This 2018 editorial in the New England Journal of Medicine concerned a clinical trial of an osteoporosis treatment:
“When measurement of bone density was first introduced 25 years ago, absolute bone mineral density (g per square centimeter) was considered as too onerous for clinicians to understand. Ultimately, these events led to a treatment gap in patients who had strong clinical risk factors for an osteoporotic fracture (particularly age) but had T scores in the osteopenic range.
The average age of the participants in the current trial was approximately 3.5 years older than that in the Fracture Intervention Trial. Owing to the interaction between age and bone mineral density, the results of the current trial should not be extrapolated to younger postmenopausal women (50 to 64 years of age) with osteopenia.
This trial reminds us that risk assessment and treatment decisions go well beyond bone mineral density and should focus particularly on age and a history of previous fractures.”
The time has passed for physicians and clinicians to consider only chronological age when evaluating a patient’s clinical age. More effective human age measurements covering the entire person as well as their body’s components include:
- The current epigenetic clock which uses 391 CpGs “to more accurately measure biological aging in the given tissue/cell-type, and therefore with the potential to be more informative of disease-risk or the success of disease interventions in the tissue or cell-type of interest” per The epigenetic clock now includes skin.
- The 2016 Using an epigenetic clock with older adults which used a frailty index of 34 parameters to establish “clinically relevant aging-related phenotypes.”
- The 2015 A study of biological aging in young adults with limited findings which used 10 biologic age markers of subjects at age 38 to find that their biological ages ranged from 28 to 61.
This editorial provided the history of how a still-generally-accepted set of diagnostic measurements were selected for their relative convenience instead of chosen for their efficacy. Add chronological age to such ineffective measurements.
Let’s recognize better aging and diagnostic measurements, then incorporate them. How else will we advance past uninformative averaging and unhelpful recommendations based on chronological age?
“The average age of the participants in the current trial was approximately 3.5 years older than that in the Fracture Intervention Trial. Owing to the interaction between age and bone mineral density, the results of the current trial should not be extrapolated to younger postmenopausal women (50 to 64 years of age) with osteopenia.”
https://www.nejm.org/doi/pdf/10.1056/NEJMe1812434 “A Not-So-New Treatment for Old Bones”