FRACTURE RISK BASED ON MANY FACTORS,
NOT JUST BONE DENSITY SCORE
New research will lead to easy-to-use fracture risk assessment tool for physicians
September 21, 2004
Physicians generally rely on bone mineral density (BMD) to determine a patient's risk of osteoporosis-related fractures.
But BMD alone is not sufficient to accurately determine fracture risk, a new study shows.
In "Assessment of Fracture Risk", John Kanis, head of the Centre for Metabolic Bone Diseases (WHO Collaborating Centre) in Sheffield, UK, points out that while BMD is an important indicator for fracture risk, other factors should be taken into account in order to obtain a more accurate prediction of risk.
This new concept is being validated by a WHO working group (established in 1998) in collaboration with IOF and the (US) National Osteoporosis Foundation, to develop an easy-to-use fracture risk assessment tool for family physicians to use with patients of both sexes, all ages, ethnic groups and in all countries.
The results of the investigation and the risk assessment tool are expected to be published by WHO in 2005 and will be announced by IOF.
In the report, scheduled for publication in Osteoporosis International, Professor Kanis, an IOF Board member, writes that "although bone mass is an important component of the risk of fracture, other abnormalities occur in the skeleton that contribute to fragility. In addition, a variety of non-skeletal factors, such as the liability to fall and force of impact, contribute to fracture risk."
He urges that various clinical risk factors be taken into account, such as a family history of fragility fracture, a previous fragility fracture, low body mass index and the long-term use of corticosteroids.
"The 'Assessment of Fracture Risk' is a very important initiative that will lead to changes in the way physicians and health policy officials determine who should be treated for osteoporosis," noted Pierre D. Delmas, IOF President and member of the WHO working group. Speaking at a press conference in Paris today organized by IOF member Groupe de Recherche et d'Information sur les Ostéoporoses (GRIO), Professor Delmas said that "because one in three women and one in five men over 50 will fracture a bone due to osteoporosis, physicians need accurate but easy to use guidelines in order to manage osteoporosis and reduce the unacceptable rate of fractures."
The assessment of fracture risk will be published as a WHO technical report next year. It will provide tables showing the 10 year facture risk, expressed in % risk, in men and women according to age, BMD value, and the presence/absence of independent risk factors for fractures such as maternal and personal history of fractures, glucocorticoid use and smoking. These risk factors have been validated in 12 cohorts of elderly men and women around the world. From the results of that technical report, the IOF will produce "friendly" documents and tables intended to be used by primary care physicians around the world. "One clear advantage of that approach, Professor Delmas said, is that it provides flexibility in deciding what is the optimal intervention threshold according to economic resources and social priorities in different countries around the world".
French researchers conduct similar research
Complementary research on assessment of fracture risk has been undertaken by the research team of Professor Delmas at INSERM Unit 403, Lyon, France. Their report was presented at the May 2004 IOF World Congress on Osteoporosis, held in Rio de Janeiro, Brazil.
While BMD is a reliable indicator for osteoporosis, about half of women who sustain fragility fractures have bone mineral densities above the WHO diagnostic threshold for osteoporosis, the group found. Most of these patients have osteopenia, a less severe loss of bone density. In these patients, the combination BMD, history of a prior fracture and measurement of bone turnover with a bone marker was a powerful method to identify osteopenic women at high risk of fractures.
"The assessment of risk factors for fractures (bone turnover markers and history of prior fracture) may play an important role in identifying women at high risk of fracture who could not be adequately detected by BMD measurement alone," said Pr. Delmas. These patients would likely benefit from therapeutic intervention. He added that the findings should be corroborated by larger longitudinal studies.
The report "Assessment of Fracture Risk", a report on the Sornay-Rendu study, and related IOF press releases on this subject, can be seen here
Osteoporosis, in which the bones become porous and break easily, is one of the world's most common and debilitating diseases. The result: pain, loss of movement, inability to perform daily chores, and in many cases, death. One out of three women over 50 will experience osteoporotic fractures, as will one out of five men (1,2,3). Unfortunately, screening for people at risk is far from being a standard practice. Osteoporosis can, to a certain extent, be prevented, it can be easily diagnosed and effective treatments are available.
||Melton U, Chrischilles EA, Cooper C et al. How many women have osteoporosis? Journal of Bone Mineral Research, 1992; 7:1005-10
||Kanis JA et al. Long-term risk of osteoporotic fracture in Malmo. Osteoporosis International, 2000; 11:669-674
||Melton LJ, et al. Bone density and fracture risk in men. JBMR. 1998; 13:No 12:1915
The International Osteoporosis Foundation (IOF) is a worldwide organization dedicated to the fight against osteoporosis. It brings together scientists, physicians, patient societies and corporate partners. Working with its 167 member societies in 85 locations, and other healthcare-related organizations around the world, IOF encourages awareness and prevention, early detection and improved treatment of osteoporosis.
For further information, please contact:
Paul Spencer Sochaczewski, Head of Communications,
International Osteoporosis Foundation