-ray absorptiometry while being observed without intervention, or treated with antiresorptive therapy or surgery. Primary analysis was of studies of up to 2-yr duration. Secondary analysis was of studies with follow-up beyond 2 yr. Data were extracted from the text of the retrieved articles or conference abstracts. Increases in BMD in response to surgical intervention were comparable to those induced by antiresorptive therapies. Significant bone loss was observed in untreated subjects, but the rates of loss ranged from 0.6-1.0%/yr. Analysis of studies reporting data beyond 2 yr of follow-up demonstrated stable increases in BMD after surgery and stable BMD or slow loss (0.1-0.3%/yr) in untreated PHPT. Surgical treatment and antiresorptive therapies increase BMD in mild PHPT to a similar degree, and each represents a reasonable option in a patient with mild PHPT and low BMD. Rapid bone loss does not occur in untreated mild PHPT, such that monitoring of BMD less frequently than every 1-2 yr is reasonable in individuals for whom intervention is not immediately required.

Consider Bisphosphonate Holiday After 5 Years

Bruce Jancin is with the Denver bureau of Elsevier Global Medical News. ESTES PARK, COLO. — Many bone disease experts are recommending a 1- to 2-year bisphosphonate holiday after 5 years of treatment in response to a recent spate of reports of atypical fractures of the femoral diaphysis. There are now more than 70 reports of such fractures of the femoral shaft occurring in patients on bisphosphonates for longer than 5 years. Affected individuals have also had severely suppressed bone turnover markers, Michael T. McDermott, MD, said at a conference sponsored by the University of Colorado. “This tells us that drugs that turn off a major process like bone remodeling may be very valuable for 3–5 years, but we have to ask, are they good for longer periods of time? We don't know the answer yet,” observed Dr. McDermott, professor of medicine and director of diabetes practice at University of Colorado Hospital, Aurora. These distinctive fractures have been bilateral in two-thirds of cases. There is no associated history of trauma. Radio-graphically they look like nonhealing stress fractures through the bone shaft. Dr. McDermott said he has informally polled many other bone experts across the country. Their consensus: A bisphosphonate holiday for 1–2 years is reasonable after 5 years of therapy in low-risk patients (individuals with a current T score greater than −2.5 and no history of fractures). “Treatment holidays are not advised for high-risk patients,” he stressed. For such patients—those who have a T score less than −2.5 and/or previous fractures—options include a switch to an anabolic agent such as teriparatide (Forteo) or to a nonbisphosphonate antiresorptive agent such as raloxifene (Evista), estrogen, or calcitonin. Continuing the bisphosphonate in a high-risk patient is also a reasonable strategy. “We truly have no data yet as to whether we should stop our medications or not,” the physician noted. Regardless, it's now doubly important to monitor bone mineral density and/or bone turnover biomarkers regularly in patients on long-term bisphosphonates, Dr. McDermott emphasized.

Update on Cystic Fibrosis-Related Bone Disease: A Special Focus on Children

A high prevalence of low bone mineralization is documented in adult patients with cystic fibrosis (CF). Osteopenia is present in up to 85% of adult patients and osteoporosis in 10% to 34%. In children, study results are discordant probably because of comparisons to different control populations and corrections for bone size in growing children. Malnutrition, inflammation, vitamin D and vitamin K deficiency, altered sex hormone production, glucocorticoid therapy, and physical inactivity are well known risk factors for poor bone health. Puberty is a critical period for bone mineralization and requires a careful follow-up to achieve optimal bone peak mass. Strategies for optimizing bone health, such as monitoring bone mineral density (BMD) and providing preventive care are necessary from childhood through adolescence to minimize CF-related bone disease in adult CF patients.

Estimation of absolute fracture risk among middle-aged and older men and women: the EPIC-Norfolk population cohort study

While estimates of relative risks associated with risk factors such as age and bone mineral density (BMD) may be of interest for etiologic and comparative purposes, clinical questions such as who might benefit most from preventive interventions or BMD monitoring depend on estimates of absolute fracture risk. The European prospective investigation into cancer (EPIC)-Norfolk study included 25,311 participants (11,476 men) aged 4,079 years in 1993-1997. All participants were followed for osteoporotic fractures to March 2007. Ten-year absolute risk of fracture in men and women were calculated using the baseline survivor function in multivariable Cox proportional-hazards models adjusting for age, sex, history of fractures, body mass index, smoking, and alcohol intake. In comparison of those without history of fracture versus those with history of fracture, the 10-year absolute risk of any fracture in men ranged from 1.0 vs. 1.2% at age 40 years to 3.0 vs. 4.4% at age 75 years. The respective estimates in women ranged from 0.7 vs. 1.0% at age 40 years to 9.3 vs. 17.2% at age 75 years. Statistically significant interaction between age and sex was found (P < 0.001), which contributed to the differences in predicted absolute fracture risks for men and women at different ages. Our study shows the need for population-specific data to develop efficient well calibrated algorithms for assessment of fracture risk. The interaction observed between sex and age points to the need for further prospective studies among men.

Value of routine monitoring of bone mineral density after starting bisphosphonate treatment: secondary analysis of trial data

Objective: To assess the value of monitoring response to bisphosphonate treatment by means of measuring bone mineral density.Design Secondary analysis of trial data using mixed models.Data source The Fracture Intervention...

Densidade mineral óssea e absortometria de raio-x de dupla energia

The objective of this review article is to gather the relevant information on bone tissue and the validation and limitations of dual-energy X-ray absorptiometry. To this end, national and international studies indexed on the Pubmed, Lilacs and Nuteses databases were analyzed. The features discussed were: bone tissue maturation, bone tissue in different populations, the impact of intervention programs on bone tissue, dual-energy X-ray absorptiometry, and its validation and limitations. According to data found in the literature, certain observations can be made. Bone mineral density changes during the different stages of life, childhood, adolescence, adulthood and old age; it can also be infl uenced by race, sex, genetic factors and life style in addition to by age. The importance of monitoring bone mineral density, both to good health and to social and economic aspects of society, is evident. Studies have confi rmed the effi cacy of dual-energy X-ray absorptiometry for measuring body composition (bone, fat and muscle). However, in recent studies, although few in number, some limitations of using this equipment have been noted, which may affect its accuracy. It is therefore understood that there is a need for further studies into this subject, with the intention of defi ning the accuracy of this equipment.

Factors Affecting Short-Term Bone Density Precision Assessment and the Effect on Patient Monitoring

The most widely used procedure for performing a BMD reproducibility assessment (same-technologist with simple repositioning on the same day) systematically underestimates precision error and will lead to over categorization of change in a large fraction of monitored patients. The most common procedure for establishing the least significant change (LSC) to monitor bone mineral density (BMD) with DXA is for the same technologist to perform repeat subject scans on the same day with simple repositioning. The objective of the current report is to determine how the reproducibility scanning procedure impacts on the precision assessment and categorization of change in routine clinical practice. The study population was drawn from the database of the Manitoba Bone Density Program which includes all clinical DXA test results for the Province of Manitoba, Canada. All patients who had baseline and follow up total spine (L1-4) and the total hip BMD measurements on the same instrument up to March 31, 2007 were included as the 'clinical monitoring population' (N = 5048 scan-pairs). BMD precision was assessed in a convenience sample of patients who were agreeable to undergoing a repeat assessment (50% performed on the same day with repositioning, 68% by different technologists) (N = 331 spine and 328 hip scan-pairs). Precision error was greater when the scan-pairs were acquired on different days than on the same day for both the total spine (p < .001) and total hip (p < .01). No other factor was consistently associated with precision error. The reference LSC (different days and different technologists) categorized the smallest fraction of the monitored population with change, whereas other combinations gave a significant rate of over categorization (up to 19.3% for the lumbar spine and up to 18.3% for the total hip). The most widely procedure for performing a BMD reproducibility assessment (same-technologist with simple repositioning on the same day) systematically underestimates precision error and will lead to over categorization of change in a large fraction of monitored patients.

Sample size requirements for bone density precision assessments and effect on patient categorization: A Monte Carlo simulation study

A sample size of 30 degrees of freedom ( df) for bone mineral density (BMD) precision studies may be insufficient for reliably categorizing change. Monte Carlo simulation was used to evaluate the effect of precision study sample size on identifying change in clinical patients. Least significant change (LSC) from 198 spine and 193 total hip scan-pairs was used to categorize change for 1420 patients undergoing BMD monitoring. Relative to this reference change fraction (RCF), LSC limits were identified that gave specified deviations from the RCF (− 25% to + 25%). Confidence limits (95% and 80%) for these LSC values (5 to 500 df) were estimated using ‘bootstrap’ samplings. A sample size providing 140 df is needed to avoid overdetecting spine change by 5% and 150 df to avoid underdetecting spine change by 5% with 95% confidence limits. A sample size of 30 df resulted in up to a 12.5% overdetection and 10.0% underdetection of spine or hip change based upon 95% confidence limits. In conclusion, assessing the effect of precision study sample size on classifying change in monitored patients is an important element of the precision assessment that is neglected in current recommendations. Sample sizes larger than 30 df are required if low levels of categorization error are to be achieved.

Bone mineral density remains stable in HAART‐treated HIV‐infected men over 2 years

Recently we reported that human immunodeficiency virus (HIV)-infected Caucasian men treated with highly active antiretroviral therapy (HAART) have normal weight-adjusted bone mineral density (BMD), in contrast to most other cross-sectional analyses, which have reported low BMD in HIV-infected patients. We have now addressed the question of whether there is accelerated BMD loss over time in HIV-infected men. A 2-year, prospective, longitudinal study. Twenty-three HAART-treated, HIV-infected men and 26 healthy controls. All participants had measurements of BMD and bone-related laboratory parameters at baseline, and a repeat measurement of BMD at 2 years. In the HIV-infected men the mean age was 47 years, the mean duration of infection was 8.2 years, and the mean duration of HAART was 54 months. Over 2 years of follow-up, BMD increased from baseline in the HIV-infected men by 2.6% at the lumbar spine (P = 0.05 vs. baseline), and remained stable at the total hip (mean change 0.1%, P > 0.99) and total body (mean change 0.6%, P = 0.39). Mean changes in BMD in the control group were 1.4% at the lumbar spine, -0.1% at the total hip, and -0.8% at the total body. The HIV-infected men lost less total body BMD than the control group (P = 0.01). In the HIV-infected men, body weight remained stable over 2 years while fat mass decreased and lean mass tended to increase, whereas in the controls, body weight and fat mass increased while lean mass remained stable. Accelerated bone loss does not occur in HIV-infected men treated with HAART. Monitoring of BMD in HIV-infected men may not be necessary.

Therapeutic management of bone demineralization in the HIV-infected population

Therapeutic management of bone demineralization in the HIV-infected population

Recommendations for Bone Mineral Density Reporting in Canada: A Shift to Absolute Fracture Risk Assessment

In June 2005, new Canadian recommendations for bone mineral density (BMD) reporting in postmenopausal women and older men were published by Osteoporosis Canada (formerly the Osteoporosis Society of Canada) and the Canadian Association of Radiologists. The recommendations were developed by a multidisciplinary working group that included the Canadian Panel of the International Society for Clinical Densitometry and were reviewed and endorsed by multiple stakeholders. Previous Canadian osteoporosis guidelines advised intervention based on an individual's World Health Organization category (normal, osteopenia, or osteoporosis) as a marker of relative fracture risk. In the new approach, an individual's 10-yr absolute fracture risk, rather than BMD alone, is used for fracture risk categorization. Absolute fracture risk is determined using not only BMD results, but also age, sex, fragility fracture history, and glucocorticoid use. A procedure is presented for estimating absolute 10-yr fracture risk in untreated individuals, leading to assigning an individual to 1 of 3 absolute fracture risk categories: low risk (<10% 10-yr fracture risk), moderate risk (10–20%), and high risk (>20%). We propose that an individual's absolute fracture risk category should be the basis for deciding on treatment and frequency of BMD monitoring.