A release from the publisher explains that the study showed that adverse events that had been noted in a pivotal clinical trial in women age 60 to 90 years old treated for three years showed no tendency to increase after a further three years of treatment

In addition, women who crossed over from three years of placebo to three years of denosumab experienced no increase in adverse effects compared with women treated for the initial three years.

The release quotes lead author Dr. Nelson Watts as saying, “All of this is consistent with an excellent safety and tolerability profile for denosumab treatment for osteoporosis.” The authors pointed out that especially in older women on long-term treatment, many if not all adverse events could be called “life events”–things that would have happened whether or not the person was participating in a clinical trial.

A bone mineral density (BMD) test is can provide a snapshot of your bone health. The test can identify osteoporosis, determine your risk for fractures (broken bones), and measure your response to osteoporosis treatment. The most widely recognized BMD test is called a central dual-energy x-ray absorptiometry, or central DXA test. It is painless—a bit like having an x-ray. The test can measure bone density at your hip and spine.

Another procedure, a peripheral bone density test, measure bone density in the lower arm, wrist, finger or heel. These tests are often used for screening purposes and can help identify people who might benefit from additional bone density testing.

What Does the Test Do?

A BMD test measures your bone mineral density and compares it to that of an established norm or standard to give you a score. Although no bone density test is 100-percent accurate, the BMD test is an important predictor of whether a person will have a fracture in the future.

The T-Score

Most commonly, your BMD test results are compared to the ideal or peak bone mineral density of a healthy 30-year-old adult, and you are given a T-score. A score of 0 means your BMD is equal to the norm for a healthy young adult. Differences between your BMD and that of the healthy young adult norm are measured in units called standard deviations (SDs). The more standard deviations below 0, indicated as negative numbers, the lower your BMD and the higher your risk of fracture.

A  T-score between +1 and −1 is considered normal or healthy. A T-score between −1 and −2.5 indicates that you have low bone mass, although not low enough to be diagnosed with osteoporosis. A T-score of −2.5 or lower indicates that you have osteoporosis. The greater the negative number, the more severe the osteoporosis.

Low Bone Mass Versus Osteoporosis

The information provided by a BMD test can help your doctor decide which prevention or treatment options are right for you.

If you have low bone mass that is not low enough to be diagnosed as osteoporosis, this is sometimes referred to as osteopenia. Low bone mass can be caused by many factors such as:

Heredity

The development of less-than-optimal peak bone mass in your youth

A medical condition or medication to treat such a condition that negatively affects bone

Abnormally accelerated bone loss.

Although not everyone who has low bone mass will develop osteoporosis, everyone with low bone mass is at higher risk for the disease and the resulting fractures.

As a person with low bone mass, you can take steps to help slow down your bone loss and prevent osteoporosis in your future. Your doctor will want you to develop—or keep—healthy habits such as eating foods rich in calcium and vitamin D and doing weight-bearing exercise such as walking, jogging, or dancing. In some cases, your doctor may recommend medication to prevent osteoporosis.

If you are diagnosed with osteoporosis, these healthy habits will help, but your doctor will probably also recommend that you take medication. Several effective medications are available to slow—or even reverse—bone loss. If you do take medication to treat osteoporosis, your doctor can advise you concerning the need for future BMD tests to check your progress.

The U.S. Preventive Services Task Force recommends that all women over age 65 get a bone density test. Women who are younger than age 65 and at high risk for fractures should also have a bone density test.

Due to a lack of available evidence, the Task Force did not make recommendations regarding osteoporosis screening in men.

Various professional medical societies have established guidelines concerning when a person should get a BMD test. Many of these guidelines can be found by conducting a search in an online database established by the National Guideline Clearinghouse at www.guideline.gov.

For more information from the NIH Osteoporosis and Related Bone Diseases National Resources Center, click here.

A releasr from AAOS notes that hip fractures, common in older adults, often occur due to falls or slips because bones are fragile.

The release quotes Robert Quinn, MD, AUC Section Leader for the AAOS Committee on Evidence-Based Quality and Value, as saying, “Hip fractures are one of the most feared injuries in older adults because this trauma creates pain and can force a change in lifestyle or limited mobility. We are providing evidence-based assistance for physicians and patients to determine the best course of action for surgery and follow-up care.”

Pinning bones back together using surgical screws versus reconstructing the hip joint through total hip replacement (THR) surgery has long been debated. The AUC criteria rely on peer-reviewed studies and practices to recommend different procedures depending on a patient’s individual indications such as activity levels, bone and joint health, location(s) of the fracture, and whether the break is stable or displaced. The AUC addresses patients age 60 and above with fractures caused by low-impact events.

The AUC panel included physicians and physical therapists from leading academic medical centers, in addition to orthopaedic and other professional medical societies, who reviewed 30 potential patient scenarios to create the “Appropriate Use Criteria for the Treatment of Hip Fractures in the Elderly.” Each treatment in each patient scenario is rated “appropriate,” “may be appropriate,” and “rarely appropriate.”

For example, THR is rated “appropriate” for a highly active patient with a non-displaced fracture in the neck of the femur bone. However, the same procedure is “rarely appropriate” for a non-ambulatory patient.

Another example rates reattaching bone with a specific type of screw (sliding hip anti-rotation screws) as “appropriate” for highly active patients with and without arthritis who have a stable fracture of the intertrochanteric crest, located near the top of the femur.

Dr. Quinn added that in some cases, the AUC review panel did not reach consensus on a single best course of action due to surgeons’ preferences and multiple correct treatments for surgery.

Accompanying the AUC, the AAOS created a “Preoperative Checklist” to assist surgeons and allied medical providers in delivering quality care to patients by completing 12 important initiatives. They include limiting preoperative traction; managing Warfarin, a blood-thinning medication; and discussing the patient’s home environment prior to discharge.

Hip fracture recovery guidelines

The second AUC, “Appropriate Use Criteria for Postoperative Rehabilitation for Low Energy Hip Fractures in the Elderly,” provides universal recommendations for recovery across elderly patient populations including:

• Interdisciplinary care to prevent deep vein thrombosis
• Prevention or management of postoperative delirium
• Multi-modal perioperative pain management
• Interdisciplinary management of recovery at rehabilitation and skilled-nursing facilities
• Home care therapy following discharge
• Osteoporosis assessment and management.

Supplementing the AUC, a “Perioperative Prevention of Future Fractures Checklist,” emphasizes important follow-up measures to reduce patients’ risk for future injuries. Participation in a fall prevention program, and supplements and medications to improve bone density are among the recommendations.

“It is very important to think ahead to make the right care choices after a fracture is repaired. Not only can this help patients recover, but this also helps prevent fractures from happening again, which is a big problem,” Dr. Quinn said.

AAOS created the AUCs following the 2014 release of the Clinical Practice Guideline (CPG) “Management of Hip Fractures in the Elderly,” which gives a broad overview of care options. In contrast, the AUC provides guidance for circumstances when a specific surgical procedure should be applied.

A study by the Johns Hopkins Bloomberg School of Public Health found frailty to be more prevalent in older people and more common among women and the poor. In addition, the study found wide regional differences in the U.S., with older people in central southern states more than three times as likely to be frail than those in the western states. The researchers also found significant racial differences, with blacks and Hispanics nearly twice as likely to be frail as whites.

The study was published in Journals of Gerontology: Medical Sciences.

Frailty, once thought of as a generalized state that befalls some people as they get older, is increasingly considered a medical process in and of itself. Frailty is thought to be exhibited by a set of symptoms including weakness, exhaustion and limited mobility. It often progresses separately from any underlying conditions, and is also common among patients with chronic diseases such as heart disease and diabetes, especially in their advanced stages.

Understanding frailty, and finding ways to prevent its onset or slow its progression, could improve older people’s quality of life by extending their so-called robust years. It could also increase their chances of surviving surgery, for example; previous research has suggested that older, frail patients are less likely to survive major surgical procedures. Reducing frailty could lower health care costs, since frail persons are prone to falls and falls often lead to hospitalization. Hospital care is the largest component of Medicare spending.

Of their findings, the authors were most surprised by the significant racial and regional differences, says study leader Karen Bandeen-Roche, PhD, the Frank Hurley and Catharine Dorrier Professor and Chair of the Department of Biostatistics at the Johns Hopkins Bloomberg School of Public Health. The study is believed to be the first that examines regional differences in frailty in the U.S.

“We can’t really explain the regional differences,” says Bandeen-Roche, who also co-directs the Johns Hopkins Older Americans Independence Center and is a Core Faculty member at the Johns Hopkins Center on Aging and Health. “We know there are health differences across the country, differences in diet and to some extent exercise habits. Observing the relatively low prevalence in the mountain west, you can imagine an active lifestyle might be a factor.” As for the racial differences, Bandeen-Roche says it’s too early to speculate and that they merit further study.

For the study, researchers drew on interviews with 7,439 participants in the 2011 National Health and Aging Trends Study, a longitudinal study of people age 65 and older drawn from Medicare records. Participants, who resided either at home or in an assisted living facility, completed a two-hour, in-person interview that assessed frailty using several criteria: exhaustion, weakness, low physical activity, shrinking and low walking speed. Participants were also asked about their medical history and ability to perform daily tasks such as meal preparation and other household activities. The researchers also assessed probable dementia.

Aside from the 15 percent found to be frail, the researchers also found that 45 percent were what the authors deemed “pre-frail,” or older people who have begun to experience the same symptoms of frailty, but to a lesser extent. “It’s a question of degree,” Bandeen-Roche says. The so-called pre-frail are a prime target of study in order to help researchers understand the progression of frailty so doctors can develop recommendations – for instance, changes in diet or exercise – that could extend a person’s robust years.

“We would love for frailty assessment to become a standard component of assessment of older Americans,” Bandeen-Roche says. “Understanding frailty could potentially help us extend people’s quality of life into their later years.”