IOF LogoIOF World Congress on Osteoporosis 2004, May 14-18, 2004, Rio de Janeiro, Brazil
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Test is particularly accurate for young people, increase in BMD doesn't correlate with reduced fracture risk, orthopaedic surgeons fail to recognize osteoporosis in their patientsTest is particularly accurate for young people, increase in BMD doesn't correlate with reduced fracture risk, orthopaedic surgeons fail to recognize osteoporosis in their patients

May 16, 2004

Worldwide, hip fractures due to osteoporosis are expected to rise from 1.7 million annually to 6.3 million annually by 2050. This alarming growth is of major concern to both public health care systems and aging populations. Currently, the European Union spends an estimated € 4.8 billion annually on hospital healthcare alone. On a personal level the impact of osteoporosis on families can be traumatic; fifteen to 30% of people who sustain a hip fracture die within a year, and osteoporosis-related disabilities confine more patients to bed than do stroke, heart attack, or chronic obstructive pulmonary disease. The financial and emotional cost of increasing incidences of osteoporosis makes it imperative that widespread diagnosis and treatment become a priority.

This week at the IOF World Congress on Osteoporosis in Rio de Janeiro, Brazil, clinicians and researchers from around the globe gathered to review the latest data on diagnosis and treatment of this debilitating disorder.

Bone mineral density confirmed as accurate indicator of fracture risk, especially in young people

Prof. Olof Johnell, vice chairman of the IOF Committee of Scientific Advisors, reemphasized the value of using bone mineral density (BMD) as a predictor of fracture risk. Johnell reported the results of an international collaboration that analyzed data from twelve different studies, which had been conducted in various parts of the world (conference abstract OC1). This "meta" analysis drew on findings from almost 40,000 men and women who had been followed by the studies.

"We now have data from Japan, Australia, Europe, the US, almost every part of the world," said Johnell, "and we find that BMD can predict fractures in any setting." But the analysis also revealed that there is an age discrepancy in the predictive ability of the measurement. In younger people, a given reduction in BMD equates to a greater increase in risk for fracture than an equivalent BMD reduction in the elderly. "This is not a huge difference, said Johnell, but it should be taken into consideration in the clinic."

Hip BMD better indicator of mortality

The site at which the bone mass measurement is taken may also be an important diagnostic criterion. Dr. Yu Bagger and colleagues at the Centre for Clinical and Basic Research, Ballerup, Denmark, reported that reduction in BMD at the hip may be a better predictor of mortality (conference abstract OC 22).

Bagger and colleagues analyzed data collected from over 6,500 postmenopausal women between 45 and 70 years old. The women were followed for an average of ten years, with bone density measurements taken at the forearm, hip, or spine. Those with a BMD reduction equivalent to 2.5 standard deviations had increased risk for mortality. Significantly, this increase was 80% if the BMD loss was at the hip, but only 30% if from the spine, and 50% if from the forearm. "We also found that women with a prevalent vertebral fracture were at a 2.6-fold higher risk for mortality," said Bagger.

But BMD increase doesn't necessarily indicate lower fracture risk

One way of reversing or halting osteoporotic declines in BMD is by taking bisphosphonates. But while decreases in BMD may translate directly into increases in fracture risk, the opposite may not be true, reported Michael Manhart and colleagues from Helen Hayes Hospital, West Haverstraw, NY, USA and Procter & Gamble Pharmaceuticals, Surrey, England. For patients taking risedronate, a bisphosphonate, Manhart found that fracture incidence was poorly related to the magnitude of BMD increase (conference abstract OC 47).

Manhart came to this conclusion after analyzing data from three clinical trials (VERT-MN, VERT-NA, and HIP) that enrolled over 2,000 postmenopausal women with osteoporosis. The participants were given placebo, 2.5 mg, or 5 mg risedronate daily for three years. The results showed that while patients on risedronate who had increased BMD were at reduced risk for fragility fracture, patients with relative large increases in BMD faired no better than those with minor increases.

Orthopedic surgeons rarely send patients for BMD test, don't focus on osteoporosis risks

While bisphosphonates, strontium ranelate, and hormonal treatments are all known to prevent osteoporotic bone mineral loss, ensuring those at risk are diagnosed and offered appropriate therapy still remains a top public health concern.

Failings in this regard were highlighted by Dr. Karsten Dreinhöfer, who reported the results of a survey jointly commissioned by the IOF and the Bone and Joint Decade (conference abstract OC 44). The survey, designed to evaluate how patients who had sustained an osteoporotic fracture are followed up in the clinic, queried over 3,000 orthopaedic surgeons in five European countries (France, Germany, Italy, Spain and the U.K.) and New Zealand.

The survey revealed that less than 20 % of orthopaedic surgeons ensure that patients they have treated for fragility fractures are given a bone mineral density scan. About 20 % of surgeons also replied that they never sent such patients for a scan. In addition, only half of the surgeons in southern Europe are aware that factors such as cataract, poor lighting, balance problems, or just obstacles, are risk factors for osteoporotic fractures.

"Unfortunately, these results are not surprising," said Dreinhöfer, "but they confirmed the lack of attention orthopaedic surgeons give to osteoporosis." "There is an urgent need to increase orthopaedic surgeons' awareness of osteoporosis and to educate them about the importance of treating the underlying disease-not only the fracture," he added.

One way to do this, suggested Dreinhöfer, would be to adopt guidelines prepared by the World Orthopaedic Osteoporosis Organization (WOOO). These feature a simple flow chart that condenses options for assessing and treating fracture patients.

"Since orthopaedic surgeons / traumatologists are often the first and only physicians to see fracture patients, they are in a unique position to identify untreated cases of osteoporosis," said Prof. Olof Johnell of the IOF, who led the development of the WOOO guidelines.


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 165 member societies in more than 85 locations, and other healthcare-related organizations around the world, IOF encourages awareness and prevention, early detection and improved treatment of osteoporosis.

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 eight men(1). 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.

1 Melton U, Chrischilles EA, Cooper C et al. How many women have osteoporosis? Journal of Bone Mineral Research, 1992; 7:1005-10

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