January 25, 2012
Volume 7 - Issue 4       

DynaMed Weekly Update

For the week ending January 20, 2012  

Last week 938 articles were evaluated via DynaMed's Systematic Literature Surveillance and 226 were added to DynaMed content. 

Based on the editors' criteria of selecting "articles most likely to change clinical practice," one article of significant interest was selected for the DynaMed Weekly Update.

Feature Article

Elderly Women with Normal Bone Mineral Density or Mild Osteopenia Appear to Have Low Risk of Progression to Osteoporosis or Hip Fracture Over 15 Years  


Bone density testing is recommended in healthy women ≥ 65 years old to screen for osteoporosis (National Osteoporosis Foundation 2010 PDF, Ann Intern Med 2011 Mar 1;154(5):356), but data to determine the optimal interval between screens have been lacking. A recent cohort study followed 4,957 women with normal bone mineral density (BMD) or osteopenia by dual-energy x-ray absorptiometry for up to 15 years. All women were ≥ 67 years old at baseline. Women with a history of hip or clinical vertebral fracture or osteoporosis were excluded.


Women were stratified by baseline BMD for analysis. Osteoporosis developed in 0.8% of women with normal BMD, in 4.6% with mild osteopenia, in 20.9% with moderate osteopenia, and in 62.3% with advanced osteopenia. Hip fracture or clinical vertebral fracture occurred in 2.4% of the whole cohort prior to diagnosis of osteoporosis by BMD.


Based on these data, the authors estimated the time interval for each group over which osteoporosis would develop in 10% of the women before they suffered a hip fracture or clinical vertebral fracture. The intervals were 16-18 years for women with normal BMD or mild osteopenia, about 5 years for moderate osteopenia, and 1 year for advanced osteopenia. They also assessed the time intervals for 2% of women to have a hip or vertebral fracture before the development of osteoporosis. These times were estimated at > 15 years for normal BMD or mild osteopenia and about 5 years for moderate or advanced osteopenia (level 2 [mid-level] evidence) (N Engl J Med 2012 Jan 19;366(3):225). While this study cannot determine the optimal interval between screening BMD tests, it may help inform the discussion between clinicians and patients.


For more information, see the Osteoporosis topic in DynaMed.


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About DynaMed Weekly Update

Prepared by the clinician members of the DynaMed Editorial Team, DynaMed Weekly Update is a compilation of one to five articles selected from DynaMed's Systematic Literature Surveillance as articles most likely to change clinical practice.

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CME Information


0.25 AMA PRA Category I Credit(s)™
Family Physicians: 0.25 Prescribed credits
Nurse Practitioners: 0.25 Contact hours
Release Date: January 25, 2012 
Expiration Date: January 25, 2013
Estimated Completion Time:
15 minutes
There is no fee for this activity.

To Receive Credit 
In order to receive your certificate of participation, you should read the information about this activity, including the disclosure statements, review the entire activity, take the post-test, and complete the evaluation form. You may then follow the directions to print your certificate of participation. To begin, click the CME icon at the end of the article.

Program Overview

Learning Objectives

Upon successful completion of this educational program, the reader should be able to:
1. Discuss the significance of this article as it relates to your clinical practice.
2. Be able to apply this knowledge to your patient's diagnosis, treatment and management.
Faculty Information
Alan Ehrlich, MD - Assistant Clinical Professor in Family Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA; Deputy Editor, DynaMed, Ipswich, Massachusetts, USA

Michael Fleming, MD, FAAFP - Assistant Clinical Professor of Family Medicine and Comprehensive Care, LSU Health Science Center School of Medicine, Shreveport, Louisiana, USA; Assistant Clinical Professor of Family Medicine, Department of Family and Community Medicine, Tulane University Medical School, New Orleans, Louisiana, USA; Chief Medical Officer, Amedisys, Inc. & Antidote Education Company

Dr. Ehrlich, Dr. Fleming, DynaMed Editorial Team members, and the staff of Antidote Education Company have disclosed that they have no relevant financial relationships or conflicts of interest with commercial interests related directly or indirectly to this educational activity.
No commercial support has been received for this activity.

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AAFP: This activity, DynaMed Weekly Update 2011, has been reviewed and is acceptable for up to 13 Prescribed credits by the American Academy of Family Physicians. AAFP accreditation begins March 2, 2011. Term of approval is for one year from this date. Each Weekly Update is approved for 0.25 Prescribed credits. Credit may be claimed for one year from the date of each Weekly Update.


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Program ID 1102071V.

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