Banefelt J, Timoshanko J, Söreskog E, et al. - This real-world demonstration of a bone mineral density (BMD)-fracture risk association in both bisphosphonate-naïve and bisphosphonate-treated patients adds to evidence from clinical trials and recent meta-regression that total hip BMD is a meaningful outcome for the clinical management of osteoporosis patients.

• It was a retrospective, observational cohort study.

• The sample consisted of Swedish females aged ≥ 55 years who had a total hip BMD measurement at one of three participating clinics.

• The study included 15,395 patients, 11,973 of whom were bisphosphonate-naïve and 3,422 of whom were bisphosphonate-treated.

• Clinical fractures occurred in 6.3% of bisphosphonate-naïve individuals and 8.4% of bisphosphonate-treated patients in the 24 months following BMD assessment.

• Both cohorts showed strong inverse associations between BMD T-score and fracture incidence.

• This connection appeared to plateau around T-score − 1.5 in bisphosphonate-naïve patients, indicating lesser marginal reductions in fracture risk above this value; bisphosphonate-treated patients demonstrated a more consistent marginal change in fracture risk across the examined T-scores (−3.0 to –‍0.5).

• Regardless of age or previous fracture status, trends remained strong.