Bone minreal density measurement and calculating T score has been used to classify osteoporosis and assess fracture risk. This has never been a perfect tool as other variables were involved too. WHO has come out with this tool called FRAX tool to evaluate fracture risk.
Click on frax...FRAX integrates the future osteoporotic fracture risk associated with clinical risk factors with that associated with femoral neck BMD. BMD of the femoral neck (although less data is available, the total hip may also be used in women) tracks in parallel to BMI except at very low BMI, so that BMI may be used when BMD is unavailable. BMI and BMD would not be used in the same individual. The incident rates of fractures are country specific and provide the clinician the 10 year probability of hip fracture and the 10 year probability of major osteoporotic fracture (clinical vertebral, forearm, hip and shoulder).
The New National Osteoporosis Federation guideline Guidelines-2008
Role of physicians who evaluate, prevent and treat osteoporosis in postmenopausal women and men age 50 and older:
* Counsel on the risk of osteoporosis and related fractures
* Check for secondary causes
* Advise on adequate calcium and vitamin D intake
* Recommend regular weight bearing and muscle strengthening exercise to reduce risk of falls and fractures
* Advise avoidance of tobacco smoking and excessive alcohol intake
BMD testing is advised for:
* Women age 65 and older
* Men age 70 and older
* In younger postmenopausal women and men age 50 and older based on risk factor profile
* Those with a fracture to determine degree of disease severity
Treatment is recommended for:
* Patients with hip or vertebral fracture (clinical or morphometric)
* Patients with osteoporosis as defined by T score <=-2.5 * Postmenopausal women or men age 50 and older with low bone mass (T score -1 to -2.5, osteopenia) at the femoral neck, total hip, or spine and 10 year hip fracture risk probability >3% or a 10 year all major osteoporosis related fracture probability of >20% based on the U.S. adapted WHO absolute fracture risk model
BMD should be monitored two years after initiating therapy and at two-year intervals thereafter.
Bottom Line:
* BMD measurement alone fails to identify a high number of subjects who subsequently develop fractures. The addition of clinical risk factors may indeed be an improvement in risk factor assessment.
* While FRAX provides a method to evaluate fracture risk with and without BMD to use for global health, understanding exactly what level of fracture risk is appropriate for therapeutic intervention probably requires additional research.
* Counsel on the risk of osteoporosis and related fractures
* Check for secondary causes
* Advise on adequate calcium and vitamin D intake
* Recommend regular weight bearing and muscle strengthening exercise to reduce risk of falls and fractures
* Advise avoidance of tobacco smoking and excessive alcohol intake
BMD testing is advised for:
* Women age 65 and older
* Men age 70 and older
* In younger postmenopausal women and men age 50 and older based on risk factor profile
* Those with a fracture to determine degree of disease severity
Treatment is recommended for:
* Patients with hip or vertebral fracture (clinical or morphometric)
* Patients with osteoporosis as defined by T score <=-2.5 * Postmenopausal women or men age 50 and older with low bone mass (T score -1 to -2.5, osteopenia) at the femoral neck, total hip, or spine and 10 year hip fracture risk probability >3% or a 10 year all major osteoporosis related fracture probability of >20% based on the U.S. adapted WHO absolute fracture risk model
BMD should be monitored two years after initiating therapy and at two-year intervals thereafter.
Bottom Line:
* BMD measurement alone fails to identify a high number of subjects who subsequently develop fractures. The addition of clinical risk factors may indeed be an improvement in risk factor assessment.
* While FRAX provides a method to evaluate fracture risk with and without BMD to use for global health, understanding exactly what level of fracture risk is appropriate for therapeutic intervention probably requires additional research.
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